Domiciliary dental care among homebound older adults: A nested case–control study in Japan

Abstract

Aim Improving the availability of dental care is essential to maintain older adults’ general health and wellbeing. Domiciliary dental care is a feasible alternative. The present study aimed to investigate factors affecting the use of domiciliary dental care among home‐dwelling dependent older adults. Methods A retrospective nested case–control study was carried out. We identified long‐term care recipients who used home care services between April 2012 and March 2014 using Japan's nationwide long‐term care service claim database. One‐to‐one case–control matching was carried out between those with and without domiciliary dental care, based on sex, age and the time home care service use was started. We carried out multivariable conditional logistic regression analyses to assess various factors associated with using domiciliary dental care. Results We identified 3 377 998 eligible homebound long‐term care beneficiaries aged ≥65 years. Of these, 278 302 (8.2%) received domiciliary dental care. Factors associated with a higher probability of receiving domiciliary dental care were: higher level of care need (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.93–2.06), exemption from out‐of‐pocket payment (OR 1.35, 95% CI 1.32–1.39]), living in a group home (OR 7.93, 95% CI 7.71–8.16), using other domiciliary services such as physician visits (OR 3.15, 95% CI 3.08–3.22) and a large number of dental clinics providing domiciliary dental care in their municipality (OR 1.74, 95% CI 1.70–1.77). Significant barriers to receiving domiciliary dental care were living alone (OR 0.64, 95% CI 0.62–0.66) and dementia (OR 0.89, 95% CI 0.88–0.91). Conclusions Our findings might help to improve the availability of dental care in this population. Geriatr Gerontol Int 2019; 19: 679–683.

What do we know about portable dental services? A scoping review

“…Human factors. The literature suggests that this stage could be relatively time-consuming for the dental team, 7,11 considering they need to prepare the dental instrument and material packages and travel to the patient's place of residence. 7,10,28 To facilitate this process and gain time, several authors suggest that dentists obtain relevant information about the patient's chief complaint, medical history and preferences beforehand.…”

“…9,10 Dentists' reluctance to provide portable dentistry could be due to their lack of training and consequent lack of familiarity with this type of service. 4,11,12 This is not surprising as portable dentistry is scarcely discussed in undergraduate dental education. 4 In order to build comprehensive models of portable dentistry that may be used in undergraduate and continuing dental education, an overview of the available research evidence is warranted.…”

Domiciliary Dentistry: A Multiple Case Study in the Province of Quebec, Canada

“…They also used multiple strategies to augment income such as: 1) charging a displacement fee; 2) focusing on LTFCs where multiple patients can be seen in one visit; and 3) Increasing e ciency during and between visits by increasing the size of the dental team or purchasing a second dental unit for LTCFs visits. The literature also points towards concerns about the costs of setting up and buying the necessary equipment (5,20), however, this was not a concern among the dentists in this study. They did not hesitate to invest in portable dental units because they believed in the potential and need for such a service, hence, justifying the initial costs.…”

Dental implant status in elderly individuals requiring domiciliary dental care in Japan

“…Although, in the cases of elderly people who need long-term care, they emphasize concerns about poor oral hygiene and periimplantitis. Consequently, there is an increase in the need for domiciliary dental care [11][12][13] whereby dentists or dental hygienists provide dental treatment and specialized oral care by visiting the homes, care facilities, or hospitals of patients who cannot visit dental clinics for physical or psychological reasons. However, the visited location is usually not equipped with dental infrastructure; hence, the treatment provided primarily includes simple caries treatment, adjustment and repair of dentures, and oral care.…”

“…However, the visited location is usually not equipped with dental infrastructure; hence, the treatment provided primarily includes simple caries treatment, adjustment and repair of dentures, and oral care. However, global awareness about domiciliary dental care is inadequate, and the system differs according to the medical insurance system, number of dentists, geographical requirements, and patient populations in different countries and regions [11][12][13].…”