# Oral Disease Prevention Model in Long Term Care: WHO Systems Thinking Framework

> **NIH NIH R21** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2024 · $246,363

## Abstract

PROJECT SUMMARY
Currently, 1.5 million older adults live in Long Term Care (LTC) facilities and that number is increasing. Their
need for dental care is also growing since almost 70% of older adults are now dentate. Even though dental
caries and periodontal disease are preventable, 96% of dentate adults over age 65 years have caries
experience, at least 20% are living with untreated decay and 68% have periodontal disease. Both conditions
are the result of dynamic processes which are accelerated by polypharmacy, comorbidities, and frailty.
Although there is no national data regarding the oral health status of long-term care (LTC) residents, small
cohort studies consistently document that LTC residents have substantially worse oral health than the
population of community-dwelling elders. Faced with the burden of declining health and diminished
independence, older adults in LTC are less likely to access dental care and more likely to develop new
cavities and worsening periodontal disease, hence preventive care is vital. However, most research in oral
health and LTC has focused on care-pathways for receiving restorative treatment, but significant barriers
exist which limit LTC residents’ ability to access this care. Alternatively, there is a focus on having care
assistants perform oral hygiene care (OHC), when in practice they are often not provided adequate training
or time to offer the OHC. This is further complicated by the fact that the residents of LTC are experiencing
diminishing independence and increasing frailty. Given the complexity of the LTC setting, a siloed biomedical
approach to disease management is also unlikely to reduce new dental caries and periodontal bone loss and
the resultant burden. To address this complexity, this project will use the Health Co-design toolbox together
with the WHO Health Systems thinking framework to co-design a system intervention to reduce the increment
of caries and periodontal disease. This investigation will seek to understand the experiences of residents and
staff as a starting point for developing a comprehensive model of preventive oral health care. Initially, the
current system supporting oral health in LTC will be mapped through a retrospective clinical audit and a series
of focus groups. Then, a design team of stakeholders will work with investigators to co-design an intervention
that works on multiple agents and processes within the system. Possible examples include, clinicians
assessing caries risk and prescribing preventive agents, equipping in-house dispensaries with oral hygiene
aides, and EMRs prompts to initiate oral health referrals for certain medical diagnosis. Simulation Modelling,
based on system mapping data, will conceptualize the effects of the intervention by using different
mechanism of prevention and different patterns of disease. An external advisory panel will provide feedback
on qualitative data and the system intervention protocol. If proven effective, this model has the pote...

## Key facts

- **NIH application ID:** 10799645
- **Project number:** 5R21DE032137-02
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Michelle M Henshaw
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $246,363
- **Award type:** 5
- **Project period:** 2023-04-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10799645

## Citation

> US National Institutes of Health, RePORTER application 10799645, Oral Disease Prevention Model in Long Term Care: WHO Systems Thinking Framework (5R21DE032137-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10799645. Licensed CC0.

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