NLM logo

National Information Center on Health Services Research and Health Care Technology (NICHSR)

HSRProj (Health Services Research Projects in Progress)

Information about ongoing health services research and public health projects


Reducing oral health disparities of older adults: comparative effectiveness of 2 treatments
Investigator (PI): Nelson, Suchitra S
Performing Organization (PO): (Current): Case Western Reserve University, School of Dental Medicine, Department of Community Dentistry / (216) 368-3469
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2019
Final Year: 2024
Record Source/Award ID: PCORI/AD-2018C1-10590
Funding: Total Award Amount: $4,199,708
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: This research project is in progress. PCORI will post the research findings on the PCORI website within 90 days after the results are final. What is the research about? Most older adults in the United States have had dental cavities. Nearly 28 percent have cavities that have gone untreated. Adults with low incomes often have higher rates of untreated cavities than adults with higher incomes. Untreated cavities can lead to painful toothaches, infection, and tooth loss. Cavities and tooth loss can contribute to other health problems and decrease quality of life. Frailty, transportation problems, multiple medical problems, and cost can make it hard for older adults to get dental care in an office. In this study, the research team is comparing two ways to treat cavities for older adults living in low-income housing facilities. Who can this research help? Results may help dentists and public health professionals when considering ways to improve dental care for older adults in general and especially those with low incomes. What is the research team doing? The research team is enrolling 550 older adults with cavities. Participants live in 22 low-income housing facilities in Ohio. The team is assigning facilities by chance to offer one of two treatments. The first treatment is topical silver fluoride. The second treatment is fluoride and a dental filling that doesn't require a drill. Participants receive their treatments and dental screening twice a year at the facility where they live. At the start of the study and again six months and one year later, the research team is checking to see if cavities were successfully treated and if participants have any new cavities. Also, the team is asking study participants about their tooth pain and quality of life. The team is comparing these outcomes between the two treatment groups. Community members, low-income housing administrators, advocacy organizations, policy makers, and health insurers are helping to design and monitor this study. Research methods. Design: The study design is a randomized controlled trial. Population: The study population is 550 adults ages 62 and older living in a participating older adult housing facility with at least one untreated active root or coronal carious lesion with ICDAS-II (2015) lesion severity code of 3 or greater. Interventions/comparators are silver diamine fluoride and atraumatic restorative treatment with glass ionomer cement and fluoride varnish. Outcomes: Outcomes are (1) primary: cavity prevention, tooth pain, and hypersensitivity; and (2) secondary: prevention of new decay and oral health quality of life. The timeframe is 1-year follow-up for primary outcomes.
Abstract Archived: Cost, transportation, multiple medical problems, being frail, and senility make traditional office-based dental care out of reach for many seniors. Nearly 60 percent in our communities have not visited a dentist in three years or over. Thus, our mission is to reduce the disparities to good oral health among low-income older adults. Since 2012, we have collaborated with our stakeholder partners through prior work, discussions, and surveys to propose the treatments and design of the project. We found that community-based dental care is feasible at the housing facilities where older adults live. The patient stakeholders said dental care was a priority and having simple and quality care where they live will address multiple barriers rather than dental office-based care. Local, state, and national stakeholder partners have enthusiastically indicated that they would use the results of our work to make changes to improve access and clinical care, Medicaid policies for reimbursement, and make results widely available. The overall goal of our proposed project is to reduce oral health disparities by determining the most effective, efficient, and patient-centered treatments that can be delivered in community-based or clinical settings. To address this goal, researchers will compare two community-based tooth decay treatments: a "simple medical" treatment of topical silver fluoride, and a "typical dental" filling which is less complicated without using a drill and fluoride. We expect that both treatments will be similarly effective in arresting untreated decay, preventing new decay, reducing tooth pain, and improving quality of life. A total of 22 subsidized housing facilities will be randomized to receive either of the two treatments. Eligible older adults who consent in a given facility will receive the treatment two times a year and be followed for 12 months. By providing dental care to older adults where they live, we will not only reduce the barriers for dental care, but also more than double the dental care access of low-income seniors, and subsequently reduce their pain and improve quality of life. Nearly 96 percent of all U.S. older adults have had a tooth decay (dental cavities), and nearly 28 percent have teeth with decay that has gone untreated because of barriers. Low-income and minority (non-Hispanic black and Hispanic) older adults have much higher rates of untreated tooth decay that has led to painful toothaches, infection, and tooth loss. Tooth decay and tooth loss makes heart and lung disease and diabetes worse, thus impacting overall quality of their lives. Most often fillings fail, and decay starts up in the roots of the teeth and treatment is difficult for many older adults to tolerate and for dentists to perform (using a dental drill). This is a disparity issue since there is lack of quality research information that can inform the best treatments for patients and providers to prevent and treat tooth decay.

MeSH Terms:
  • Access to Health Care
  • African Americans
  • Aged
  • Comparative Effectiveness Research
  • Dental Care /*organization & administration
  • Dental Caries /ethnology
  • /*prevention & control /*therapy
  • Dental Filling, Permanent
  • * Dentists
  • Diabetes Complications
  • Health Care Disparities
  • Health Services for Aged /*organization & administration
  • Health Status Disparity
  • Humans
  • Medicaid
  • * Oral Health
  • Poverty
  • Quality of Life
  • Residence Characteristics
  • United States
Country: United States
State: Ohio
Zip Code: 44106
UI: 20193073
CTgovId: NCT03916926
Project Status: Ongoing
Record History: ('2020: Archived abstract to Abstract Archived 1 field and added new abstract. Alternate Title: Comparing two treatments for dental cavities in older adults living in low-income housing',)