Effect of applying teledentistry in Residential Aged Care Facilities on oral health outcomes: a feasibility study

Materials to be used • Mouthwatch intra-oral camera • QLD Health approved teleconferencing software, Microsoft Teams and hardware (Logitech webcam) set up for telehealth at the residential aged care facilities • Appropriate oral hygiene products provided e.g. Oral 7 SLS-free toothpaste, dry mouth gel and moisturising mouthwash; Colgate Neutraflour 5000ppm high fluoride toothpaste; Open wide mouthrest to assist in mouth opening during oral hygiene; Surround toothbrush Procedure 1. Teledentistry consultation. Resident and staff will be paired to complete this part of the study. The examination will be completed through a real time videoconference. 2. Randomised controlled trial (RCT). We want to assess whether teledentistry can be used to give preventive oral health advice and whether this would improve oral hygiene. This would be conducted through an RCT. The groups will be assigned through an online random number generator. Intervention group: given preventive dental advice through teledentistry only. Appropriate oral hygiene products will be recommended and provided (delivery to RACF prior to the study). 3. In person site visit. The site visit will be in person, at 1 month after the teledentistry consultation. The aim of this part of the study is to compare the data collected from the self-assessment, the teledentistry consultation and the in-person visit. Who will deliver the intervention The study would be completed by a dental specialist or specialist in training in special needs dentistry Mode of delivery During the study, there will be a few parts: a dental screen questionnaire, discussion about your oral hygiene and health, and a post study evaluation. The whole study will take approximately 1.5 hours to complete. The study is divided in different parts and the longest time for each of these will be around 20mins. Number of times intervention delivered • Teledentistry consultation will happen once • Oral health and hygiene advice will be delivered once at different stages of the study depending on group allocation • The aim of the study is to identified underlying oral health problems that require further attention. For participants with dental care needs, referral pathways will be established. (see further treatment requirements) Location where intervention will occur The study will involve participants in Metro North (Qld Health) aged care services at Cooinda House and Gannet House in Brisbane. A site visit and small focus group meetings have been conducted at both facilities with the Nurse Unit Manager (NUM) and associate NUM at both facilities. The study will commence online through Microsoft Teams. For ambulant participants, the consultation would occur in the designated room at the RACF with a desktop, a webcam and Mouthwatch intra-oral camera. For non-ambulant participants, this can be accessed via a laptop with a webcam and Mouthwatch intra-oral camera at their bedside. The in-site portion will be conducted at the respective facilities. Appropriate rooms are available for a clinical exam. Participant adherence can be monitored through a spreadsheet, with participant ID and task required: 1. Pre-teledentistry screening 2. Teledentistry consultation 3. Oral hygiene advice: teledentistry (intervention) in person (control) 4. In person site visit Oral hygiene advice This would be based on the Government of South Australia “Better Oral Health in Residential Care” resources which can be found here: https://www.sahealth.sa.gov.au/wps/wcm/connect/774e660047d747529e6d9ffc651ee2b2/BOHRC_Staff_Portfolio_Module_2%5B1%5D.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-774e660047d747529e6d9ffc651ee2b2-nKKILB9 This is the training manual for residential aged care staff which outlines protective equipment requirement, oral hygiene aids and products, toothbrushing alternatives, positioning tips and denture cleaning. Input could also be based on professional opinions from the clinicians conducting the study. Further treatment requirements A domiciliary service can be provided for residents, if appropriate. For those who require dental care beyond the scope of a domiciliary service, referral to appropriate dental care providers will be facilitated. Appropriate dental providers could be a private dentist of their choice. For those who are eligible for public dental services, they will be placed on the appropriate waiting list. This would include waiting list at our own specialist Special Needs Dentistry Clinic depending on the case. For residents this would be either private or public pathways. Investigators in this project are all experienced clinicians in both public and private sectors and impartial and appropriate recommendations will be made to ensure that dental needs are managed.