Oral Health Therapists in Aged Care: Pilot Study Unveils Promising NZ Findings

The Critical State of Oral Health in New Zealand Aged Residential Care

New Zealand's population is ageing rapidly, with over 17 percent now aged 65 and older, numbering around 906,300 individuals. This demographic shift has led to increased occupancy in aged residential care facilities, where oral health challenges are particularly acute. Residents often enter these homes with some natural dentition remaining, but high rates of dental caries quickly emerge, impacting quality of life, nutrition, and overall health. Conditions like aspiration pneumonia, frailty, and malnutrition are linked to poor oral hygiene, yet routine dental care remains minimal or absent in many facilities.

Historical data from the 2012 New Zealand Older People's Oral Health Survey highlighted stark realities: only 43 percent of residents were fully edentulous, with 66 percent partially dentate in both arches, underscoring the need for proactive interventions. Recent efforts highlight the potential of expanding the role of oral health therapists, mid-level professionals trained to bridge gaps in preventive and restorative care.

Understanding Oral Health Therapists: New Zealand's Trained Workforce

Oral health therapists (OHTs) represent a key innovation in New Zealand's dental workforce. Graduates of the Bachelor of Oral Health programme primarily from the University of Otago, OHTs possess dual qualifications in dental therapy and hygiene. Traditionally focused on paediatric care, recent expansions through postgraduate certificates like the Adult Restorative Dental Care allow OHTs to treat adults, including simple restorations, scaling, and preventive advice.

This training equips them with skills in assessment, treatment planning, and patient education, making them ideal for underserved settings like aged care. By deploying OHTs on-site, facilities can address immediate needs without relying solely on scarce dentist visits, potentially reducing disease progression and hospitalisations.

University of Otago's Leadership in Oral Health Research and Training

The University of Otago stands at the forefront of New Zealand's oral health advancements through its Sir John Walsh Research Institute and Faculty of Dentistry. Home to the nation's only OHT training programme, Otago produces professionals ready to tackle public health challenges. Recent initiatives, including scope expansions for adult care, reflect the university's commitment to workforce development amid rising aged care demands.

Otago researchers have driven evidence-based pilots, informing policy on integrating OHTs into community and residential settings, positioning the institution as a hub for gerodontology innovation.

Designing the Pilot: Methods and Implementation

The groundbreaking pilot study, conducted from November 2022 to December 2023, targeted two Otago facilities: one urban (85 residents) and one provincial (60 residents), covering rest home, hospital, dementia, and psychogeriatric levels. Seventy-eight residents participated, reflecting typical demographics—74 percent female, ages spanning under 80 to over 90.

OHTs performed baseline and three-month follow-up exams using validated tools for plaque, calculus, gingival health, food debris, tooth mobility, and odour. Interventions included personalised advice on brushing, flossing, denture hygiene, and diet; staff seminars; nurse training; and resource distribution. No dedicated facilities were available, testing real-world feasibility.

Baseline Oral Health Profile: Revealing Gaps

At baseline, 27 percent were edentulous, 63 percent partially dentate in both arches, and nine percent had an edentulous maxilla opposing partial dentition. Half showed low salivary flow, 44 percent of dentate residents had untreated caries, and seven percent had unpleasant oral odour. Mean scores indicated moderate plaque (1.2), calculus (0.7), gingival inflammation (1.4), and debris (0.7), highlighting intervention urgency.

Photo by Andrew Yu on Unsplash

Three-Month Outcomes: Mixed but Promising Results

Follow-up revealed nuanced changes among dentate residents. Calculus scores improved moderately (0.8 to 0.4, effect size 0.4), gingival appearance and food debris showed small gains (1.4 to 1.2 and 0.7 to 0.5, effect size 0.2), while plaque slightly worsened (1.2 to 1.3, effect size -0.2) and odour rose (7 to 11 percent). Tooth mobility remained stable. Thirteen percent attrition occurred, mostly hospital-level residents.

Facility-specific variations emerged, with stronger calculus reductions in the urban home. For details, see the full peer-reviewed study by University of Otago researchers.

Stakeholder Feedback: Acceptance and Enthusiasm

Residents, families, and staff valued OHT presence, reporting heightened awareness and confidence in oral care. Nurses appreciated training, noting improved skills despite initial cultural gaps between dental and nursing teams. Therapists experienced professional satisfaction from building relationships, though ergonomic challenges like absent sinks persisted. Resources were widely shared, fostering sustained engagement.

• Staff gained practical knowledge on assessments and aids.
• Families received tailored advice, enhancing home support.
• Residents felt empowered, with better hygiene adherence.

Overcoming Challenges: Lessons from the Field

Short duration limited impacts; cognitive impairments complicated consent and adherence; COVID disruptions affected staffing. High turnover and no control group posed analytical hurdles. Solutions included rapport-building, simplified resources, and advocacy for infrastructure like portable units. Cultural alignment between professions emerged as key.

Policy Implications: Reshaping Aged Care Oral Health

The pilot underscores OHT viability in aged care, supporting calls for scope expansions and funding. Aligning with NZ's oral health strategy, it advocates routine OHT visits, integrated training, and teledentistry pilots—like companion Otago research on acceptability. Potential cost savings from prevented complications could transform sector sustainability. Explore the University of Otago Dentistry for ongoing initiatives.

Future Outlook: Scaling OHT Deployment Nationwide

Larger randomised trials are recommended to quantify long-term gains. Nationwide rollout could leverage Otago's training pipeline, addressing workforce shortages. Integrating OHTs with multidisciplinary teams promises holistic care, reducing hospital burdens. Emerging adult scope extensions position NZ as a gerodontology leader.

Photo by Andrew Yu on Unsplash

University Contributions to National Health Solutions

Otago's interdisciplinary approach—spanning public health, dentistry, and population studies—drives actionable research. Collaborations with Auckland enhance generalisability, informing Health NZ policies. Such studies exemplify higher education's role in tackling societal challenges.