Oral Health in Residential Settings: A Public Health Priority

Introduction

The recent article by Doshi et al. (2025) sheds light on the important issue of oral health for adults in residential settings. As a team of public health professionals, we recently aimed to conduct an umbrella review of oral health interventions for older adults in residential settings. However, there was insufficient high-quality evidence in this area to conduct a thorough review; therefore, we reflected on why this may be the case, synthesised what is known and identified key challenges that need to be addressed for research to move forward in addressing this significant public health challenge.

One of the greatest successes of public health is that many more people are living longer than ever before; however, disparities in ageing persist, and this is particularly evident in the area of oral health. Poor oral health has been linked with a greater risk of all-cause mortality and chronic conditions (stroke, diabetes, respiratory and cardiovascular diseases) (Bakker et al., 2024; Li et al., 2024). A recent systematic review of oral health outcomes among care home residents in Europe identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health (Janssens et al., 2023). Other prevalent challenges are tooth wear (Chan et al., 2024) and denture-related problems (Taira et al., 2023; Mameno et al., 2025; Nitschke et al., 2022), which can be under-recognised factors within oral health care in residential settings. Globally, it is estimated that direct costs of $387 billion per year is attributed to oral health diseases (Jevdjevic & Listl, 2025), and in the UK, this cost is estimated to be around £3.6 billion per year (Office for Health Improvement and Disparities, 2022).

While there have been positive developments in population oral health, the prevalence of oral health diseases remains high among older adults, with nearly five in ten suffering from an oral health condition aged 65 and above (World Health Organization, 2024). In particular, oral healthcare in dependent older adults in residential settings requires a greater focus and recognition of the health, access, and operational challenges (Janssens et al., 2025). Most dental diseases can be prevented, and while a wealth of evidence-based oral health interventions exists, high-quality published research to support evidence-informed interventions specifically for older adults in residential settings remains limited.

Oral health in the residential setting

Common oral health problems for older adults include dry mouth, altered wound healing, dental caries, gum disease (e.g., gingivitis and periodontitis), ill-fitting dentures, and tooth loss. Those in residential settings are often older adults with physical or cognitive impairments who will face significant challenges, including with their oral health due to functional decline, barriers in access to routine dental services and supports and concurrent use of multiple medications (Desai & Nair, 2023; Patel et al., 2021). In addition to pain, infection and difficulty eating, poor oral health has also been linked to adverse general health outcomes including challenges with diabetic control and aspiration pneumonia, one of the leading causes of death in residential settings, which is particularly evident among older adults (Office for Health Improvement and Disparities, 2022). Evidence shows that in community settings, compared to fully dentate adults, edentulous adults were more likely to have depression, experience loneliness and have reduced quality of life (Sheehan et al., 2017).

Research challenges to oral health intervention in residential settings

Oral health interventions in older people in residential facilities are an under-researched area. Most research conducted in the residential setting is through cross-sectional studies rather than trials or longitudinal studies. This may be due to the various challenges encountered when implementing oral health interventions, including methodological considerations, participant retention, institutional capacity, health instability, high attrition rates, access for researchers, practicalities, ethics, logistics, behavioural, and contextual factors (Nocivelli et al., 2023). Impediments to conducting interventional studies in residential settings are outlined in a recently published randomised feasibility study (Tsakos et al., 2025) and include consent issues for individuals experiencing cognitive impairment, high levels of participant attrition, and the capacity of residential settings to participate. It is also suggested that physical limitations, low health literacy and medical complexity can also play a role in the lack of studies in this cohort. Furthermore, the COVID-19 pandemic had a significant impact on oral research in residential settings, creating accessibility issues for older adults and altering the way dental professionals worked with this cohort. However, these issues are not insurmountable, and robust research has the potential to improve the quality of life for the ageing population living in residential care. Potential challenges can be minimised if residential facilities (i.e. staff and residents) are willing to participate in research interventions, and this could be achieved, for example, by integrating the research into their existing schedules, training and support, recognition and incentives, streamlining data collection, and flexibility within the research timeline.

Implications and future research

It is important to build the public health intelligence in the area of oral health in residential care settings. The World Health Organization (2024) launched a global oral health action plan in 2023, calling for research to address evidence gaps in public health interventions and oral health promotion. Existing evidence supports the need to increase competency-based oral health training, education and support for staff and the need to highlight the importance of oral health, particularly for mouth care, proper toothbrushing and denture care, to improve oral health outcomes in those living in residential care (Care Quality Commission, 2025a; Doshi et al., 2025). Staff training is important in providing the appropriate dental care to older people in residential settings, for example, when the residents may have a cognitive impairment. Research highlights the importance of utilising the available online training resources (Pradhan & Lalloo, 2021). In addition, the wider inclusion of older adult oral health care in dentistry training programmes is a priority (Nilsson et al., 2019). Furthermore, it is important to understand the optimal staff-to-resident ratio for improving oral health in residential settings (Csikar et al., 2025; Weening-Verbree et al., 2025; Care Quality Commission, 2019).

It is recognised that there can be significant organisational barriers for residential care settings taking part in oral health research. Research has highlighted that effective care home management, staff development and training, and a commitment to research studies are key success factors and those with a greater focus on oral health care plans (Care Quality Commission, 2025b). Tsakos et al. (2025) demonstrated that co-designed interventions can be utilised to deliver consistent oral healthcare to older adults in residential settings; however, further research, particularly trials, is needed. Future work should prioritise the development of recruitment and ethics protocols suitable for all older adults, age-appropriate outcome measures, and longitudinal co-designed studies with key stakeholders to support real-world relevance. In particular, there is a need for agreement on practical and ethical solutions to include residents who are unable to provide informed consent (Tsakos et al., 2025). Future research should also utilise qualitative methods and studies to a greater degree, to allow an understanding of how all those in the residential setting (administrators, care team, those in receipt of care) view routine oral health care. This may help provide a more in-depth knowledge of the complexities of oral health care in the residential setting.

Conclusion

In summary, oral health interventions in residential settings represent an essential but often overlooked population. The need for high-quality evidence on oral health interventions for older people in residential settings, including multidisciplinary research teams, to inform key practices, policies, and strategies in older people’s oral health, is a public health priority.

Institutional review board statement

Not applicable.

Informed consent statement

Not applicable.

Author contributions

Conceptualization, R.O., L.B. E.H. and R.D.N.; validation, R.O., L.B. E.H. and R.D.N.; formal analysis, R.H. R.D.N. and R.O.; investigation, E.H. R.O., L.B. and R.D.N.; data curation, E.H. R.O., L.B. and R.D.N.; writing—original draft preparation, R.O., L.B. E.H. and R.D.N.; writing—review and editing, R.O., E.H. L.B. and R.D.N.; visualisation, R.O., E.H., L.B. and R.D.N.; supervision, R.O.; project administration, L.B. All authors have read and agreed to the published version of the manuscript.