A Randomized Controlled Trial of the Effects of Oral Health on Systemic Health, Oral Health & Health Care Among Older Adults
PI: David Meltzer, Department of Medicine (Hospital Medicine)
Funder: The George Richmond Foundation
Description: Despite the recognition and growing evidence that oral health influences systemic health, there is insufficient knowledge about the extent to which oral health care improves systemic health and may reduce health care costs. Recent studies suggest that these effects may be large, but the observational design, size and/or duration of these studies has prevented them from clearly establishing and quantifying causal effects of oral health care on systemic health and health care costs. The need for such data is especially important for older adults, who often have substantial oral health challenges and lack dental insurance, resulting in important deficits in care. Given the high prevalence of oral health conditions and associated chronic diseases in older adults and the interest of many leaders in oral health and medicine in the better integration of oral and systemic care, data on the effects of improving access to integrated oral and general health care for older adults has great potential to influence policy and practice. We propose a randomized controlled trial that will study both systemic and oral health outcomes, and health care costs over 5 years for 1060 older adults without recent dental coverage and preventive dental care who are randomly assigned either to 1) an intervention group that is offered core preventive and restorative services free of charge or 2) a control group that is not offered such services free of charge. Our proposed random assignment, sample size, and 5-year study duration will allow us to assess and quantify causal effects of access to oral and systemic health care on outcomes and costs, addressing the key limitations of existing evidence. We hypothesize that patients in the intervention group will have fewer negative systemic outcomes (e.g., self-rated health status, conditions associated with poor oral health such as diabetes, cardiovascular conditions and others), oral health outcomes (e.g., tooth loss, periodontal disease, or worsening systemic health), and lower costs for oral and systemic health care than patients in the control group.