4.3. Strengths and Limitations of the Study
cognitive impairment, caries, tooth, denture, dry mouth
CARIES, PLAQUE, CAVITY, PLAQUE, DRY MOUTH, DISEASES
The present study contributes to the evidence that IndOHCT is effective for enhancing tooth and denture brushing skills in geriatric inpatients during hospitalization. Furthermore, the narrow selection of geriatric inpatients with precise group assignment according to dentition status, wearing of prostheses, and sex reduced selection bias and fostered good comparability between groups. Bias due to various general diseases and associated general conditions could not be avoided. Furthermore, caries experience in the study sample was consistent with the national average (older patients in need of care, 25.4 vs. 24.6 DMFT) [It is well known that learning new skills can be inhibited by existing habits [This study had some limitations. First, it was conducted in a hospital setting. An examination at the inpatient’s bed does not provide comfort or the ability to position the inpatient to sufficiently inspect the dorsal areas of the oral cavity. Plaque might have been overlooked in areas that were difficult to inspect. In addition, the study was conducted exclusively at a single site; therefore, generalization and transfer to other sites is limited.Second, only inpatients with an MMSE score of at least 24 points were included in the study. Therefore, the weak relationship between cognitive impairment and oral health might have selection bias. To investigate the ability to learn effective oral hygiene, inpatients with moderate and severe cognitive impairment should be included in further investigations.Third, the influence of medication was not considered, which could lead to dry mouth and poorer plaque values [Fourth, the study covered an average hospitalization period of 12.4 days; therefore, it is unclear whether the effect of IndOHCT is sustained after hospitalization. The literature reveals that short-time observations failed to have essential long-term effects [Therefore, due to the limited number of studies, further research on the effectiveness of tooth and denture cleaning training in geriatric wards is of particular interest, as well as long-term follow-up studies evaluating the sustained success of IndOHCT in geriatric inpatients.