Rethinking Dental Hygiene Practice: Home‐Based Oral Health Care for Older Adults With Complex Care Needs

BACKGROUND: As populations age, increasing numbers of older adults live with multimorbidity, frailty and functional decline, making it difficult or impossible for many older adults to access traditional dental clinics. Despite this growing need, oral health care in home-care settings remains underdeveloped, with limited guidelines, resources and professional support. Dental hygienists are well positioned to address this gap, yet little is known about how oral health assessments unfold in the home environment. AIM: Was to explore, from a dental hygienist perspective, (i) how oral health assessments and interprofessional care planning are conducted in home-care settings for older adults with complex care needs and (ii) how dental hygienists' competence can support the integration of oral health into broader home-care processes. METHODS: A multiple-case study design was used, including four older adults with varying levels of functional, cognitive and oral health status. Data consisted of clinical oral assessments and detailed field notes capturing the dental hygienist's lived experiences of communication, collaboration and contextual conditions during each home visit. RESULTS: The cases revealed substantial variation in oral health, self-care ability and environmental conditions. Three participants were unable to attend dental clinics due to mobility limitations, pain, or environmental barriers. Conducting assessments in the home required the dental hygienist to adapt to challenging physical environments, navigate emotional responses and past dental trauma and collaborate closely with the older adults and the nursing assistant. Over time, interprofessional collaboration was considered to be strengthened and became essential for gaining access, building rapport and ensuring safe and person-centred care. The findings also identified major gaps in guidelines, training and organisational structures for home-based oral health care. CONCLUSION: Home-based oral health care for older adults is complex and requires dental hygienists to integrate clinical expertise with adaptability, communication skills and interprofessional collaboration. As emphasised by the body of knowledge, oral health must be embedded within primary and community care systems. Dental hygienists are well positioned to lead this development, but clearer guidelines, enhanced training and supportive organisational frameworks are urgently needed to ensure equitable and person-centred oral health care for ageing populations.