Oral Health in Residential Settings: A Public Health Priority

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Neill" }, { "@type": "Person", "name": "Louise Bradley" } ], "publisher": { "@type": "Organization", "name": "HRB Open Research", "logo": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 566, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 1200, "width": 127 }, "description": "Poor oral health is associated with increased mortality and chronic conditions. Ageing remains an unequal experience, particularly in the area of oral health. Evidence-based interventions for oral health in residential settings are limited, posing a significant public health challenge that warrants greater attention. This commentary highlights the importance of oral health and oral health research within the residential care setting, especially the need for increased research on oral health interventions." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://hrbopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://hrbopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://hrbopenresearch.org/articles/8-120/v1", "name": "Oral Health in Residential Settings: A Public Health Priority" } } ] } Home Browse Oral Health in Residential Settings: A Public Health Priority ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article O'Sullivan R, Hunter E, Neill RD and Bradley L. Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.12688/hrbopenres.14265.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Correspondence Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] Roger O'Sullivan 1,2 , Emma Hunter 1 , Ruth D. Neill https://orcid.org/0000-0001-6387-4213 1 , Louise Bradley 1 Roger O'Sullivan 1,2 , Emma Hunter 1 , Ruth D. Neill https://orcid.org/0000-0001-6387-4213 1 , Louise Bradley 1 PUBLISHED 17 Nov 2025 Author details Author details 1 Institute of Public Health, Dublin, D08 NH90, Ireland 2 The Bamford Centre, Ulster University, Coleraine, BT52 1SA, UK Roger O'Sullivan Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Emma Hunter Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ruth D. Neill Roles: Conceptualization, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Louise Bradley Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Poor oral health is associated with increased mortality and chronic conditions. Ageing remains an unequal experience, particularly in the area of oral health. Evidence-based interventions for oral health in residential settings are limited, posing a significant public health challenge that warrants greater attention. This commentary highlights the importance of oral health and oral health research within the residential care setting, especially the need for increased research on oral health interventions. READ ALL READ LESS Keywords Residential settings, dental research, oral health, older people, interventions Corresponding Author(s) Roger O'Sullivan ( [email protected] ) Close Corresponding author: Roger O'Sullivan Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 O'Sullivan R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: O'Sullivan R, Hunter E, Neill RD and Bradley L. Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.12688/hrbopenres.14265.1 ) First published: 17 Nov 2025, 8 :120 ( https://doi.org/10.12688/hrbopenres.14265.1 ) Latest published: 11 Feb 2026, 8 :120 ( https://doi.org/10.12688/hrbopenres.14265.2 )  There is a newer version of this article available. Suppress this message for one day. 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 ). 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 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, regular 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. This may be due to the various challenges encountered when implementing oral health interventions, including methodological considerations, 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. Implications and future research 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 in strategic settings, including the challenges of oral health in older adults residing in care facilities. Existing evidence supports the need to increase oral health training and education for staff, 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 ). 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 ). 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. 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. Data availability This study did not create or analyse new data, and data sharing does not apply to this article. 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. Faculty Opinions recommended References Bakker MH, de Smit MJ, Valentijn A, et al. : Oral health assessment in institutionalized elderly: a scoping review. BMC Oral Health. 2024; 24 (1): 272. PubMed Abstract | Publisher Full Text | Free Full Text Care Quality Commission CQC finds improvements to oral health in care homes. 2025b; [25 May 2025, last accessed]. 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Reference Source Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Nov 2025 ADD YOUR COMMENT Comment Author details Author details 1 Institute of Public Health, Dublin, D08 NH90, Ireland 2 The Bamford Centre, Ulster University, Coleraine, BT52 1SA, UK Roger O'Sullivan Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Emma Hunter Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ruth D. Neill Roles: Conceptualization, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Louise Bradley Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 11 Feb 2026, 8:120 https://doi.org/10.12688/hrbopenres.14265.2 version 1 Published: 17 Nov 2025, 8:120 https://doi.org/10.12688/hrbopenres.14265.1 Copyright © 2025 O'Sullivan R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article O'Sullivan R, Hunter E, Neill RD and Bradley L. Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.12688/hrbopenres.14265.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 17 Nov 2025 Views 0 Cite How to cite this report: Pradhan A. Reviewer Report For: Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.21956/hrbopenres.15689.r51850 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-120/v1#referee-response-51850 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Jan 2026 Archana Pradhan , University of Sydney, Sydney, Australia Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15689.r51850 Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults ... Continue reading READ ALL Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults in residential care settings. The article would be of interest to both researchers and practitioners interested in geriatric oral health. I have a few comments and suggestions as below: Abstract Evidence-based interventions for oral health exist, however are not implemented in residential settings and warrants greater attention. Rather than emphasis on the need for increased research on oral health interventions, which is acknowledged as being challenging, the focus should be on the implementation of evidenced-based preventive and minimal intervention dentistry onsite and the cost-effectiveness, acceptability and sustainability of such programs. Introduction The authors reflected on why there is insufficient high-quality evidence, synthesised and identified key challenges to address this significant public health issue. They have referred to recent systematic review by Janssens et al. , 2023 who identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health among care home residents in Europe. However, tooth wear (Chan et al. 2024) and denture related problems (Taira et al. 2023 , Mameno et al. 2023) have been overlooked. Oral health in the residential setting Under this topic, the adverse effects of oral health have been stated, rather than oral health problems. Research challenges to oral health intervention in residential settings Most challenges implementing oral health interventions, including ethics, consent, methodological considerations, behavioural issues for people with cognitive impairment, high levels of participant attrition, medical complexity and physical limitations, low health literacy with additional impacts from the COVID-19 pandemic on accessibility and dental services were discussed. The robust research needed to improve the quality of life for the ageing population living in residential care was suggested but not specified. Implications and future research It is important to increase oral health training and education for staff for mouth care, toothbrushing and denture care, to improve oral health outcomes in those living in residential care. In addition, It is important to note that dental practitioners themselves lack confidence in providing dental care to older people, especially those with cognitive impairment due to inadequate training and experience and yet many do not take advantage of the online training made available/accessible to them (Pradhan and Lalloo 2021). inclusion of Geriatric dentistry in dental education is therefore urgently needed to prepare the dental workforce to meet the complex dental treatment needs of the growing ageing population (Nilsson et al. 2019). Is the rationale for commenting on the previous publication clearly described? Yes Are any opinions stated well-argued, clear and cogent? Partly Are arguments sufficiently supported by evidence from the published literature or by new data and results? Partly Is the conclusion balanced and justified on the basis of the presented arguments? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Special Needs Dentistry and Gerodontology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Pradhan A. Reviewer Report For: Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.21956/hrbopenres.15689.r51850 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-120/v1#referee-response-51850 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 11 Feb 2026 Ruth Neill , Institute of Public Health, Dublin, D08 NH90, Ireland 11 Feb 2026 Author Response Author response to reviewer comments. Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps ... Continue reading Author response to reviewer comments. Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults in residential care settings. The article would be of interest to both researchers and practitioners interested in geriatric oral health. I have a few comments and suggestions as below: Author comment: The authors would like to thank the reviewer for their time in reviewing the manuscript. Abstract Evidence-based interventions for oral health exist, however are not implemented in residential settings and warrants greater attention. Rather than emphasis on the need for increased research on oral health interventions, which is acknowledged as being challenging, the focus should be on the implementation of evidenced-based preventive and minimal intervention dentistry onsite and the cost-effectiveness, acceptability and sustainability of such programs. Author comment: The authors have amended the text in the section: Abstract to address the reviewers' comments to highlight the gap in the research and the need for more evidence based practice. Introduction The authors reflected on why there is insufficient high-quality evidence, synthesised and identified key challenges to address this significant public health issue. They have referred to recent systematic review by Janssens et al. , 2023 who identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health among care home residents in Europe. However, tooth wear (Chan et al. 2024) and denture related problems (Taira et al. 2023 , Mameno et al. 2023) have been overlooked. Author comment: The authors have amended the text in the section: Introduction to include the new references and addressed the reviewer’s comments. Oral health in the residential setting Under this topic, the adverse effects of oral health have been stated, rather than oral health problems. Author comment: The authors have amended the text in the section on oral health in residential settings to address the reviewers' comments and to discuss oral health problems and their adverse effects.​​​​​​​ Research challenges to oral health intervention in residential settings Most challenges implementing oral health interventions, including ethics, consent, methodological considerations, behavioural issues for people with cognitive impairment, high levels of participant attrition, medical complexity and physical limitations, low health literacy with additional impacts from the COVID-19 pandemic on accessibility and dental services were discussed. The robust research needed to improve the quality of life for the ageing population living in residential care was suggested but not specified. Author comment: ​​​​​​​The authors have amended the text in the section: research challenges to oral health intervention in residential settings to address the reviewers' comments and to highlight some of the methodological considerations that are important challenges in oral health care research.​​​​​​​ Implications and future research It is important to increase oral health training and education for staff for mouth care, toothbrushing and denture care, to improve oral health outcomes in those living in residential care. In addition, It is important to note that dental practitioners themselves lack confidence in providing dental care to older people, especially those with cognitive impairment due to inadequate training and experience and yet many do not take advantage of the online training made available/accessible to them (Pradhan and Lalloo 2021). inclusion of Geriatric dentistry in dental education is therefore urgently needed to prepare the dental workforce to meet the complex dental treatment needs of the growing ageing population (Nilsson et al. 2019). Author comment: The authors have amended the text in the section: implications and future research to address the reviewers' comments and add the suggested references. Author response to reviewer comments. Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults in residential care settings. The article would be of interest to both researchers and practitioners interested in geriatric oral health. I have a few comments and suggestions as below: Author comment: The authors would like to thank the reviewer for their time in reviewing the manuscript. Abstract Evidence-based interventions for oral health exist, however are not implemented in residential settings and warrants greater attention. Rather than emphasis on the need for increased research on oral health interventions, which is acknowledged as being challenging, the focus should be on the implementation of evidenced-based preventive and minimal intervention dentistry onsite and the cost-effectiveness, acceptability and sustainability of such programs. Author comment: The authors have amended the text in the section: Abstract to address the reviewers' comments to highlight the gap in the research and the need for more evidence based practice. Introduction The authors reflected on why there is insufficient high-quality evidence, synthesised and identified key challenges to address this significant public health issue. They have referred to recent systematic review by Janssens et al. , 2023 who identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health among care home residents in Europe. However, tooth wear (Chan et al. 2024) and denture related problems (Taira et al. 2023 , Mameno et al. 2023) have been overlooked. Author comment: The authors have amended the text in the section: Introduction to include the new references and addressed the reviewer’s comments. Oral health in the residential setting Under this topic, the adverse effects of oral health have been stated, rather than oral health problems. Author comment: The authors have amended the text in the section on oral health in residential settings to address the reviewers' comments and to discuss oral health problems and their adverse effects.​​​​​​​ Research challenges to oral health intervention in residential settings Most challenges implementing oral health interventions, including ethics, consent, methodological considerations, behavioural issues for people with cognitive impairment, high levels of participant attrition, medical complexity and physical limitations, low health literacy with additional impacts from the COVID-19 pandemic on accessibility and dental services were discussed. The robust research needed to improve the quality of life for the ageing population living in residential care was suggested but not specified. Author comment: ​​​​​​​The authors have amended the text in the section: research challenges to oral health intervention in residential settings to address the reviewers' comments and to highlight some of the methodological considerations that are important challenges in oral health care research.​​​​​​​ Implications and future research It is important to increase oral health training and education for staff for mouth care, toothbrushing and denture care, to improve oral health outcomes in those living in residential care. In addition, It is important to note that dental practitioners themselves lack confidence in providing dental care to older people, especially those with cognitive impairment due to inadequate training and experience and yet many do not take advantage of the online training made available/accessible to them (Pradhan and Lalloo 2021). inclusion of Geriatric dentistry in dental education is therefore urgently needed to prepare the dental workforce to meet the complex dental treatment needs of the growing ageing population (Nilsson et al. 2019). Author comment: The authors have amended the text in the section: implications and future research to address the reviewers' comments and add the suggested references. Competing Interests: The authors declare no competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 11 Feb 2026 Ruth Neill , Institute of Public Health, Dublin, D08 NH90, Ireland 11 Feb 2026 Author Response Author response to reviewer comments. Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps ... Continue reading Author response to reviewer comments. Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults in residential care settings. The article would be of interest to both researchers and practitioners interested in geriatric oral health. I have a few comments and suggestions as below: Author comment: The authors would like to thank the reviewer for their time in reviewing the manuscript. Abstract Evidence-based interventions for oral health exist, however are not implemented in residential settings and warrants greater attention. Rather than emphasis on the need for increased research on oral health interventions, which is acknowledged as being challenging, the focus should be on the implementation of evidenced-based preventive and minimal intervention dentistry onsite and the cost-effectiveness, acceptability and sustainability of such programs. Author comment: The authors have amended the text in the section: Abstract to address the reviewers' comments to highlight the gap in the research and the need for more evidence based practice. Introduction The authors reflected on why there is insufficient high-quality evidence, synthesised and identified key challenges to address this significant public health issue. They have referred to recent systematic review by Janssens et al. , 2023 who identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health among care home residents in Europe. However, tooth wear (Chan et al. 2024) and denture related problems (Taira et al. 2023 , Mameno et al. 2023) have been overlooked. Author comment: The authors have amended the text in the section: Introduction to include the new references and addressed the reviewer’s comments. Oral health in the residential setting Under this topic, the adverse effects of oral health have been stated, rather than oral health problems. Author comment: The authors have amended the text in the section on oral health in residential settings to address the reviewers' comments and to discuss oral health problems and their adverse effects.​​​​​​​ Research challenges to oral health intervention in residential settings Most challenges implementing oral health interventions, including ethics, consent, methodological considerations, behavioural issues for people with cognitive impairment, high levels of participant attrition, medical complexity and physical limitations, low health literacy with additional impacts from the COVID-19 pandemic on accessibility and dental services were discussed. The robust research needed to improve the quality of life for the ageing population living in residential care was suggested but not specified. Author comment: ​​​​​​​The authors have amended the text in the section: research challenges to oral health intervention in residential settings to address the reviewers' comments and to highlight some of the methodological considerations that are important challenges in oral health care research.​​​​​​​ Implications and future research It is important to increase oral health training and education for staff for mouth care, toothbrushing and denture care, to improve oral health outcomes in those living in residential care. In addition, It is important to note that dental practitioners themselves lack confidence in providing dental care to older people, especially those with cognitive impairment due to inadequate training and experience and yet many do not take advantage of the online training made available/accessible to them (Pradhan and Lalloo 2021). inclusion of Geriatric dentistry in dental education is therefore urgently needed to prepare the dental workforce to meet the complex dental treatment needs of the growing ageing population (Nilsson et al. 2019). Author comment: The authors have amended the text in the section: implications and future research to address the reviewers' comments and add the suggested references. Author response to reviewer comments. Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults in residential care settings. The article would be of interest to both researchers and practitioners interested in geriatric oral health. I have a few comments and suggestions as below: Author comment: The authors would like to thank the reviewer for their time in reviewing the manuscript. Abstract Evidence-based interventions for oral health exist, however are not implemented in residential settings and warrants greater attention. Rather than emphasis on the need for increased research on oral health interventions, which is acknowledged as being challenging, the focus should be on the implementation of evidenced-based preventive and minimal intervention dentistry onsite and the cost-effectiveness, acceptability and sustainability of such programs. Author comment: The authors have amended the text in the section: Abstract to address the reviewers' comments to highlight the gap in the research and the need for more evidence based practice. Introduction The authors reflected on why there is insufficient high-quality evidence, synthesised and identified key challenges to address this significant public health issue. They have referred to recent systematic review by Janssens et al. , 2023 who identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health among care home residents in Europe. However, tooth wear (Chan et al. 2024) and denture related problems (Taira et al. 2023 , Mameno et al. 2023) have been overlooked. Author comment: The authors have amended the text in the section: Introduction to include the new references and addressed the reviewer’s comments. Oral health in the residential setting Under this topic, the adverse effects of oral health have been stated, rather than oral health problems. Author comment: The authors have amended the text in the section on oral health in residential settings to address the reviewers' comments and to discuss oral health problems and their adverse effects.​​​​​​​ Research challenges to oral health intervention in residential settings Most challenges implementing oral health interventions, including ethics, consent, methodological considerations, behavioural issues for people with cognitive impairment, high levels of participant attrition, medical complexity and physical limitations, low health literacy with additional impacts from the COVID-19 pandemic on accessibility and dental services were discussed. The robust research needed to improve the quality of life for the ageing population living in residential care was suggested but not specified. Author comment: ​​​​​​​The authors have amended the text in the section: research challenges to oral health intervention in residential settings to address the reviewers' comments and to highlight some of the methodological considerations that are important challenges in oral health care research.​​​​​​​ Implications and future research It is important to increase oral health training and education for staff for mouth care, toothbrushing and denture care, to improve oral health outcomes in those living in residential care. In addition, It is important to note that dental practitioners themselves lack confidence in providing dental care to older people, especially those with cognitive impairment due to inadequate training and experience and yet many do not take advantage of the online training made available/accessible to them (Pradhan and Lalloo 2021). inclusion of Geriatric dentistry in dental education is therefore urgently needed to prepare the dental workforce to meet the complex dental treatment needs of the growing ageing population (Nilsson et al. 2019). Author comment: The authors have amended the text in the section: implications and future research to address the reviewers' comments and add the suggested references. Competing Interests: The authors declare no competing interests. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Thu KM. Reviewer Report For: Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.21956/hrbopenres.15689.r51851 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-120/v1#referee-response-51851 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Dec 2025 Khaing Myat Thu , The University of Hong Kong, Hong Kong, China Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15689.r51851 This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. To strengthen the piece, please consider explicitly noting that most studies in these ... Continue reading READ ALL This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. To strengthen the piece, please consider explicitly noting that most studies in these settings are cross-sectional and briefly explaining why trials or longitudinal studies are uncommon. Participation and willingness of facilities, staff, and residents, as research activities can add burden beyond their daily routines. Please discuss strategies to minimize burden and enhance engagement. As the qualitative research is crucial to understand how administrators and care teams perceive the importance and feasibility of routine oral care, please consider to discuss it. These additions would sharpen the articulation of current research needs and provide clearer guidance for future work. Given the commentary’s aim to frame this as a public health priority, please also consider including: National policy and government support: how evidence can inform policy design and how the policy shape the oral healthcare in residential setting Caregiver-to-resident ratios from an oral care perspective: the imbalanced ratios increase caregiver burden and may crowd out oral care tasks. The role of caregivers in oral care: as the caregivers are key for daily oral care of frail and disabled residents, highlight the need for their motivation, competency-based training and support. Is the rationale for commenting on the previous publication clearly described? Partly Are any opinions stated well-argued, clear and cogent? Yes Are arguments sufficiently supported by evidence from the published literature or by new data and results? Yes Is the conclusion balanced and justified on the basis of the presented arguments? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Geriatric Dentistry, Special Care Dentistry, Artificial Intelligence, Removable Prosthodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Thu KM. Reviewer Report For: Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.21956/hrbopenres.15689.r51851 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-120/v1#referee-response-51851 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 11 Feb 2026 Ruth Neill , Institute of Public Health, Dublin, D08 NH90, Ireland 11 Feb 2026 Author Response Author responses to reviewer comments. This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. Author ... Continue reading Author responses to reviewer comments. This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. Author comment: The authors would like to thank the reviewer for taking the time to review the manuscript. 1. To strengthen the piece, please consider explicitly noting that most studies in these settings are cross-sectional and briefly explaining why trials or longitudinal studies are uncommon. Author comment:The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings to highlight the different types of studies. 2. Participation and willingness of facilities, staff, and residents, as research activities can add burden beyond their daily routines. Please discuss strategies to minimize burden and enhance engagement. Author comment: The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings , to challenges to research in this setting, and how these challenges could be minimised. 3. As the qualitative research is crucial to understand how administrators and care teams perceive the importance and feasibility of routine oral care, please consider to discuss it. Author comment: The authors have amended the Implications and future research section to address the reviewers' comments on the importance of future qualitative studies. These additions would sharpen the articulation of current research needs and provide clearer guidance for future work. Given the commentary’s aim to frame this as a public health priority, please also consider including 1. National policy and government support: how evidence can inform policy design and how the policy shape the oral healthcare in residential setting. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight public health policy. 2. Caregiver-to-resident ratios from an oral care perspective: the imbalanced ratios increase caregiver burden and may crowd out oral care tasks. Author comment: The authors have amended the section titled "Implications and future research" to highlight staff-to-resident ratios. 3. The role of caregivers in oral care: as the caregivers are key for daily oral care of frail and disabled residents, highlight the need for their motivation, competency-based training and support. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight the need to improve and utilise training and education pathways for staff. Author responses to reviewer comments. This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. Author comment: The authors would like to thank the reviewer for taking the time to review the manuscript. 1. To strengthen the piece, please consider explicitly noting that most studies in these settings are cross-sectional and briefly explaining why trials or longitudinal studies are uncommon. Author comment:The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings to highlight the different types of studies. 2. Participation and willingness of facilities, staff, and residents, as research activities can add burden beyond their daily routines. Please discuss strategies to minimize burden and enhance engagement. Author comment: The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings , to challenges to research in this setting, and how these challenges could be minimised. 3. As the qualitative research is crucial to understand how administrators and care teams perceive the importance and feasibility of routine oral care, please consider to discuss it. Author comment: The authors have amended the Implications and future research section to address the reviewers' comments on the importance of future qualitative studies. These additions would sharpen the articulation of current research needs and provide clearer guidance for future work. Given the commentary’s aim to frame this as a public health priority, please also consider including 1. National policy and government support: how evidence can inform policy design and how the policy shape the oral healthcare in residential setting. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight public health policy. 2. Caregiver-to-resident ratios from an oral care perspective: the imbalanced ratios increase caregiver burden and may crowd out oral care tasks. Author comment: The authors have amended the section titled "Implications and future research" to highlight staff-to-resident ratios. 3. The role of caregivers in oral care: as the caregivers are key for daily oral care of frail and disabled residents, highlight the need for their motivation, competency-based training and support. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight the need to improve and utilise training and education pathways for staff. Competing Interests: The authors have no competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 11 Feb 2026 Ruth Neill , Institute of Public Health, Dublin, D08 NH90, Ireland 11 Feb 2026 Author Response Author responses to reviewer comments. This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. Author ... Continue reading Author responses to reviewer comments. This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. Author comment: The authors would like to thank the reviewer for taking the time to review the manuscript. 1. To strengthen the piece, please consider explicitly noting that most studies in these settings are cross-sectional and briefly explaining why trials or longitudinal studies are uncommon. Author comment:The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings to highlight the different types of studies. 2. Participation and willingness of facilities, staff, and residents, as research activities can add burden beyond their daily routines. Please discuss strategies to minimize burden and enhance engagement. Author comment: The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings , to challenges to research in this setting, and how these challenges could be minimised. 3. As the qualitative research is crucial to understand how administrators and care teams perceive the importance and feasibility of routine oral care, please consider to discuss it. Author comment: The authors have amended the Implications and future research section to address the reviewers' comments on the importance of future qualitative studies. These additions would sharpen the articulation of current research needs and provide clearer guidance for future work. Given the commentary’s aim to frame this as a public health priority, please also consider including 1. National policy and government support: how evidence can inform policy design and how the policy shape the oral healthcare in residential setting. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight public health policy. 2. Caregiver-to-resident ratios from an oral care perspective: the imbalanced ratios increase caregiver burden and may crowd out oral care tasks. Author comment: The authors have amended the section titled "Implications and future research" to highlight staff-to-resident ratios. 3. The role of caregivers in oral care: as the caregivers are key for daily oral care of frail and disabled residents, highlight the need for their motivation, competency-based training and support. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight the need to improve and utilise training and education pathways for staff. Author responses to reviewer comments. This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. Author comment: The authors would like to thank the reviewer for taking the time to review the manuscript. 1. To strengthen the piece, please consider explicitly noting that most studies in these settings are cross-sectional and briefly explaining why trials or longitudinal studies are uncommon. Author comment:The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings to highlight the different types of studies. 2. Participation and willingness of facilities, staff, and residents, as research activities can add burden beyond their daily routines. Please discuss strategies to minimize burden and enhance engagement. Author comment: The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings , to challenges to research in this setting, and how these challenges could be minimised. 3. As the qualitative research is crucial to understand how administrators and care teams perceive the importance and feasibility of routine oral care, please consider to discuss it. Author comment: The authors have amended the Implications and future research section to address the reviewers' comments on the importance of future qualitative studies. These additions would sharpen the articulation of current research needs and provide clearer guidance for future work. Given the commentary’s aim to frame this as a public health priority, please also consider including 1. National policy and government support: how evidence can inform policy design and how the policy shape the oral healthcare in residential setting. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight public health policy. 2. Caregiver-to-resident ratios from an oral care perspective: the imbalanced ratios increase caregiver burden and may crowd out oral care tasks. Author comment: The authors have amended the section titled "Implications and future research" to highlight staff-to-resident ratios. 3. The role of caregivers in oral care: as the caregivers are key for daily oral care of frail and disabled residents, highlight the need for their motivation, competency-based training and support. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight the need to improve and utilise training and education pathways for staff. Competing Interests: The authors have no competing interests. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Nov 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 11 Feb 26 read Version 1 17 Nov 25 read read Khaing Myat Thu , The University of Hong Kong, Hong Kong, China Archana Pradhan , University of Sydney, Sydney, Australia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Thu K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Feb 2026 | for Version 2 Khaing Myat Thu , The University of Hong Kong, Hong Kong, China 0 Views copyright © 2026 Thu K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The author has addressed the comments. No further questions. Competing Interests No competing interests were disclosed. Reviewer Expertise Geriatric Dentistry, Special Care Dentistry, Artificial Intelligence, Removable Prosthodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Thu KM. Peer Review Report For: Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.21956/hrbopenres.15800.r53440) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-120/v2#referee-response-53440 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Pradhan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Jan 2026 | for Version 1 Archana Pradhan , University of Sydney, Sydney, Australia 0 Views copyright © 2026 Pradhan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults in residential care settings. The article would be of interest to both researchers and practitioners interested in geriatric oral health. I have a few comments and suggestions as below: Abstract Evidence-based interventions for oral health exist, however are not implemented in residential settings and warrants greater attention. Rather than emphasis on the need for increased research on oral health interventions, which is acknowledged as being challenging, the focus should be on the implementation of evidenced-based preventive and minimal intervention dentistry onsite and the cost-effectiveness, acceptability and sustainability of such programs. Introduction The authors reflected on why there is insufficient high-quality evidence, synthesised and identified key challenges to address this significant public health issue. They have referred to recent systematic review by Janssens et al. , 2023 who identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health among care home residents in Europe. However, tooth wear (Chan et al. 2024) and denture related problems (Taira et al. 2023 , Mameno et al. 2023) have been overlooked. Oral health in the residential setting Under this topic, the adverse effects of oral health have been stated, rather than oral health problems. Research challenges to oral health intervention in residential settings Most challenges implementing oral health interventions, including ethics, consent, methodological considerations, behavioural issues for people with cognitive impairment, high levels of participant attrition, medical complexity and physical limitations, low health literacy with additional impacts from the COVID-19 pandemic on accessibility and dental services were discussed. The robust research needed to improve the quality of life for the ageing population living in residential care was suggested but not specified. Implications and future research It is important to increase oral health training and education for staff for mouth care, toothbrushing and denture care, to improve oral health outcomes in those living in residential care. In addition, It is important to note that dental practitioners themselves lack confidence in providing dental care to older people, especially those with cognitive impairment due to inadequate training and experience and yet many do not take advantage of the online training made available/accessible to them (Pradhan and Lalloo 2021). inclusion of Geriatric dentistry in dental education is therefore urgently needed to prepare the dental workforce to meet the complex dental treatment needs of the growing ageing population (Nilsson et al. 2019). Is the rationale for commenting on the previous publication clearly described? Yes Are any opinions stated well-argued, clear and cogent? Partly Are arguments sufficiently supported by evidence from the published literature or by new data and results? Partly Is the conclusion balanced and justified on the basis of the presented arguments? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Special Needs Dentistry and Gerodontology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 11 Feb 2026 Ruth Neill, Institute of Public Health, Dublin, D08 NH90, Ireland Author response to reviewer comments. Summary The commentary is well-written addressing the critical issue of oral health among older adults in residential care settings. It synthesizes key evidence gaps and challenges, and it directly aligns the discussion with recent global initiatives for older adults in residential care settings. The article would be of interest to both researchers and practitioners interested in geriatric oral health. I have a few comments and suggestions as below: Author comment: The authors would like to thank the reviewer for their time in reviewing the manuscript. Abstract Evidence-based interventions for oral health exist, however are not implemented in residential settings and warrants greater attention. Rather than emphasis on the need for increased research on oral health interventions, which is acknowledged as being challenging, the focus should be on the implementation of evidenced-based preventive and minimal intervention dentistry onsite and the cost-effectiveness, acceptability and sustainability of such programs. Author comment: The authors have amended the text in the section: Abstract to address the reviewers' comments to highlight the gap in the research and the need for more evidence based practice. Introduction The authors reflected on why there is insufficient high-quality evidence, synthesised and identified key challenges to address this significant public health issue. They have referred to recent systematic review by Janssens et al. , 2023 who identified a high prevalence of oral health needs, including suboptimal oral hygiene, dental caries, and poor periodontal health among care home residents in Europe. However, tooth wear (Chan et al. 2024) and denture related problems (Taira et al. 2023 , Mameno et al. 2023) have been overlooked. Author comment: The authors have amended the text in the section: Introduction to include the new references and addressed the reviewer’s comments. Oral health in the residential setting Under this topic, the adverse effects of oral health have been stated, rather than oral health problems. Author comment: The authors have amended the text in the section on oral health in residential settings to address the reviewers' comments and to discuss oral health problems and their adverse effects.​​​​​​​ Research challenges to oral health intervention in residential settings Most challenges implementing oral health interventions, including ethics, consent, methodological considerations, behavioural issues for people with cognitive impairment, high levels of participant attrition, medical complexity and physical limitations, low health literacy with additional impacts from the COVID-19 pandemic on accessibility and dental services were discussed. The robust research needed to improve the quality of life for the ageing population living in residential care was suggested but not specified. Author comment: ​​​​​​​The authors have amended the text in the section: research challenges to oral health intervention in residential settings to address the reviewers' comments and to highlight some of the methodological considerations that are important challenges in oral health care research.​​​​​​​ Implications and future research It is important to increase oral health training and education for staff for mouth care, toothbrushing and denture care, to improve oral health outcomes in those living in residential care. In addition, It is important to note that dental practitioners themselves lack confidence in providing dental care to older people, especially those with cognitive impairment due to inadequate training and experience and yet many do not take advantage of the online training made available/accessible to them (Pradhan and Lalloo 2021). inclusion of Geriatric dentistry in dental education is therefore urgently needed to prepare the dental workforce to meet the complex dental treatment needs of the growing ageing population (Nilsson et al. 2019). Author comment: The authors have amended the text in the section: implications and future research to address the reviewers' comments and add the suggested references. View more View less Competing Interests The authors declare no competing interests. reply Respond Report a concern Pradhan A. Peer Review Report For: Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.21956/hrbopenres.15689.r51850) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-120/v1#referee-response-51850 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Thu K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Dec 2025 | for Version 1 Khaing Myat Thu , The University of Hong Kong, Hong Kong, China 0 Views copyright © 2025 Thu K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. To strengthen the piece, please consider explicitly noting that most studies in these settings are cross-sectional and briefly explaining why trials or longitudinal studies are uncommon. Participation and willingness of facilities, staff, and residents, as research activities can add burden beyond their daily routines. Please discuss strategies to minimize burden and enhance engagement. As the qualitative research is crucial to understand how administrators and care teams perceive the importance and feasibility of routine oral care, please consider to discuss it. These additions would sharpen the articulation of current research needs and provide clearer guidance for future work. Given the commentary’s aim to frame this as a public health priority, please also consider including: National policy and government support: how evidence can inform policy design and how the policy shape the oral healthcare in residential setting Caregiver-to-resident ratios from an oral care perspective: the imbalanced ratios increase caregiver burden and may crowd out oral care tasks. The role of caregivers in oral care: as the caregivers are key for daily oral care of frail and disabled residents, highlight the need for their motivation, competency-based training and support. Is the rationale for commenting on the previous publication clearly described? Partly Are any opinions stated well-argued, clear and cogent? Yes Are arguments sufficiently supported by evidence from the published literature or by new data and results? Yes Is the conclusion balanced and justified on the basis of the presented arguments? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Geriatric Dentistry, Special Care Dentistry, Artificial Intelligence, Removable Prosthodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 11 Feb 2026 Ruth Neill, Institute of Public Health, Dublin, D08 NH90, Ireland Author responses to reviewer comments. This commentary effectively highlights the research gap in oral health within residential aged-care facilities, an area that remains challenging for oral health researchers. Author comment: The authors would like to thank the reviewer for taking the time to review the manuscript. 1. To strengthen the piece, please consider explicitly noting that most studies in these settings are cross-sectional and briefly explaining why trials or longitudinal studies are uncommon. Author comment:The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings to highlight the different types of studies. 2. Participation and willingness of facilities, staff, and residents, as research activities can add burden beyond their daily routines. Please discuss strategies to minimize burden and enhance engagement. Author comment: The authors have added new text to the section titled: Research challenges to oral health intervention in residential settings , to challenges to research in this setting, and how these challenges could be minimised. 3. As the qualitative research is crucial to understand how administrators and care teams perceive the importance and feasibility of routine oral care, please consider to discuss it. Author comment: The authors have amended the Implications and future research section to address the reviewers' comments on the importance of future qualitative studies. These additions would sharpen the articulation of current research needs and provide clearer guidance for future work. Given the commentary’s aim to frame this as a public health priority, please also consider including 1. National policy and government support: how evidence can inform policy design and how the policy shape the oral healthcare in residential setting. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight public health policy. 2. Caregiver-to-resident ratios from an oral care perspective: the imbalanced ratios increase caregiver burden and may crowd out oral care tasks. Author comment: The authors have amended the section titled "Implications and future research" to highlight staff-to-resident ratios. 3. The role of caregivers in oral care: as the caregivers are key for daily oral care of frail and disabled residents, highlight the need for their motivation, competency-based training and support. Author comment: The authors have amended the text within the section titled: Implications and future research to highlight the need to improve and utilise training and education pathways for staff. View more View less Competing Interests The authors have no competing interests. reply Respond Report a concern Thu KM. Peer Review Report For: Oral Health in Residential Settings: A Public Health Priority [version 1; peer review: 1 approved, 1 approved with reservations] . HRB Open Res 2025, 8 :120 ( https://doi.org/10.21956/hrbopenres.15689.r51851) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); }); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a00cde734c97f047',t:'MTc3OTYzMTY3MA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();