Bedside Intraoral Scanning to Reduce Procedural Burden in Older Adults With Dementia: Nonrandomized Counterbalanced...

Older adults living with dementia often have limited tolerance for intraoral procedures, which can restrict access to even basic oral health assessment in clinical care. Procedural burden-characterized by sustained intraoral manipulation, sensory overload, and limited opportunities for interruption-may represent a key barrier to equitable oral care. Intraoral scanning (IOS) enables stepwise, interruptible acquisition of oral data and may reduce this burden, but feasibility and tolerability in people living with dementia have not been systematically evaluated.

This study aimed to assess the feasibility and tolerability of bedside maxillary IOS compared with a conventional impression procedure in people living with dementia.

A single-center, nonrandomized, counterbalanced, crossover feasibility study was conducted in a geriatric ward. Nineteen hospitalized participants with dementia (mean age 83.5, SD 3.4 years; mean Mini-Mental State Examination score 18.2, SD 4.8) underwent both bedside maxillary IOS and a conventional alginate-based impression procedure during a single visit. The order of procedures was not randomized but assigned using an alternating allocation sequence based on chronological enrollment to counterbalance potential order effects. The primary outcome was feasibility, defined as procedure completion without premature termination due to gag reflex, defensive movements, participant refusal, or withdrawal of assent or cooperation. Secondary outcomes included participant-rated discomfort using a 0 to 10 visual analog scale (VAS); clinician-rated manageability using a 0 to 10 VAS, with higher scores indicating greater difficulty; adverse reactions, including gag reflex and defensive movements; and active bedside procedural time in minutes. Paired comparisons were performed using the Wilcoxon signed-rank tests for VAS outcomes, a sign test for active bedside procedural time, and McNemar tests for binary outcomes, with a 2-sided significance level of .05.

Participants reported significantly lower discomfort with IOS than with the conventional impression procedure (median 1.0, IQR 0.5-1.5 vs median 7.75, IQR 3.7-8.5; P<.001), and clinician-rated manageability was more favorable for IOS (median 2.0, IQR 1.0-3.0 vs median 5.0, IQR 3.0-6.5; P<.001). Active bedside procedural time was similar in the analysis of all initiated procedures, with a mean duration of 3.02 (SD 0.72) minutes for IOS and 2.92 (SD 0.78) minutes for the conventional impression procedure. Exploratory analyses showed no statistically detectable evidence of an order effect. Gag reflex occurred less frequently during IOS (1/19, 5.3% vs 9/19, 47.4%; P=.004).

Bedside IOS was feasible in hospitalized older adults living with dementia and was associated with lower immediate procedural burden than a conventional alginate-based impression procedure. These findings support further evaluation of IOS as a low-burden approach for oral data acquisition in dementia care, while downstream treatment effects and implementation in other settings require further study.