Oral Health Intervention Strategies for Self-Caring Adults With Disabilities: A Systematic Review.

Background: Oral health disparities among adults with disabilities remain a significant challenge. Objective: To systematically evaluate the effectiveness of educational, behavioral, and pharmacological strategies intended to enhance oral health self-care among independent adults with disabilities. Methods: This systematic review adhered to PRISMA 2020 recommendations and was registered with PROSPERO (CRD420251015528). We identified randomized controlled trials (RCTs) published in English from 2000 to 2024 through extensive searches of PubMed, Scopus, EBSCOhost, the Cochrane Library, ProQuest, and relevant gray literature sources. Studies were eligible if they involved adults aged 18-70 years with psychiatric, neurological, intellectual, or physical disabilities who were able to perform their own oral hygiene. Interventions included educational, behavioral, or pharmacological strategies compared to any control. Two reviewers independently completed the screening and data-extraction processes and appraised study quality using the Cochrane RoB 2.0 tool. Narrative synthesis was conducted due to heterogeneity. Results: Ten RCTs involving 681 participants from diverse countries met the inclusion criteria. Educational and behavioral interventions, including oral hygiene instruction (OHI), visual aids, hands-on demonstration, and motivational interviewing (MI), significantly improved oral health knowledge, attitudes, and self-care practices in adults with disabilities. These interventions were particularly effective when tailored to the specific needs of participants and delivered with ongoing reinforcement. Pharmacological strategies, primarily chlorhexidine-based adjuncts, further reduced plaque, gingival bleeding, and oral microbial load, especially when combined with education or behavioral support. While most interventions produced significant short-term improvements in clinical and behavioral outcomes, overall certainty of evidence was limited by heterogeneity in study designs, intervention protocols, and risk of bias. Conclusions: Multifaceted interventions that combine tailored education, behavioral reinforcement, and pharmacological support improve oral health outcomes for independent adults with disabilities. Future research should prioritize standardized methodologies, rigorous risk-of-bias assessment, and long-term follow-up to strengthen the evidence base and guide clinical practice and policy.