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Effectiveness of supervised implementation of an oral health care guideline in care homes; a single-blinded cluster randomized controlled trial

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Abstract

Objectives

The objective of this study was to assess the effectiveness of a supervised implementation of the “Oral health care Guideline for Older people in Long-term care Institutions” (OGOLI) in The Netherlands.

Materials and methods

A sample of 12 care homes in the Netherlands was allocated randomly to an intervention or control group. While the residents in the control group received oral health care as before, the intervention consisted of a supervised implementation of the OGOLI.

Results

At baseline, the overall random sample comprised 342 residents, 52 % in the intervention group and 48 % in the control group. At 6 months, significant differences were observed between the intervention and the control group for mean dental as well as denture plaque, with a beneficial effect for the intervention group. The multilevel mixed-model analyses conducted with the plaque scores at 6 months as outcome variables showed that the reduction by the intervention was only significant for denture plaque.

Conclusions

Supervised implementation of the OGOLI was more effective than non-supervised implementation in terms of reducing mean plaque scores at 6 months. However, the multilevel mixed-model analysis could not exclusively explain the reduction of mean dental plaque scores by the intervention.

Clinical relevance

A supervised implementation of an oral health care guideline improves oral health of care home residents.

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References

  1. Naito M, Kato T, Fujii W, Ozeki M, Yokoyama M, Hamajima N, Saitoh E (2010) Effects of dental treatment on the quality of life and activities of daily living in institutionalized elderly in Japan. Arch Gerontol Geriatr 50:65–68

    Article  PubMed  Google Scholar 

  2. Petersen PE (2003) The World Oral Health Report 2003: continuous improvement of oral health in the 21st century—the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 31(Suppl 1):3–23

    Article  PubMed  Google Scholar 

  3. Petersen PE, Yamamoto T (2005) Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 33:81–92

    Article  PubMed  Google Scholar 

  4. Kandelman D, Petersen PE, Ueda H (2008) Oral health, general health, and quality of life in older people. Spec Care Dentist 28:224–236

    Article  PubMed  Google Scholar 

  5. Marino R, Schofeld M, Wright C, Calache H, Minichiello V (2008) Self-reported and clinically determined oral health status predictors for quality of life in dentate older migrant adults. Community Dent Oral Epidemiol 36:85–94

    PubMed  Google Scholar 

  6. Tsakos G, Steele JG, Marcenes W, Walls AW, Sheiham A (2006) Clinical correlates of oral health-related quality of life: evidence from a national sample of British older people. Eur J Oral Sci 114:391–395

    Article  PubMed  Google Scholar 

  7. Forsell M, Sjogren P, Johansson O (2009) Need of assistance with daily oral hygiene measures among nursing home resident elderly versus the actual assistance received from the staff. Open Dent J 3:241–244

    Article  PubMed  Google Scholar 

  8. Isaksson R, Soderfeldt B (2007) Oral status and treatment needs among elderly within municipal long-term care 2002–2004. Swed Dent J 31:45–52

    PubMed  Google Scholar 

  9. Konishi C, Hakuta C, Ueno M, Shinada K, Wright FA, Kawaguchi Y (2010) Factors associated with self-assessed oral health in the Japanese independent elderly. Gerodontology 27:53–61

    Article  PubMed  Google Scholar 

  10. Mello AL, Erdmann AL, Brondani M (2010) Oral health care in long-term care facilities for elderly people in southern Brazil: a conceptual framework. Gerodontology 27:41–46

    Article  PubMed  Google Scholar 

  11. Montal S, Tramini P, Triay JA, Valcarcel J (2006) Oral hygiene and the need for treatment of the dependent institutionalised elderly. Gerodontology 23:67–72

    Article  PubMed  Google Scholar 

  12. Polzer I, Schimmel M, Muller F, Biffar R (2010) Edentulism as part of the general health problems of elderly adults. Int Dent J 60:143–155

    PubMed  Google Scholar 

  13. Samson H, Strand GV, Haugejorden O (2008) Change in oral health status among the institutionalized Norwegian elderly over a period of 16 years. Acta Odontol Scand 66:368–373

    Article  PubMed  Google Scholar 

  14. Sweeney MP, Williams C, Kennedy C, Macpherson LM, Turner S, Bagg J (2007) Oral health care and status of elderly care home residents in Glasgow. Community Dent Health 24:37–42

    PubMed  Google Scholar 

  15. Unluer S, Gokalp S, Dogan BG (2007) Oral health status of the elderly in a residential home in Turkey. Gerodontology 24:22–29

    Article  PubMed  Google Scholar 

  16. Montebugnoli L, Servidio D, Miaton RA, Prati C, Tricoci P, Melloni C (2004) Poor oral health is associated with coronary heart disease and elevated systemic inflammatory and haemostatic factors. J Clin Periodontol 31:25–29

    Article  PubMed  Google Scholar 

  17. Scully C, Ettinger RL (2007) The influence of systemic diseases on oral health care in older adults. J Am Dent Assoc 138(Suppl):7S–14S

    PubMed  Google Scholar 

  18. Rautemaa R, Lauhio A, Cullinan MP, Seymour GJ (2007) Oral infections and systemic disease—an emerging problem in medicine. Clin Microbiol Infect 13:1041–1047

    Article  PubMed  Google Scholar 

  19. Rhodus NL (2005) Oral health and systemic health. Minn Med 88:46–48

    PubMed  Google Scholar 

  20. Taylor GW, Loesche WJ, Terpenning MS (2000) Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia. J Public Health Dent 60:313–320

    Article  PubMed  Google Scholar 

  21. Ghezzi EM, Ship JA (2000) Systemic diseases and their treatments in the elderly: impact on oral health. J Public Health Dent 60:289–296

    Article  PubMed  Google Scholar 

  22. Bartold PM (1999) Oral health and systemic health. Aust Dent J 44:211

    Article  PubMed  Google Scholar 

  23. Beck JD, Offenbacher S (1998) Oral health and systemic disease: periodontitis and cardiovascular disease. J Dent Educ 62:859–870

    PubMed  Google Scholar 

  24. van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C (2011) Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc 12:344–354

    Google Scholar 

  25. Scannapieco FA (2006) Pneumonia in nonambulatory patients. The role of oral bacteria and oral hygiene. J Am Dent Assoc 137(Suppl):21S–25S

    PubMed  Google Scholar 

  26. Scannapieco FA, Dasanayake AP, Chhun N (2010) Does periodontal therapy reduce the risk for systemic diseases? Dent Clin North Am 54:163–181

    Article  PubMed  Google Scholar 

  27. O’Loughlin G, Shanley C (1998) Swallowing problems in the nursing home: a novel training response. Dysphagia 13:172–183

    Article  PubMed  Google Scholar 

  28. Attin T, Hornecker E (2005) Tooth brushing and oral health: how frequently and when should tooth brushing be performed? Oral Health Prev Dent 3:135–140

    PubMed  Google Scholar 

  29. Hancock EB, Newell DH (2001) Preventive strategies and supportive treatment. Periodontol 2000 25:59–76

    Article  PubMed  Google Scholar 

  30. Gil-Montoya JA, de Mello AL, Cardenas CB, Lopez IG (2006) Oral health protocol for the dependent institutionalized elderly. Geriatr Nurs 27:95–101

    Article  PubMed  Google Scholar 

  31. Stein PS, Henry RG (2009) Poor oral hygiene in long-term care. Am J Nurs 109:44–50

    Article  PubMed  Google Scholar 

  32. de Mello AL, Padilha DM (2009) Oral health care in private and small long-term care facilities: a qualitative study. Gerodontology 26:53–57

    Article  PubMed  Google Scholar 

  33. Young BC, Murray CA, Thomson J (2008) Care home staff knowledge of oral care compared to best practice: a West of Scotland pilot study. Br Dent J E15:450–451

    Google Scholar 

  34. McGrath C, Zhang W, Lo EC (2009) A review of the effectiveness of oral health promotion activities among elderly people. Gerodontology 26:85–96

    Article  PubMed  Google Scholar 

  35. O’Reilly M (2003) Oral care of the critically ill: a review of the literature and guidelines for practice. Aust Crit Care 16:101–110

    Article  PubMed  Google Scholar 

  36. Vanobbergen JN, De Visschere LM (2005) Factors contributing to the variation in oral hygiene practices and facilities in long-term care institutions for the elderly. Community Dent Health 22:260–265

    PubMed  Google Scholar 

  37. De Visschere LM, van der Putten GJ, de Baat C, Schols JM, Vanobbergen JN (2009) Oral health care guidelines for elderly people in long-term care facilities. Effectiveness and implementation in The Netherlands and Flanders. Ned Tijdschr Tandheelkd 116:23–27

    PubMed  Google Scholar 

  38. Deerenberg-Kessler W, Nieuwlands T, Vreeburg E, Brevé M, Hazen J, Koel E, de Lugt-Lustig K, Pelkmans-Tijs W, van der Putten GJ (2007) Richtlijn mondzorg voor zorgafhankelijke cliënten in verpleeghuizen

  39. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project (2003) Qual Saf Health Care 12:18–23

  40. Nicol R, Petrina Sweeney M, McHugh S, Bagg J (2005) Effectiveness of health care worker training on the oral health of elderly residents of nursing homes. Community Dent Oral Epidemiol 33:115–124

    Article  PubMed  Google Scholar 

  41. Scott IA, Denaro CP, Bennett CJ, Mudge AM (2004) Towards more effective use of decision support in clinical practice: what the guidelines for guidelines don’t tell you. Intern Med J 34:492–500

    Article  PubMed  Google Scholar 

  42. De Visschere L, Schols J, van der Putten G-J, de Baat C, Vanobbergen J (2012) Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial. Gerodontology 29:e96–e106

  43. De Visschere LM, Grooten L, Theuniers G, Vanobbergen JN (2006) Oral hygiene of elderly people in long-term care institutions—a cross-sectional study. Gerodontology 23:195–204

    Article  PubMed  Google Scholar 

  44. van der Putten GJ, De Visschere L, Schols J, de Baat C, Vanobbergen J (2010) Supervised versus non-supervised implementation of an oral health care guideline in (residential) care homes: a cluster randomized controlled clinical trial. BMC Oral Health 10:17

    Article  PubMed  Google Scholar 

  45. Ribbe MW (1993) Care for the elderly: the role of the nursing home in the Dutch health care system. Int Psychogeriatr 5:213–222

    Article  PubMed  Google Scholar 

  46. Schols JM (2005) Nursing home medicine in The Netherlands. Eur J Gen Pract 11:141–143

    Article  PubMed  Google Scholar 

  47. Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135

    Article  PubMed  Google Scholar 

  48. Augsburger RH, Elahi JM (1982) Evaluation of seven proprietary denture cleansers. J Prosthet Dent 47:356–359

    Article  PubMed  Google Scholar 

  49. Dijkstra A, Tiesinga LJ, Plantinga L, Veltman G, Dassen TW (2005) Diagnostic accuracy of the care dependency scale. J Adv Nurs 50:410–416

    Article  PubMed  Google Scholar 

  50. Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935

    PubMed  Google Scholar 

  51. Kim SY, Caine ED (2002) Utility and limits of the mini mental state examination in evaluating consent capacity in Alzheimer’s disease. Psychiatr Serv 53:1322–1324

    Article  PubMed  Google Scholar 

  52. Frenkel H, Harvey I, Newcombe RG (2001) Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial. Community Dent Oral Epidemiol 29:289–297

    Article  PubMed  Google Scholar 

  53. Coleman P, Watson NM (2006) Oral care provided by certified nursing assistants in nursing homes. J Am Geriatr Soc 54:138–143

    Article  PubMed  Google Scholar 

  54. Forsell M, Sjogren P, Kullberg E, Johansson O, Wedel P, Herbst B, Hoogstraate J (2011) Attitudes and perceptions towards oral hygiene tasks among geriatric nursing home staff. Int J Dent Hyg 9:199–203

    Google Scholar 

  55. MacEntee MI, Wyatt CC, Beattie BL, Paterson B, Levy-Milne R, McCandless L, Kazanjian A (2007) Provision of mouth-care in long-term care facilities: an educational trial. Community Dent Oral Epidemiol 35:25–34

    Article  PubMed  Google Scholar 

  56. Munoz N, Touger-Decker R, Byham-Gray L, Maillet JO (2009) Effect of an oral health assessment education program on nurses’ knowledge and patient care practices in skilled nursing facilities. Spec Care Dentist 29:179–185

    Article  Google Scholar 

  57. Peltola P, Vehkalahti MM, Simoila R (2007) Effects of 11-month interventions on oral cleanliness among the long-term hospitalised elderly. Gerodontology 24:14–21

    Article  PubMed  Google Scholar 

  58. Simons D, Baker P, Jones B, Kidd EA, Beighton D (2000) An evaluation of an oral health training programme for carers of the elderly in residential homes. Br Dent J 188:206–210

    PubMed  Google Scholar 

  59. Wardh I, Berggren U, Andersson L, Sorensen S (2002) Assessments of oral health care in dependent older persons in nursing facilities. Acta Odontol Scand 60:330–336

    Article  PubMed  Google Scholar 

  60. De Visschere LM, De Baat C, Schols JMGA, Deschepper E, Vanobbergen J (2011) Evaluation of the implementation of an ‘oral hygiene protocol’ in nursing homes: a 5-year longitudinal study. Community Dent Oral Epidemiol 39:416–425

    Google Scholar 

  61. Huizing AR, Hamers JP, Gulpers MJ, Berger MP (2009) A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. J Am Geriatr Soc 57:1139–1148

    Article  PubMed  Google Scholar 

  62. Neyens JC, Dijcks BP, Twisk J, Schols JM, van Haastregt JC, van den Heuvel WJ, de Witte LP (2009) A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT). Age Ageing 38:194–199

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by The Open Ankh Foundation, Utrecht; The Opbouw Foundation, Utrecht; Birkhoven Care Estate, Amersfoort; ZonMw, The Haque; Vereniging Het Zonnehuis, Amstelveen; Stichting Wetenschapsbevordering Verpleeghuiszorg, Amsterdam; MarkTwo Communications, Leusden and Fonds NutsOhra, Amsterdam, The Netherlands. The authors would like to express their gratitude to GABA International, Johnson & Johnson, and Novia Cura for supplying the oral health care products and materials needed for this study.

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The authors declare that they have no conflict of interest.

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Correspondence to Gert-Jan van der Putten.

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van der Putten, GJ., Mulder, J., de Baat, C. et al. Effectiveness of supervised implementation of an oral health care guideline in care homes; a single-blinded cluster randomized controlled trial. Clin Oral Invest 17, 1143–1153 (2013). https://doi.org/10.1007/s00784-012-0793-2

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  • DOI: https://doi.org/10.1007/s00784-012-0793-2

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