Oral health improvement in care homes


A number of studies have demonstrated that the oral health status of older people in institutional care is poor.

The aim of this study was to explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses’ and nurses’ aides’ oral health-related knowledge and attitude.


This was a cluster-randomised controlled trial with twelve homes being randomised to the oral health intervention (6 homes) or control (6 homes). The intervention consisted of a supervised implementation of the guideline ‘Oral health care Guideline for Older people in Long-term care Institutions’ (OGOLI) and a daily oral healthcare protocol derived from the guideline. A 34-item validated questionnaire was used to gathered personal information, as well as information on oral health attitudes and behaviours. It was administered at base line at after 6 months.


  • There were a total of 760 nurses and nurses’ aides in the 12 nursing homes
  • 651 (86%) completed the questionnaire at baseline (404 in the intervention group and 247 in the control).
  • At 6 month follow up 512 (67%) persons completed the questionnaire: (300 in the intervention group and 212 in the control).
  • mean age of all participants was 38.28 years (SD = 10.54).
  • mean working experience in the nursing home was 13.52 years (SD = 9.27)
  • At baseline, there were no differences between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37).
  • There were no significant differences in knowledge or attitude at baseline.
  • At six months there was a significant difference for variable knowledge in favour of the intervention group (p < 0.0001) but not for attitude (p = 0.78).
  • Age, level of education and ward type had a significant influence on attitude. While educational level had a significant impact on knowledge.


The authors concluded: –

The intervention applied in this study significantly improved knowledge in both study groups with the increase being significantly higher in the intervention group compared to the control group. In contrast, no significant improvements could be demonstrated in attitude.


This study presents a secondary analysis of data from a trial that was published in 2012 (Dental Elf – Aug 22nd 2012) that found the supervised implementation of OGOLI helped reduce plaque scores at months. This analysis demonstrated an improvement in knowledge but not attitude and to maintain and improve oral health in this age group a sustained behaviour change is required.

Achieving behaviour change is important to improve health and this can be challenging. And evidence shows that interventions based on theoretic frameworks have more success. Recently the theoretical domains framework (TDF) has been developed (Cane et al 2011) to simplify and integrate a range of behaviour change theories. The TDF identified 14 domains that can be mapped to the behaviour change wheel’s C-OMB system [Capability, Opportunity, Motivation, Behaviour (Michie S et al 2012)], which may a useful basis for developing interventions in this are in the future.


Janssens B, De Visschere L, van der Putten GJ, de Lugt-Lustig K, Schols JM, Vanobbergen J. Effect of an oral healthcare protocol in nursing homes on care staffs’ knowledge and attitude towards oral health care: a cluster-randomised controlled trial. Gerodontology. 2014 Nov 26. doi: 10.1111/ger.12164. [Epub ahead of print] PubMed PMID: 25424132.

Dental Elf – Aug 22nd 2012 – Implementation of an oral health care protocol led to short term improvements in care home residents

Dental Elf – 4th Sept  2013 – Limited evidence on the benefit of providing oral healthcare education to care home nurses on their attitude and their oral hygiene care skills

Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011 Apr 23;6:42. doi: 10.1186/1748-5908-6-42. Review. PubMed PMID: 21513547; PubMed Central PMCID: PMC3096582.

Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012 Apr 24;7:37. doi: 10.1186/1748-5908-7-37. PubMed PMID: 22530986; PubMed Central PMCID: PMC3483008.

Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+