Implementation of an oral health care protocol led to short term improvements in care home residents


With an increasing proportion of the population living longer and retaining their teeth into old age ensuring that they are maintained in good oral health is important. However,the literature indicates that the oral health of older people in care homes is poor.  The aim of this study was to assess the effectiveness of an Oral health care Guideline for Older people in Long-term care Institutions (OGOLI) in The Netherlands.  The key elements of OGOLI are; integrated oral health care, continuous education of nurses and nurse assistants, and continuous monitoring of structure, process and effect indicators.

This was a cluster randomised controlled trial (RCT) where 12 care homes in the Netherlands with between 120–250 somatically as well as cognitively impaired residents were allocated randomly to an intervention or control group. The intervention consisted of a supervised implementation of the OGOLI and a daily oral health care protocol derived from the OGOLI. The same products and materials were provided to the intervention group. The control group residents received oral health care products as determined by the management of the care home.  The primary outcome variables were the dental and denture plaque scores.

2,331 residents were involved in the project, 1,157 in the intervention and 1,174 in the control group. A random sample of the residents in the selected homes were examined, 177 (52 %) in the intervention group and 165 (48 %) in the control group.

  • 111 of the residents (32 %) were lost to follow-up, 62 (35 %) in the intervention group and 49 (29.5 %) in the control group.
  • At the end of the study period, data were available for 232 residents, 115 in the intervention and 117 in the control group.
  • At 6 months there was a statistically significant difference in favour of the intervention group for both mean dental as well as denture plaque, with a beneficial effect for the intervention group

The authors concluded that

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.


van der Putten GJ, Mulder J, de Baat C, De Visschere LM, Vanobbergen JN, Schols JM. Effectiveness of supervised implementation of an oral health care guideline in care homes; a single-blinded cluster randomized controlled trial. Clin Oral Investig. 2012 Jul 28. [Epub ahead of print] PubMed PMID: 22842777.







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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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