Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial

Objectives: This cluster-randomised controlled trial assessed whether oral health care education (OHCE) for nursing home caregivers would achieve impr ovements in clients' oral health. Methods: Twenty-two nursing homes were ra ndomly allocated to intervention or control group. Clients were examined at baseline and at follow-up visits 1- and 6-months after caregivers received OHCE. Main outcome measures were denture plaque, denture-induced stomatiti s, dental plaque and gingivitis. Differences in group means/medians were co mpared with adjustment for cluster randomisation. Results: Clients' baselin e oral health was poor. After OHCE, the intervention group's oral health sc ores improved significantly. Reductions in denture plaque scores (0-4 scale ) exceeded those of the control group by 1.15 (95%CI=0.83, 1.47) at 1 month and by 1.47 (95%CI=1.13, 1.80) at 6 months. Denture-induced stomatitis pre valence reduced significantly over 6 months compared to the control group ( P<0.0001), Group differences in favour of the intervention group were 0.41 (95%CI=0.18, 0.65) at 1 month and 0.34 (95%CI=0.14, 0.53) at 6 months for d ental plaque (0-3 scale), and 0.17 (95%CI= -0.01, 0.35) at 1 month and 0.28 (95%CI 0.15, 0.42) at 6 months for gingivitis (0-2 scale). Key differences remained significant after adjustment for clustering effects. The provider 's costs would currently be approximately <pound>6700 per year to deliver t he intervention to a Health Authority with 100 homes. Conclusions: Although final levels of residents' oral health were still short of ideal, this stu dy clearly shows that, for a modest cost, OHCE can improve caregivers' know ledge, attitudes and oral health care performance for elderly, functionally dependent clients.