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 improvements in clients' oral health. METHODS Twenty-two nursing homes were randomly 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 stomatitis, dental plaque and gingivitis. Differences in group means/medians were compared with adjustment for cluster randomisation. RESULTS Clients' baseline oral health was poor. After OHCE, the intervention group's oral health scores 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 prevalence 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 dental 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 pounds 6700 per year to deliver the intervention to a Health Authority with 100 homes. CONCLUSIONS Although final levels of residents' oral health were still short of ideal, this study clearly shows that, for a modest cost, OHCE can improve caregivers' knowledge, attitudes and oral health care performance for elderly, functionally dependent clients.