Strategies to promote oral health improve knowledge but not necessarily the oral health of people living in long-term care facilities

Weening-Verbree L, Huisman-de Waal G, van Dusseldorp L, van Achterberg T, Schoonhoven L. Oral health care in older people in long term care facilities: A systematic review of implementation strategies. Int J Nurs Stud. 2013; 50:569-582

Review question

How effective are implementation strategies in promoting or improving oral health care for older people in long-term care facilities?

Background

Oral hygiene is needed to maintain oral health and quality of life. Delivering oral health care is standard practice in long-term care facilities. Compliance with available guidelines and protocols, however, is inconsistent. Strategies have been designed to address this problem, but the effects have been small to moderate and are often short-term. Analyzing the behaviour change recommended in the guidelines may provide insight on how to improve oral health among seniors in long-term care facilities.

How the review was done

This is a summary based on a systematic review of 20 implementation studies, conducted mainly in nursing homes, and ranging from 41 to almost 2,000 participants. Dentists or dental hygienists delivered the implementation strategy to nurses and nurse assistants, who provided the oral health care to seniors. Half of the included studies were uncontrolled before-after studies; the rest were controlled before-after studies, randomized controlled trials or controlled clinical trials. Outcomes were measured from several weeks to several years following the implementation strategy.

What the researchers found

Implementation strategies were developed to impact knowledge, awareness, social influence, self-efficacy, intention and maintenance. While significant positive effects were reported for knowledge and health beliefs, inconsistent findings were observed for oral health. The most successful strategies for improving oral health focused on improving knowledge and self-efficacy, and facilitation of behaviour.

Conclusion

Implementation strategies for promoting or improving oral health care have a positive impact on knowledge and health beliefs, but do not necessarily improve oral health.