Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

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?


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.


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.


Clinical trials
Studies where people are assigned to one of the treatments but not purely by chance.
Controlled clinical trials
A research design that differs from experimental studies in that participants are not randomly assigned to groups, but the investigator still controls the intervention(s) (e.g. test, or treatment) received by at least one of the groups. This means a researcher can't draw conclusions about 'cause and effect'. This design is frequently used when it is not feasible, or not ethical, to conduct a randomized controlled trial.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Dementia in long-term care

    Canadian Institute for Health Information
    Older adults with dementia may need to move into long-term care homes if they can no longer stay at home. These people have higher risk of getting physically restrained or given antipsychotic medication. Changes to policy and education have made these things happen less often.
  • Treating pressure ulcers: New evidence, continued uncertainty

    Evidently Cochrane
    Gauze dressings should not be used to treat pressure ulcers (bed sores). Other options include alginate dressings, hydrogel dressings, and negative pressure wound therapy. More evidence is needed about which options are best to improve pain and reduce complications. Research should measure outcomes that matter to patients and carers as well as health professionals.
  • Patient education: Delirium (Beyond the Basics)

    UpToDate - patient information
    Delirium is the result of brain changes that lead to confusion, lack of focus and memory problems. There is no specific treatment for delirium - it is best to avoid risks, treat underlying illnesses and receive supportive care. Sedatives and physical restraints should be avoided.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Want the latest in aging research? Sign up for our email alerts.

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use