Effectiveness of an Oral Health Intervention for Institutionalized Elderly

Objectives: Available literature reflects that institutionalized elderly frequently face variable oral problems. Therefore the objective of this research was to evaluate the effectiveness of an oral health intervention for care dependent and cognitively impaired elderly in nursing homes compared to those without intervention.
Methods: 269 seniors living in 14 nursing homes in Southwestern Germany (intervention: n=178; control: n=91) were enrolled in this study. For each participant, Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Denture Hygiene Index (DHI), Periodontal Index of Dental Treatment Needs (CPITN) and Revised Oral Assessment Guide (ROAG) were assessed at baseline as well as after 6 and 12 months following the interventions, respectively. In addition, demographic parameters such as age, gender, diseases, medications, dependency level and cognitive state were collected. For the intervention carers were comprehensively educated and ultrasound bathes for denture cleaning were implemented. Changes of the dental target variables PCR, GBI, DHI, CPITN and ROAG at follow-up after 6 and 12 months were compared to baseline for subjects in the intervention and control group, respectively.
Results: In the intervention group PCR, GBI and DHI significantly improved during the 12-month study period (p<0.05). For CPITN and ROAG as well as for all target variables in the controls no significant changes were observed (p>0.05). PCR, GBI and DHI improved likewise in subjects with and without dementia (p>0.05), but CPITN was significantly different in demented subjects (p<0.05).
Conclusions: Carers’ education can improve some aspects of oral health over a clinically relevant period of time. Implementation of ultrasound bathes is an effective measure to improve denture hygiene of institutionalized older people. However, substantial improvements were primarily achieved within the first 6 months following the interventions with maintenance of the status quo for additional six months. Further research with longer observation periods is needed to confirm the long-term effectiveness.