Table 2 Effectiveness of interventions to oral health promotion of older people among their caregivers

1

Frenkel HF

(2002) [37]

Bristol, UK

RCT

All: n = 322

Age: ≥ 16 y

Female: n = 283

Male: n = 12

I: n = 166

C: n = 156

Intervention: Caregivers in intervention group received oral health care education program (OHCE)

Baseline: A Health Promoter presented the intervention. Each session lasted one hour and included an opportunity for caregivers to discuss their feelings about oral health, coverage of the role of plaque in oral disease, and demonstrations of brushing techniques for dentures and natural teeth

Month 1: Oral health care knowledge and attitudes assessed

Month 6: Oral health care knowledge and attitudes assessed

Control: Not received education

At month 6, the intervention group significantly improved dental health knowledge (P < 0.003)

and attitude (P < 0.001), compared with control group

Conclusion: The OHCE was well received and resulted in improved oral health care knowledge and attitudes

2

Frenkel HF

(2001) [38]

Cardiff, UK

Cluster-RCT

All: n = 412

Mean age: 84.4 y

Female: n = 323

Male: n = 89

I: n = 201

C: n = 211

Intervention: Caregivers in intervention group received oral health care education program (OHCE)

Baseline: A Health Promoter presented the intervention

Each session lasted 1 h and covered the role of plaque in oral disease, demonstrations of cleaning techniques for dentures and natural teeth

Month 1,6: Main outcome measures were denture plaque, denture-induced stomatitis, dental plaque and gingivitis

Control: Not received education

At month 6, the intervention group significantly improved oral health scores, and significantly reductions in denture plaque scores, denture-induced stomatitis prevalence compared to the control group (P < 0.0001)

Conclusion: For a modest cost, OHCE can improve caregivers’ knowledge, attitudes and oral health care performance for older people, functionally dependent clients

3

Khanagar S

(2014) [39]

India

RCT

All: n = 78

Age:18–40 y

Female: n = 72

Male: n = 6

I: n = 38

C: n = 40

Intervention: Caregivers in intervention group received oral health care education)

Baseline: The health educator gave a PowerPoint presentation on oral health to the caretakers and a live demonstration of oral hygiene techniques on study models. Also, a health education CD and manual were provided to the respective institutions

Month 6: Main outcome measures were oral health knowledge of the caretakers

Control: Not received education

At month 6, the intervention group significantly improved oral health knowledge compared with control group (P < 0.001)

Conclusion: Educating the caretakers for assisting or enabling residents for maintaining oral hygiene is essential

4

Khanagar S

(2015) [40]

India

Cluster RCT

All: n = 322

Age:18–40 y

Gender isn't mentioned

I: n = 162

C: n = 160

Intervention: Caregivers in intervention group received oral health care education)

Baseline: Oral hygiene status of older people residents was assessed by levels of debris, plaque of dentate and denture plaque, and denture stomatitis of denture wearing residents, respectively

Month 6: Main outcome measures were levels of debris, plaque of dentate and denture plaque, and denture stomatitis of denture wearing residents, respectively

Control: Not received education

At month 6, the intervention group significantly improved oral health knowledge compared with control group (P < 0.001)

And significant reduction of plaque score, debris score, denture plaque score, denture stomatitis score (P < 0.001)

Conclusion: There was a significant improvement in the oral-health knowledge among the caregivers and oral-hygiene status of the older people residents

5

Nicol R

(2005) [44]

UK

Quasi experimental

All: n = 78

Age: ≥ 65 y

Female: n = 63

Male: n = 15

Group I: n = 39

Group II: n = 39

Intervention: Caregivers in intervention group II received intensive training in mouth care based upon a resource pack entitled "Making Sense of the Mouth" containing a videotape, CD-ROM and full color pocket book

Baseline: training sessions were undertaken for groups of six during working hours and lasted for approximately 90 min. An introductory 30-min lecture illustrating the mouth in health and disease (seven protocols on basic mouth care procedures)

Month 3,9: Main outcome measures were Oral hygiene frequency, oral mucosal disease, angular cheilitis, Denture hygiene, Denture wearing habits, denture stomatitis

Month 18: Final oral health assessment of all participants

Control: After assessment of all patients at 9 months, training was provided to cares of patients in group I

At month 18, the intervention group (group II) significantly reduction in the number of residents left to undertake their own oral care (P < 0.001), significant improvements in denture hygiene and a reduction in the number of residents wearing dentures overnight (P < 0.001). The prevalence of oral mucosal disease dropped, with significant reductions in angular cheilitis and denture stomatitis (P < 0.001), compared with control group (group I)

Conclusion: This education program was effective in changing oral health care procedures within long-stay institutions for the older people, with measurable improvements in oral health of the resident

6

Schwindling FS (2018) [42]

Germany

RCT

All: n = 269

Mean age:83.3 y

Female: n = 189

Male: n = 80

I: n = 178

C: n = 91

Intervention: In the intervention group, caregivers were given oral health education, and ultrasonic cleaning devices were provided to clean removable prostheses

Baseline: A PowerPoint lecture was given with the purpose of improving knowledge of oral health care and prevention of oral diseases

The topics of the lecture:

common oral problems in geriatric dentistry, brushing techniques for teeth and prostheses, handling of interdental space brushes and advice on other auxiliaries (for example mouth rinses)

practical training with different types of prosthetic restoration was performed by use of typodonts

Month 6,12: Main outcome measures were Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Community Periodontal Index of Treatment Needs (CPITN) and Denture Hygiene Index (DHI)

Control: Not received education

At month 12, the intervention group significantly improved PCR and DHI, compared with control group (P < 0.001)

Conclusion: Education of caregivers improves and maintains the oral health of care dependent nursing home residents over longer periods. Use of ultrasonic devices is a promising means of improving denture hygiene among the severely care-dependent. Such interventions can be easily and cheaply implemented in routine daily care

7

Seleskog B

(2018) [43]

Sweden

RCT

All: n = 66

Mean age: 88.5 y

Female: n = 65

Male: n = 1

I: n = 33

C: n = 33

Intervention: Caregivers in intervention group received oral health care education)

Baseline: Interventions included weekly theoretical and hands-on guidance from dental hygienists on oral hygiene procedures and discussions on oral care routines

Month 3: Main outcome measures were residents’ oral health, dental plaque and gingival bleeding, Attitudes the staff to oral health care

Control: Oral care was performed as usual

At month 3, the intervention group significantly improved Revised Oral Assessment Guide gums and lips scores showed a tendency to decrease, plaque levels improved significantly and a trend towards less gingival bleeding was observed compared with control group (P < 0.05)

Conclusions: The oral healthcare situation for older people today is so complex that theoretical education at the group level regarding different aspects of oral health is not sufficient. Individual hands-on guidance by dental hygienists on a regular basis in everyday care may be a new approach

8

Paulsson G

(1998) [45]

Sweden

Quasi-experimental

All: n = 2882 Age and gender are not mentioned

I: n = 1816

C: n = 1066

Intervention: Caregivers in intervention group (HHCE & LHCE) received oral health education program (OHEP)

Baseline: The instruction material for the OHEP was thoroughly demonstrated and discussed: One series of slides (120 pictures), one

videotape, and the compendium” oral health care knowledge for nursing personnel” were produced

by one of the authors

12 months: Main outcome measures were attitude to oral Hygiene, ability to handle, implementation Possibilities, knowledge of importance

Control: (LHCE group) received oral health education program

After the OHEP, the HHCE group significantly improved their ability to perform oral hygiene for care receivers compared with the LHCE group (P < 0.01)

Conclusion: oral health education program, offered to nursing personnel in special housing for the older people, positively affected the personnel’s ability to perform oral hygiene procedures for care receivers by improving attitude factors

9

MacEntee MI (2007) [41]

Canada

RCT

All: n = 152

Age: 79.1 y

Gender is not mentioned

I: n = 59

C: n = 68

Intervention: Care-aides in the active group participated with a full-time nurse educator in a seminar about oral health care, and had unlimited access to the educator for oral health-related advice throughout the 3-month trial

Baseline: The dental hygienist trained the nurse by discussing an annotated series of clinical photographs and a text summarizing the appearance and management of the more usual oral diseases encountered among frail elders

Month 3: Main outcome measures were oral hygiene, gingival health, masticatory potential, Body Mass Index and Malnutrition Indicator Score, and asked to report on chewing difficulties

Control: Care-aides in the control group participated in a similar seminar with a dental hygienist but they received no additional advice

At month 3, the intervention group were not significantly different from baseline in either group, indicating that education neither influenced the oral health nor the dental hygiene of the residents

Conclusions: A pyramid-based educational scheme with nurses and care-aides did not improve the oral health of frail elders in this urban sample of LTC facilities