Cochrane · intervention · CD010535
Oral health educational interventions for nursing home staff and residents
Albrecht, M, Kupfer, R, Reissmann, DR, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
16
current version
GRADE rated
5
No studies
4
Included studies
9
as reported
No studies 4 · 25%Ungraded 7 · 43.8%Very low 0 · 0%Low 5 · 31.3%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Nursing home residents (majority aged over 64 years, or mean age at least 65 years); nursing staff working in those facilities; or a combination of residents and staff | 3253 nursing home residents across 9 trials; mean resident age 78.3 to 86.0 years; more than 66% women in all studies; 62.1% to 87.3% with dental prostheses; mean number of natural teeth 4.7 to 17.4; 32.4% to 89.9% edentulous (n=3253) |
| Intervention | Oral health education programme: direct-to-staff programmes, direct-to-resident programmes (e.g. oral hygiene promotion or skills training), or any combination of both, versus (optimised) usual oral health care or any other oral healthcare intervention | Educational intervention with information and practical components (n=8); Educational intervention with information only (n=1) |
| Comparison | (Optimised) usual oral health care, or any other oral healthcare intervention; optimised care means the control group receives an additional component beyond usual standardised care (e.g. dental care auxiliaries or informative presentations) | Usual care (n=7); Optimised usual care, i.e. unsupervised guideline implementation (n=2) |
| Outcomes | Primary: Oral health-related quality of life (OHIP, OHIP-14, GOHAI, DIP); Oral health (BOHSE, OHAT); Dental health (dental or denture plaque; gingivitis or denture-induced stomatitis; caries/incidence of new caries). Secondary: Nutritional status (e.g. body weight, BMI); Incidence of respiratory diseases and pneumonia; Adverse effects. Intermediate: Oral health-related knowledge of staff or residents; Oral health-related attitude and behaviour of staff or residents | Oral health-related quality of life (n=0); Oral health (n=0); Dental plaque (n=6); Denture plaque (n=5); Gingivitis (n=3); Denture-induced stomatitis (n=2); Caries/root caries (n=2); Nutritional status (n=1); Incidence of respiratory diseases and pneumonia (n=0); Adverse effects (n=0); Oral health-related knowledge of staff (n=2); Oral health-related attitude of staff (n=2); Oral health-related behaviour of residents (n=1) |
| Study designs | Individually randomised controlled trials (RCTs) or cluster-RCTs with a follow-up period of at least two weeks, including groups of nursing home staff or residents, or both | Individually randomised RCT (n=2); Cluster-RCT (n=7) |
| Timing | At least 2 weeks' follow-up; short-term and long-term subgroup analyses (using the longest follow-up per study) | Short-term follow-up, 3 to 6 months (n=6); Long-term follow-up, 9 months to 5 years (n=3) |
Search date: 2016-01. Databases: Cochrane Oral Health Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; Web of Science Conference Proceedings; ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform
Questions and results
Current version onlyEducational intervention with information and practical components (theoretical oral health education plus practical skills training) for nursing staff and/or residents vs (Optimised) usual care
Population: Nursing home residents (mean age 78.3 to 86.0 years; more than 66% women; 62.1% to 87.3% with dental prostheses)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Nutritional status | OR 1.0 [0.3, 3.1] | 1 study | Ungraded |
Oral health-related knowledge of nursing staff Population: Nursing home nursing staff (approximately 95% female in the two contributing studies) | SMD 0.94 [-0.04, 1.92] | 2 studies · 453 participants | Ungraded |
Oral health | SoF row 'Oral health': Illustrative risks -, relative effect -, participants/studies -, quality -; Comment: Outcome not reported. Not measured in any included study. | 0 studies | No studies |
Caries/root caries 6 to 18 months | SoF: Caries/root caries (follow-up 6 to 18 months). No meta-analysis. 178 participants (2 RCTs); low quality. Comment: 2 studies at unclear (Frenkel 2001) or high risk of bias (Mojon 1998) showed no apparent… | 2 studies · 178 participants | Low Downgraded: risk of bias, inconsistency |
Adverse effects of the interventions | None of the included studies assessed adverse effects of the intervention. | 0 studies | No studies |
Denture-induced stomatitis 6 to 18 months | SoF: Denture-induced stomatitis (method of Budtz-Jorgensen; follow-up 6 to 18 months). No meta-analysis (data not comparable). 417 participants (2 RCTs); low quality. Comment: 2 studies at unclear (Frenkel 2001) or… | 2 studies · 417 participants | Low Downgraded: risk of bias, inconsistency |
Oral health-related attitude of nursing staff Population: Nursing home nursing staff (approximately 95% female in the two contributing studies) | SMD 0.30 [-0.23, 0.83] | 2 studies · 459 participants | Ungraded |
Incidence of respiratory diseases and pneumonia | None of the included studies assessed incidence of respiratory diseases or pneumonia. | 0 studies | No studies |
Oral health-related behaviour of residents Population: Nursing home residents | One study (Bellomo 2005) assessed oral health-related behaviour of residents; 60 residents were interviewed about toothbrushing habits. Use of toothbrushes and the frequency of brushing during the study period were… | 1 study · 60 participants | Ungraded |
Denture plaque 3 to 60 months | SMD -0.60 [-1.25, 0.05] | 5 studies · 816 participants | Low Downgraded: risk of bias, inconsistency |
Gingivitis 3 to 6 months | SoF: Gingivitis (Gingival Bleeding Index and method of Suomi; follow-up 3 to 6 months). No meta-analysis (data not comparable). 245 participants (3 RCTs); low quality. Comment: 3 studies at unclear risk of bias showed… | 3 studies · 245 participants | Low Downgraded: risk of bias, inconsistency |
Oral health-related quality of life | SoF row 'Oral health-related quality of life': Illustrative risks -, relative effect -, participants/studies -, quality -; Comment: Outcome not reported. Not measured in any included study. | 0 studies | No studies |
Dental plaque 3 to 60 months | MD -0.04 [-0.26, 0.17] | 6 studies · 437 participants | Low Downgraded: risk of bias, inconsistency |
Educational intervention with information only (theoretical dental health education, no practical training) vs Usual care
Population: Residents of institutions for elderly people (nursing staff and residents took part in the education programme)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Denture-induced stomatitis | Schou 1989 (114 residents, unclear risk of bias): no difference in the prevalence of denture stomatitis between the groups. | 1 study · 114 participants | Ungraded |
Denture plaque | One study (Schou 1989), at unclear risk of bias and analysing 114 residents, provided insufficient evidence to determine whether denture plaque scores are lower when educating residents or nursing staff without… | 1 study · 114 participants | Ungraded |
Oral health-related behaviour (denture cleaning habits) | Schou 1989 (114 residents, unclear risk of bias): the number of residents reporting correct denture cleaning habits increased, but not significantly compared to baseline (baseline N = 28; follow-up N = 38). | 1 study · 114 participants | Ungraded |
Oral health education programme: direct-to-staff programmes, direct-to-resident programmes (e.g. oral hygiene promotion or skills training), or any combination (educational and/or oral hygiene promotion) vs (Optimised) usual oral health care, or any other oral healthcare intervention
Population: Nursing home residents (majority aged over 64 years, or mean age at least 65 years); nursing staff working in those facilities; or a combination of residents and staff
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health | no estimate extracted | NR | No studies |
Caries/root caries | no estimate extracted | NR | No studies |
Oral health-related quality of life | no estimate extracted | NR | No studies |
Oral health-related knowledge of staff or residents | no estimate extracted | NR | No studies |
Adverse effects of the interventions | no estimate extracted | NR | No studies |
Oral health-related attitude of staff or residents | no estimate extracted | NR | No studies |
Nutritional status | no estimate extracted | NR | No studies |
Denture plaque | no estimate extracted | NR | No studies |
Incidence of respiratory diseases and pneumonia | no estimate extracted | NR | No studies |
Dental plaque | no estimate extracted | NR | No studies |
Oral health-related behaviour of staff or residents | no estimate extracted | NR | No studies |
Gingivitis | no estimate extracted | NR | No studies |