A 2-year cluster randomized trial of Mouth Care Without a Battle (MCWB) was conducted in nursing homes (NHs) to determine if recommended mouth care practices provided by NH staff could improve residents' oral hygiene and denture outcomes.
Cluster randomized trial of NHs.
Setting and Participants
Seven MCWB NHs and 6 control NHs. A total of 219 NH residents completed baseline and 24-month oral examinations and, if applicable, denture assessments (control = 98, intervention = 121).
The intervention consisted of training NH staff in the MCWB protocol, and providing support in its use for 2 years.
Descriptive data from the Minimum Data Set and clinical oral health assessments: the Plaque Index for Long-Term Care (range 0‒3), the Gingival Index for Long-Term Care (range 0‒4), and the Denture Plaque Index (range 0‒4), with lower scores indicating better oral health.
There were no significant demographic or health differences between groups at baseline. Residents' mean age (standard deviation) was 77.8 years (13.5), 71% were female, and 49% had cognitive impairment. At 24 months, there were significant improvements in oral and denture hygiene in the intervention group compared with control (all P < .05) with mean changes in indices that were 0.44 (Plaque Index for Long-Term Care), 0.55 (Gingival Index for Long-Term Care), and 0.67 (Denture Plaque Index) points lower in intervention NHs than control NHs.
Conclusions and Implications for Practice
Training NH staff to attend to residents' oral hygiene and denture care had a sustained, favorable impact on residents' oral and denture hygiene after 24 months compared with usual care. The protocol, MCWB, can be used by direct caregivers to improve the oral hygiene and denture care of NH residents.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Improving the oral health of older people in long-term residential care: A review of the literature.Int J Older People Nurs. 2009; 4: 97-113
- Is compromised oral health associated with a greater risk of mortality among nursing home residents? A controlled clinical study.Aging Clin Exp Res. 2018; 30: 581-588
- Oral health-related quality of life and prosthetic status of nursing home residents with or without dementia.Clin Interv Aging. 2017; 12: 659-665
- Effective strategies to motivate nursing home residents in oral care and to prevent or reduce responsive behaviors to oral care: A systematic review.Plos One. 2017; 12: e0178913
- Oral hygiene care for residents with dementia: A literature review.J Adv Nurs. 2005; 52: 410-419
- Oral health in Florida nursing homes.Int J Dent Hyg. 2006; 4: 198-203
- Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, Maryland, 2017.(Available at:)https://www.cdc.gov/nchs/data/hus/hus16.pdfDate accessed: September 12, 2018
- 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
- The effect of programs to improve oral hygiene outcomes for older residents in long-term care: A systematic review.Res Gerontol Nurs. 2014; 7: 87-100
- Oral health educational interventions for nursing home staff and residents.Cochrane Database Syst Rev. 2016; 9: CD010535
- Strategies to improve dental health in elderly patients with cognitive impairment. A systematic review.J Am Dent Assoc. 2017; 148: 236-245
- University of North Carolina, the Cecil G. Sheps Center for Health Services Research. Mouth care without a battle.(Available at:)http://www.mouthcarewithoutabattle.org/Date accessed: July 15, 2018
- Effect of a person-centered mouth care intervention on care processes and outcomes in three nursing homes.J Am Geriatr Soc. 2013; 61: 1158-1163
- Changing the culture of mouth care: Mouth Care Without a Battle.Gerontologist. 2014; 54: S25-S34
- The simplified oral hygiene index.J Am Dent Assoc. 1964; 68: 7-13
- A modified gingival index for use in clinical trials.Clin Prev Cent. 1986; 8: 3-6
- Evaluation of seven proprietary denture cleansers.J Prosthet Dent. 1982; 47: 356-359
- The integration of oral health care into day-to-day care in nursing homes: A qualitative study.Gerodontology. 2015; 32: 115-122
- Nursing homes in the U.S. Nursing home average length of stay in the United States in 2014 and 2015, by ownership (in days).(Available at:)https://www.statista.com/statistics/323219/average-length-of-stay-in-us-nursing-homes-by-ownership/Date accessed: July 16, 2018
- A Systematic review examining the oral health status of persons with dementia.JDR Clin Translational Res. 2017; 2: 330-342
- Oral health status is associated with common medical comorbidities in older hospital inpatients.J Am Geriatr Soc. 2016; 64: 1696-1700
- Dental care for geriatric and special needs populations.Dent Clin North Am. 2018; 62: 245-267
- Diabetes-attributable nursing home costs for each U.S. state.Diabetes Care. 2018; 41: 1455-1461
Drs. Sloane and Zimmerman are co-principals in Generativity, LLC, which assists in dissemination of Mouth Care Without a Battle.
This research was supported by grant R01HS022298 from the Agency for Healthcare Research and Quality.
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.