@inproceedings{01GQEPTV3JJMJY9TVZ65626FQ8,
  abstract     = {{Abstract ECG 

Title: The effect of a structured oral healthcare programme on oral hygiene in nursing homes in Flanders (Belgium). 

Authors: Janssens L 1, Janssens B1 
Affiliation: ELOHA (Equal Lifelong Oral Health for All) research group, Gerodontology, Oral Health Sciences, Ghent University, Belgium

Aim: To evaluate the oral hygiene of residents of nursing homes being part of a structured oral healthcare programme (Gerodent) in Flanders (Belgium) and compare the results with previously collected data on oral hygiene in nursing homes in Flanders. Further research will compare the results also to a control group in a clustered cross-sectional study. 

Background: Gerodent is a complex, long-term (6 to 11 years) intervention comprising preventive and curative components, including a mobile dental team visiting each participating nursing home every 6 months. Previous research showed a positive effect of Gerodent on the clinical treatment needs of the nursing home residents, and on the knowledge and attitude of the nursing staff. No research was conducted so far on the oral hygiene effects of the programme. 

Methods: This is a cross-sectional study with dental plaque (Turesky index, Sillness & Loë index) and denture plaque (Augsburger & Elahi index) as the two primary outcome variables. For the sample size calculation, the proportion of edentulous residents was estimated at 44%, and at 75% for residents with full or partial dentures(1). The sample size calculation also considered the future study. A clinically relevant difference in both plaque indices was discussed and set at 0.8 (SD=1,3, Intra Class Correlation 0,05) for dental plaque(2), and at 0.7 (SD=0,91, ICC 0,25) for denture plaque(3). Sample size calculation yielded 12 clusters (nursing homes) of 15 participants in both the intervention and control group. A two-step randomisation was applied, first at nursing home level, then at resident level. The residents in each cluster were proportionally stratified according to the size of the different wards. Nursing home personnel and participants were blinded to the moment of data collection. Examiners were trained and calibrated to assess dental plaque levels (Sillness & Loë index, Turesky index), denture plaque levels (Augsburger & Elahi) and tongue plaque (Winkel). Moreover, data on the presence of daily oral care materials was collected. Data collection was conducted in 2020-2022. The  results were compared to the outcomes of a previously conducted study in nursing homes in Flanders evaluating the effectiveness of a similar preventive oral health care intervention, nevertheless excluding mobile curative care(3). 

Results: Assessment took place of 172 residents in 12 nursing homes with a mean age of 86 (SD 10), 73,8% being female and high care-dependency (82% of residents Katz scale B, C or Cd). The mean Sillness & Loë dental plaque level, denture plaque score and tongue plaque were 2,0 (SD 0,56; n=81; max=3), 1,7 (SD 0,8; n=114; max=4) and 4,3 (SD 3,5; n=171; max 12) respectively. Comparing the present results with those of the study published in 2012 previous dental plaques scores were better at baseline (1,47; SD 0,77) and at T1 (1,58; SD 0,79). For denture plaque, the present results scored significantly better compared to baseline (2,14; SD 0,91) and similar to T1 (1,99; SD 1).  Furthermore, among the dentate residents 5% had no toothbrush or toothpaste. Half of denture wearing residents lacked a denture brush and only 2% of dentate residents had interdental brushes. 

Discussion: Levels of dental plaque remain high, despite the implementation of the complex oral health intervention ‘Gerodent’. Although differences in dental and denture plaque could be found compared to the previous study, these differences remain below the clinically relevant difference that was discussed in the methods section. This could be attributed to an insufficient effect of the intervention itself, or to changes in the profile of the residents over time. The participants in the present study had higher levels of care-dependency, a higher mean age and a higher average number of medications compared to the previous study. Data from the control group in the future study will be important to distinguish the cohort effects from the effects of the intervention. For dentate residents, a minority lacked the right material for daily oral care (toothbrush and toothpaste), while interdental brushes were rarely found. Half of denture-wearing residents had no denture brush, despite purchasing policies of the included nursing homes and regular individual advice by the dental team. These results may show a remaining lack of priority for daily oral care, or a problematic communication flow between nursing staff or towards the respective families, who are often responsible for the oral care materials. Finally, data collection was carried out during the Covid-19 pandemic, which had a negative impact on the workload and stress levels of the nursing staff, possibly leading to lower prioritisation of daily oral care. 

Conclusion: Oral hygiene in nursing home residents remains insufficient and the results were comparable to a previous intervention study. 
1. 	De Visschere LM, Grooten L, Theuniers G, Vanobbergen JN, L.M. DV, L. G, et al. Oral hygiene of elderly people in long-term care institutions–a cross-sectional study. Gerodontology. 2006;23(4):195–204. 
2. 	Barbe AG, Kottmann HE, Derman SHM, Noack MJ. Efficacy of regular professional brushing by a dental nurse for 3 months in nursing home residents—A randomized, controlled clinical trial. Int J Dent Hyg. 2019 Nov;17(4):327–35. 
3. 	De Visschere L, Schols J, van der Putten G-JJ, De Baat C, Vanobbergen J, L. DV, et al. Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial. Gerodontology. 2012 Jun;29(2):e96-106.}},
  author       = {{Janssens, Lynn and Janssens, Barbara}},
  booktitle    = {{European College of Gerodontology (ECG) Annual Conference 2022 , Abstracts}},
  keywords     = {{oral health,nursing home,oral hygiene,Gerodontology}},
  language     = {{eng}},
  location     = {{Edinburgh, UK (virtual)}},
  publisher    = {{ECG}},
  title        = {{The effect of a structured oral healthcare programme on oral hygiene in nursing homes in Flanders (Belgium)}},
  url          = {{http://gerodontology.eu/award2022.php}},
  year         = {{2022}},
}