Objectives: The effect of an oral health care education programme (OHCE) upon nursing home caregivers was assessed in a randomised controlled trial. Methods: A self-administered questionnaire assessed oral health care knowledge and attitudes at baseline among 369 caregivers working in 22 nursing homes. Homes were randomly allocated to two groups. The intervention was a workplace OHCE. Caregivers assessed the value of the presentations. Questionnaires were re-administered 1 month (time 2) and 6 months (time 3) after the OHCE was delivered. The knowledge and attitude score means of the groups were compared. Open-ended questions solicited qualitative data. Results: Questionnaire response rates at the three time points ranged from 76.3% to 85.4%. Two-thirds of caregivers employed at the time of the intervention attended the presentations. The OHCE was favourably assessed in 79% of responses. The intervention group significantly improved their scores over the control group at times 2 and 3 for knowledge (P<0.003) and attitude (P<0.001). Analysed across both arms at baseline, the main predictors for knowledge and attitude scores were age and dental attendance pattern. Qualitative responses showed an acceptance of caregivers' roles in oral health care and criticism of existing provision within homes. Conclusions: The OHCE was well received and resulted in improved oral health care knowledge and attitudes. When viewed with separately reported trial results of clients' oral health status, knowledge and attitude score improvements coincided with improved delivery of oral health care.

Oral health care education and its effect on caregivers’ knowledge and attitudes: a randomised controlled trial

Survey of oral care practices in US intensive care units

Improving oral health care for the frail elderly: a review of widespread problems and best practices.

Oral care for patients in the hospital's Intensive Care Unit (ICU) is important, but this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow. The problems of maintaining oral care with oral intubation, performing oral assessment, guidelines for oral hygiene care, frequency of oral care needed, and suggested mouth care protocol followed by recommendations are presented and discussed in this paper.

Oral care in the intensive care unit: a review.

Background. Few nursing studies have aimed to determine the effectiveness of different mouth care tools to remove plaque which is associated with the tooth/ gingival margin and, therefore, with gingivitis and chronic inflammatory perio- dontal disease. Findings from a previous case study of two people that compared the ability of foam swabs and toothbrushes to remove plaque at the gum/tooth margin (gingival crevice) and plaque from between teeth (approximal plaque) suggested that the success of a toothbrush is affected by user technique and that foam swabs are not able to remove plaque from someshelteredareas of teeth. Methods. A time-series, cross-over controlled trial with 34 volunteers was used to determine the ability of foam swabs and toothbrushes to remove dental plaque which had been allowed to accumulate overnight. Plaque accumulations were scored at each approximal and crevice site for the buccal surfaces of the eight upper and eight lower teeth after each treatment of either toothbrushing or swabbing. Results. Plaque frequency distributions in the form of boxplots, together with results from summary statistics demonstrate that toothbrushes performed substan- tially better than foam swabs in the ability to remove plaque from the sites studied in this larger sample of people. Conclusions. The trial verified the findings from the previous study. The conclu- sions can be generalized to a wider population because of the magnitude and direction of the differences measured. The implications for nurse education and the development of nursing in practice settings include the need to teach effective toothbrushing skills to nurses, and to support clinical staff in developing mouthcare practice, particularly in relation to the use of assessment strategies that include the choice of effective tools.

A controlled trial to compare the ability of foam swabs and toothbrushes to remove dental plaque.

The concept of nurse administered oral hygiene is developed in a summary of selected nursing, medical and dental literature. The purpose of the review is to identify implications for nursing practice and research. The significance of oral hygiene to nursing is presented from physiologic, pathophysiologic, psychosocial, epidemiologic and economic perspectives. Tools, chemicals and frequency for nurse administered oral hygiene are discussed in relation to dental theory and relevant nursing research is critically reviewed. The therapeutic value of common commercial products, such as the foamstick and the lemon and glycerol swab, is not established in the literature. Methodological issues, implications for practice and suggestions for future research are presented.

N S Creason

Papers

Nurse administered oral hygiene: is there a scientific basis?