Effect of a Person‐Centered Mouth Care Intervention on Care Processes and Outcomes in Three Nursing Homes

Abstract

Objectives To develop and test a person‐centered, evidence‐based mouth care program in nursing homes. Design Pre–post assessment, with an 8‐week intervention period and a pilot 6‐month extension at one site. Setting Three North Carolina nursing homes. Participants Ninety‐seven residents and six certified nursing assistants (CNAs). Intervention CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands‐on training in evidence‐based mouth care products and techniques and in person‐centered behavioral care. Measurements Primary outcome measures for natural teeth were the Plaque Index for Long‐Term Care (PI‐LTC) and Gingival Index for Long‐Term Care(GI‐LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided. Results Outcome scores significantly improved (P < .001 for PI‐LTC and GI‐LTC; P = .04 for DPI). Coding of videotaped care episodes indicated that care was more thorough (P < .001–P = .03) but took more time (P < .001) after training. Consistency of care appeared to be more important for natural teeth than dentures. Conclusion As little as 8 weeks of mouth care can significantly improve oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial.