title: Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial.
abstract: OBJECTIVE
  To compare a supervised versus a non-supervised implementation of an oral health care guideline in Flanders (Belgium).
  
  
  BACKGROUND
  The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline 'Oral health care in care homes for elderly people' was developed to improve oral health of institutionalised elderly.
  
  
  METHODS
  A random sample of 12 nursing homes was randomly allocated to the intervention or the control group. Representative samples of 30 residents in each home were monitored during a 6-month study period. The intervention included a supervised implementation of the guideline.
  
  
  RESULTS
  At the 6-month follow-up, only a small but statistically significant (p = 0.002) beneficial effect (0.32) of the intervention was observed for denture plaque after adjustment for baseline value and the random effect of the institution. In the linear mixed regression models, including a random institution effect, difference in denture plaque level was no longer statistically significant at the 5% level.
  
  
  CONCLUSIONS
  Only denture hygiene has been improved by the supervised implementation, although with lower benefits than presumed. Factors on institutional level, difficult to assess quantitatively, may play an important role in the final result.
authors.affiliation: Community Dentistry and Oral Public Health, Ghent University, Ghent, Belgium. luc.devisschere@UGent.be
authors.forename: Luc
authors.initials: L
authors.lastname: De Visschere
authors.forename: Jos
authors.initials: J
authors.lastname: Schols
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: van der Putten
authors.forename: Cees
authors.initials: C
authors.lastname: de Baat
authors.forename: Jacques
authors.initials: J
authors.lastname: Vanobbergen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002908:Chronic Disease; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D004396:Coloring Agents; D003729:Dental Care / Q000451:nursing; D003773:Dental Plaque / Q000517:prevention & control; D003774:Dental Plaque Index; D003778:Dentures; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D007326:Institutionalization; D007902:Length of Stay; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D009735:Nursing Homes; D009910:Oral Hygiene / Q000193:education / Q000451:nursing; D017410:Practice Guidelines as Topic; D016037:Single-Blind Method; D014059:Tongue / Q000473:pathology; D000078329:Workforce
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue