Randomised clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care

Gerodontology. 2018 Dec;35(4):365-375. doi: 10.1111/ger.12357. Epub 2018 Jul 13.


Objectives: The purpose of this study was to test the efficacy of MOUTh (Managing Oral Hygiene Using Threat Reduction), a nonpharmacologic, relationship-based intervention vs. control on 2 primary outcomes for nursing home (NH) residents with dementia who resisted mouth care: (i) reduction in the occurrence and intensity of care-resistant behaviours (CRBs) and (ii) improvement in oral health. Two secondary outcomes were also examined: (i) the duration of mouth care and (ii) the completion of oral hygiene activities.

Background: Persons with dementia who exhibit CRBs are at risk for inadequate mouth care and subsequent systemic illnesses.

Materials and methods: The study used a randomised repeated measures design. Recruitment occurred in 9 nursing homes that varied in size, ownership, reimbursement patterns and location. One hundred and one nursing home residents with dementia were randomised at the individual level to experimental (n = 55) or control groups (n = 46). One hundred participants provided data for the analyses.

Results: Compared to the control group, persons in the experimental group had twice the odds of allowing mouth care and completing oral hygiene activities; they also allowed longer duration of mouth care (d = 0.56), but showed only small reductions in the intensity of CRBs (d = 0.16) and small differential improvements in oral health (d = 0.18).

Conclusion: The data suggest that this intervention facilitates mouth care among persons with dementia. The management of refusal behaviour may be a clinically more realistic approach than reducing or eradicating refusals.

Keywords: care-rejection; care-resistant behaviour; dementia; nursing home; oral health; resistiveness to care.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dementia* / psychology
  • Dental Care for Aged / methods*
  • Dentures
  • Female
  • Humans
  • Male
  • Nursing Homes*
  • Oral Health
  • Oral Hygiene*
  • Treatment Refusal