Improving the oral health of older people in care homes (TOPIC): a protocol for a feasibility study

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  • George Tsakos
    University College London
  • Paul Brocklehurst
  • Sinead Watson
    Queen's University, Belfast
  • Anna Verey
    University College London
  • Nia Goulden
  • Alison Jenkins
  • Kirstie Pye
  • Rebecca Wassall
    University of Newcastle
  • Andrea Sherriff
    University of Glasgow
  • Anja Heilmann
  • Ciaran O'Neill
    Queen's University, Belfast
  • Craig Smith
    University of Manchester
  • Joe Langley
    Sheffield Hallam University
  • Renato Venturelli
    University College London
  • Peter Cairns
    Queen's University, Belfast
  • Nat Lievesley
  • Richard Watt
    University College London
  • Frank Kee
    Queen's University, Belfast
  • Gerald McKenna
    Queen's University, Belfast

BACKGROUND: Evidence for interventions promoting oral health amongst care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial.

METHODS: This is a protocol for a pragmatic cluster randomised controlled trial with a 12-month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n = 6) will receive the complex intervention based on the NG48 guideline, whilst care homes randomised to the control arm (n = 6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a 'support worker assisted' daily tooth-brushing regime with toothpaste containing 1500 ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context.

DISCUSSION: The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes.

TRIAL REGISTRATION: ISRCTN10276613. Registered on 17th April 2020. .


  • care homes, cluster randomised controlled trial, complex intervention, Feasibility study, older adults, oral health
Original languageEnglish
Article number138
JournalPilot and Feasibility Studies
Issue number1
Publication statusPublished - 2 Jul 2021

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