Van der Putten 2013.

Methods	Cluster‐randomised controlled trial, 2 arms Study period: not reported Planned follow‐up period: 6 months
Participants	Country: Netherlands Setting: 12 nursing homes Target audience for the intervention: nursing home staff Number of randomised participants (nursing home residents): 343 Number of analysed participants (nursing home residents): 232 Age, mean, years (SD): 80.4 (9.4) in IG, 80.7 (10.9) in CG Female: 66% in IG, 69% in CG Edentulous: 70% in IG, 62% in CG Residents with dental prosthesis: 84% in IG, 75% in CG Inclusion criteria: having teeth and/or (removable) partial or complete dentures; physically suitable for examination; expected to be residing in the care home during the entire 6‐month period Exclusion criteria: residents in day care, in short‐term residency (on a rehabilitation ward, residing 2 weeks to 3 months = less than 6 months on this ward), in coma, in palliative care or terminally ill, using a denture adhesive, expressing verbal or physical resistiveness before or during an oral examination
Interventions	Intervention group Supervised implementation of the "Oral health care Guideline for Older people in Long‐term care Institutions (OGOLI)" including multiple components: Education/skills training: oral presentation (1.5 hours) for the managing director, care home study supervisor, the ward heads, and the ward oral healthcare organiser (WOO) about OGOLI, daily oral healthcare protocol, and the supervised implementation project lecture (2 hours) for the WOOs including theoretical and practical essentials of OGOLI and the daily oral healthcare protocol practical education (3 hours) for the WOOs according to the train‐the‐trainer concept theoretical and practical education session (1.5 hours) for all nurses and nurse assistants at ward level, presented by the ward’s WOO using all education materials. WOOs presented a summary of OGOLI, and all executive actions (e.g. tooth brushing) were taught and demonstrated with ward residents on site. Information material: PowerPoint presentation, OGOLI, daily oral healthcare protocol Additional components: WOO encouraged and assisted nursing staff in the daily delivery of oral health care. monitoring visits of a dental hygienist together with an investigator (every 6 weeks including WOOs support and where necessary repeating educational sessions for (new) nursing staff) daily oral healthcare protocol Control group Usual oral health care according to the no‐supervised implemented guideline (since 2007 Dutch guideline OGOLI) Co‐interventions (for the intervention group) oral healthcare material and products
Outcomes	Primary outcomes Oral hygiene measures were assessed at baseline and 6 months after the start of the study. Dental plaque: Plaque Index (Silness 1964) Denture plaque: method of Augsburger 1982 Planned outcomes oral health‐related knowledge (staff) using a self administered questionnaire (15 statements assessing knowledge of oral pathology and oral hygiene) oral health‐related attitude (staff) using a self administered questionnaire (4 statements)
Funding	Research project is funded by Open Ankh Foundation, Utrecht; The Opbouw Foundation, Utrecht; ZonMw, The Hague; Vereniging Zonnehuis, Amstelveen; Stichting Wetenschapsbevordering Verpleeghuiszorg, Amsterdam; MarkTwo Communications, Leusden und Fonds NutsOhra, Amsterdam. Oral healthcare products were provided free by GABA International, NoviaCura, and Johnson & Johnson.
Notes	Publication of oral health‐related knowledge and attitude in preparation
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "allocated randomly" Comment: Probably done, since another report from the same investigators (one study protocol for both trials) described use of "computer‐aided tools"
Allocation concealment (selection bias)	Unclear risk	Insufficient information
Blinding of participants and personnel (performance bias) All outcomes	Low risk	No blinding of participants and personnel or incomplete blinding, but the review authors judge that the assessed outcomes are not likely to be influenced by lack of blinding.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "examiners were blinded"
Incomplete outcome data (attrition bias) All outcomes	Low risk	Quote: "Over the course of the trial, 111 of the residents (32%) were lost to follow‐up, 62 (35%) in the intervention group and 49 (29.5%) in the control group. There were no significant differences in loss to follow‐up between the intervention and the control group (Chi‐square, p=0.18). The main reasons for loss to follow‐up were: deceased (66%), administrative error (7%), moved to another care home or otherwise absent (8%), intermediate disease (14%) or refusal (5%). There were also no statistically significant differences in residents’ personal and medical characteristics and dental and denture plaque scores at baseline between residents who completed the study and those who did not."
Selective reporting (reporting bias)	Low risk	Additional outcomes planned in the protocol (knowledge and attitude of nursing staff), paper in preparation for knowledge and attitude results (correspondence)
Other bias	Low risk	None apparent