Objectives: To compare a designated shared oral care intervention in a group of public nursing home residents with a standard oral care programme, focusing on levels of oral plaque and oral inflammation. Methods:A cluster randomized field trial was undertaken in 14 Danish public nursing homes. There were 145 participants included in the intervention group and 98 in the control group. We undertook a six-month intervention based on the principle of situated interprofessional learning. The primary outcomes were plaque and inflammation levels measured with the mucosal plaque index (MPS); this was assessed at baseline, after three and six months (end of intervention), and at follow-up (six months postintervention). The odds ratios (OR) and 95% confidence intervals (CI) were estimated with ordinal regression.Results: Socio-demographic characteristics and oral health status at baseline were comparable between the two groups, with the exception of age: the intervention group were significantly younger than controls (median 82 vs 87 years). After three and six months, those receiving the shared oral care intervention had significantly lower plaque and inflammation than the control group. The adjusted ORs for a reduction in MPS were 11.8 (CI: 6.5-21.3) and 11.0 (CI: 5.8-20.9), respectively. At follow-up, plaque levels and oral inflammation had approached the pre-intervention level, with no remaining statistically significant group differences. Conclusions:The shared oral care intervention based on a situated learning perspective was effective in improving oral health among care home residents. However, after termination of the intervention, the effect quickly decreased. This confirms the challenges of achieving long-term improvement in oral health in nursing home residents. An implementation strategy focusing on achieving changes at both organizational and individual levels with persistent attention to oral health care seem required for long-term improvement.

Aims and objectives To evaluate the process of implementing an oral care intervention in nursing homes in a Danish municipality. Background Older people with aged natural dentition require preventive and curative oral health care. An intervention based on principles of situated learning was implemented to establish closer cooperation between dental and nursing staff in nursing homes, leading to improved oral hygiene in nursing home residents. Design An embedded multiple‐case study combined with principles of realist evaluation unfolded in three phases: Formulation of initial programme theory, Testing and Refining the programme theory. The COREQ checklist is followed in reporting. Methods Observations, six group interviews and 22 face‐to‐face interviews with dentists, dental practitioners, nursing home managers, care professionals and residents were conducted in three nursing homes (n = 41). Results Three main outcomes of a programme theory were identified, relating to (a) residents, in the form of new oral care routines; (b) interdisciplinary working, in the form of professional pride in performing sufficient oral care; (c) organisational level changes, in the form of increased interdisciplinary knowledge sharing. The overarching supportive mechanisms were the creation of relationships between residents, dental practitioners and care professionals as well as nursing home management taking responsibility for structure, planning and knowledge sharing. Conclusion The situated learning perspective supported residents and care professionals' competencies in performing sufficient oral care. The shared oral care intervention supports an individual and multidisciplinary assessment of nursing home residents’ ability to self‐care concerning oral care. Contextual factors, supportive and restraining mechanisms influence the intervention's success. Relevance to clinical practice Understanding the complexity within interdisciplinary cooperation in primary nursing and unravelling the necessary properties to enhance nursing home residents’ oral health care are areas of improvement for care service in nursing homes.

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