Ethical issues in dental education-A cross-sectional study with pre-clinical and clinical dental students.

INTRODUCTION: Although ethics is an indispensable part of dental education, it has not yet played a relevant role in the dental curriculum in Germany. The study aimed at assessing their prior knowledge of ethical aspects, and their expectations of and wishes for ethics course of dental students, preclinical vs. clinical, at the dental school Kiel, Germany by means of a validated questionnaire. METHODS: A descriptive cross-sectional study design was used. The study population consisted of dental students, from pre-clinical (n = 105) and clinical semesters (n = 110). In January 2019, each student completed a validated questionnaire to identify semester-specific ethical teaching content. Besides descriptive analyses, Mann-Whitney U test was used to compare pre-clinical and clinical students. RESULTS: A total of 215 dental students, with a mean age of 25.3 (SD 4.1), participated in the study, of which 150 were female (69.8%) and 65 were male students (30.2%). The results in the areas of 'previous knowledge of ethical issues' and 'expectations and desires in terms of teaching medical ethics' showed similarities and differences between pre-clinical and clinical students. Both groups stated that they need training in ethics. Moreover, especially clinical students recognize that more ethical competence is needed if the first patient contact will start. CONCLUSION: The study indicates that there is a clear need for ethics education. Student awareness of the relevance of ethical competences and the perception of ethical problems increased progressively during the course of their studies. Overall, the study provides good support for the development of specific ethics courses.

[Pilot project for the "Internship to Gain Experience in the Professional Field" in dentistry studies with a focus on acquiring communicative skills]. / Pilotprojekt zum "Praktikum der Berufsfelderkundung" im Zahnmedizinstudium mit Fokus auf den Erwerb kommunikativer Kompetenzen.

BACKGROUND: The new dental licensing regulations provide for a professional field internship to give students an initial, comprehensive insight into their later professional field. The location, implementation and assessment are not specified and can take place within university dentistry or in cooperation with dental practices. The Kiel Dental Clinic decided to develop a concept for a two-week course, including practical training in private practices, and to take greater account of aspects of medical interviewing. Based on a theoretical introduction and an e­learning module, this is to be the introduction to a longitudinal communication curriculum. In the summer semester of 2021, a pilot project was carried out with the aim of developing the necessary course infrastructure and content and linking it with teaching content on communicative competences. METHODS: A controlled intervention study (one measurement point) was conducted with 21 fourth-semester students (two groups with and without e­learning module) and 20 dental practices. The students received documents on the organisation, procedure and documentation of various interview situations before the one-week internship. Students and practices were comprehensively evaluated after the end of the internship. RESULTS: Students and practices were satisfied with the organisation, the documents provided and the process. The e­learning module was well received. The format of the internship report proved to be impractical and was adapted. DISCUSSION: The project goals were successfully achieved. The results will be incorporated into the concrete design and implementation of the new curricular course starting summer semester 2022.

Covid-19: teaching and learning in practical courses under special regulations - a qualitative study of dental students and teachers.

BACKGROUND: The coronavirus pandemic led to a lockdown of public life. For universities, this meant suspensions or corresponding adaptations of practical courses. In Germany, Kiel Dental Clinic received special permission to start practical courses under appropriate hygiene conditions. The study aimed at recording the experiences and associated challenges of course implementation under the special regulations from the perspective of students and teachers. METHODS: Qualitative guided interviews were conducted with students and teachers at Kiel in the summer semester 2020. Students (4th, 6th, 8th, 10th semesters) were recruited and lecturers responsible for conducting the practical courses within the dental clinic's four departments. Evaluation was carried out by means of qualitative content analysis, whereby deductive procedures were supplemented by inductive ones. RESULTS: Thirty-nine students and 19 lecturers took part. The flow of information at the start of the course was welcomed by students and teachers across the board. The lack of or limited adjustment to the scope tended to be assessed positively by students. The majority of both groups suspected there had been no reduction in learning, and learning had been improved due to the smaller group sizes. Regarding the necessary conditions for conducting the course, positive and negative aspects became apparent. CONCLUSION: Students and teachers felt very relief to start the practical courses under special conditions although the implementation was very challenging for both groups. The structural and content-related course adaptations required a high degree of flexibility on the part of students and lecturers alike, but also meant that courses were able to be conducted without serious deficits in learning gains.

Suspension of face-to-face teaching and ad hoc transition to digital learning under Covid-19 conditions - a qualitative study among dental students and lecturers.

BACKGROUND: In mid-March 2020, the coronavirus pandemic led to a national lockdown in Germany. Face-to-face teaching was cancelled in universities for the 2020 summer semester. Teaching moved online with no prior IT testing and lecturer training. The study analyses experiences of the suspension of face-to-face teaching and the move to digitalised learning for students and lecturers of dentistry at Kiel. METHODS: In summer 2020, qualitative guided interviews were conducted with students (4th, 6th, 8th, and 10th semesters), and lecturers. Deductive and inductive qualitative content analysis of the results was carried out. RESULTS: Thirty-nine students (69% female) and 19 lecturers (32% female) were interviewed. Reactions to the changes in teaching were observed. Feelings ranged from an essentially positive attitude, through insecurity and uncertainty to a failure to fully appreciate the situation. The loss of social contact was lamented. Digitalisation was associated with technological challenges and additional work. However, it also fostered learning independent of time and place, and encouraged autonomy. Negative aspects of digitalisation included a lack of feedback and loss of interaction. CONCLUSION: The introduction of ad hoc digitalisation challenged both students and lecturers alike. Dealing with lockdown and the changes in teaching and studying required significant flexibility.

Identification of semester-specific teaching contents for dental ethics: development, testing and validation of a questionnaire.

BACKGROUND: Although medical ethics is an indispensable part of dental education, it has not played a relevant role in the dental curriculum thus far. This study is aimed at developing and validating a questionnaire that identifies semester-specific ethical issues, in order to develop longitudinal ethic modules. METHODS: March 2018 a workshop on item generation was coordinated, using Delphi method; followed by a cognitive testing with students (2nd, 4th, 10th semesters, n = 12). A pilot test was carried out with students from different semesters (n = 60). The distribution of response frequencies and missing values were determined. The questionnaire used for validation consisted of three dimensions: ethical knowledge, dealing with ethical issues, expectations in terms of teaching. The psychometric examination was carried out by preclinical students (n = 105) and clinical semesters (n = 110) January 2019. RESULTS: After cognitive testing and piloting, some items were reformulated, so that a questionnaire with 127 items was used for validation. The individual dimensions were assigned to various factors with excellent to acceptable internal consistency (Cronbach's α 0.72-0.96). CONCLUSION: The questionnaire has an acceptable to excellent consistency and suggests that the different dimensions are conclusive. With this questionnaire, ethical issues in dentistry can be mapped and teaching contents identified.

[Design and quality control of the oral health status examination in the German National Cohort (GNC)]. / Design und Qualitätskontrolle der zahnmedizinischen Untersuchung in der NAKO Gesundheitsstudie.

BACKGROUND: Caries and periodontitis are highly prevalent worldwide. Because detailed data on these oral diseases were collected within the framework of the German National Cohort (GNC), associations between oral and systemic diseases and conditions can be investigated. OBJECTIVES: The study protocol for the oral examination was designed to ensure a comprehensive collection of dental findings by trained non-dental staff within a limited examination time. At the mid-term of the GNC baseline examination, a first quality evaluation was performed to check the plausibility of results and to propose measures to improve the data quality. MATERIALS AND METHODS: A dental interview, saliva sampling and oral diagnostics were conducted. As part of the level­1 examination, the number of teeth and prostheses were recorded. As part of the level­2 examination, detailed periodontal, cariological and functional aspects were examined. All examinations were conducted by trained non-dental personnel. Parameters were checked for plausibility and variable distributions were descriptively analysed. RESULTS: Analyses included data of 57,967 interview participants, 56,913 level­1 participants and 6295 level­2 participants. Percentages of missing values for individual clinical parameters assessed in level 1 and level 2 ranged between 0.02 and 3.9%. Results showed a plausible distribution of the data; rarely, implausible values were observed, e.g. for measurements of horizontal and vertical overbite (overjet and overbite). Intra-class correlation coefficients indicated differences in individual parameters between regional clusters, study centres and across different examiners. CONCLUSIONS: The results confirm the feasibility of the study protocol by non-dental personnel and its successful integration into the GNC's overall assessment program. However, rigorous dental support of the study centres is required for quality management.

Exploratory Research Focusing on Oral Cancer Prevention: Challenges of Dealing With Informational and Cognitive Barriers.

Oral cancer is a considerable public health problem, and a low level of awareness and knowledge about this tumor and its risk factors is prevalent. To gain a profound understanding of risks groups and to identify suitable communication strategies for a prevention campaign in Northern Germany, an exploratory research was realized. In semistructured face-to-face interviews, the participants of the study (n = 28) described their individual oral cancer-related perceptions and information-seeking behaviors. A computer-assisted qualitative data analysis showed a vague but also deterring picture of cancer combined with restricted attitudes toward the topic and an inactive or even avoiding information behavior. Four underlying cognitive patterns of self-distancing were identified: (a) optimistic bias, (b) fatalism, (c) hedonism, and (d) pragmatism. The main challenge of oral cancer prevention is to deal with the target groups' informational and cognitive barriers.

The influence of clinical experience on dental students' ethical awareness.

INTRODUCTION: There has been no structured integration of ethical issues into the dental curriculum and currently no data for certain ethics modules exists in Germany. The study aimed at evaluating the attitudes to ethical issues that affect students at the Dental School in Kiel during patient treatment. MATERIAL AND METHODS: In the summer of 2017, students were recruited from the 6th and 10th semesters. A qualitative study design with interviews was chosen. The dimensions included, for example, experience with ethical issues, definitions and expectations of teaching content and methods. A qualitative content analysis was performed. RESULTS: Twelve and eleven students from semesters (32% each) participated. No student was able to name an ethical question based on his own experience (private/study). The need to address ethical issues was justified solely by personal treatment experiences. DISCUSSION: The study revealed a lack of basic ethical knowledge resulting in a lack of ability to deal with ethical issues. Instead, participants described experiences of psychological pressure, feelings of helplessness. CONCLUSION: The results suggest that ethical-theoretical foundations should be taught before the beginning of patient treatment. A didactic combination with clinical facts and case vignettes is recommended.

Challenges of early detection of oral cancer: raising awareness as a first step to successful campaigning.

In Germany, ∼ 13,000 people are found to have oral and pharyngeal cancer every year. Awareness and knowledge about this cancer remain insufficient, particularly amongst elderly people. A campaign for early detection was launched in Northern Germany in April 2012. The first step of the campaign was to increase awareness about oral cancer. Prior to a pre-campaign evaluation at the campaign start, March 2012 and an intermediate-campaign evaluation, November 2012, a sample representative for the population aged 50 ≥ years (target group; N = 500) was drawn for a first process evaluation. The surveys were conducted by means of telephone interviews including questions on behaviour, knowledge and sociodemographic/socioeconomic aspects and target group-oriented questions on issue, media and campaign material awareness. The process evaluation showed an increase in issue awareness from 25 to 40% (P < 0.001) and the media awareness increased by over 10% (P < 0.001). The results suggested that particularly women, the core age group (60-79 years) and the educationally disadvantaged group might benefit from the campaign. Awareness about the issue 'oral cancer' was already significantly increased 7 months after the campaign start. The highest general and media-related increase in awareness was achieved in the target group.

The Fifth German Oral Health Study (Fünfte Deutsche Mundgesundheitsstudie, DMS V) - rationale, design, and methods.

BACKGROUND: Oral diseases rank among the most prevalent non-communicable diseases in modern societies. In Germany, oral epidemiological data show that both dental caries and periodontal diseases are highly prevalent, though significant improvements in oral health has been taking in the population within the last decades, particularly in children. It is, therefore, the aim of the Fifth German Oral Health Study (DMS V) to actualize the data on current oral health status and to gather information on oral health behavior and risk factors. In addition to current oral health monitoring, the study will also permit conclusions about trends in the development of oral health in Germany between 1989 and 2014. METHODS/DESIGN: DMS V is a cross-sectional, multi-center, nationwide representative, socio-epidemiological study to investigate the oral health status und behavior of the German resident population in four age cohorts. Study participants are children (12-year-olds), adults (35- to 44-year-olds), young olds (65- to 74-year-olds), and old olds (75- to 100-year-olds) who are drawn from local residents' registration offices. Social-science investigation parameters concern subjective perceptions and attitudes regarding oral health and nutrition, sense of coherence, and socio-demographic data. Clinical oral parameters are tooth loss, caries and periodontitis, prosthodontic status, further developmental and acquired dental hard tissue and mucosal lesions. To ensure reproducibility, the dental investigators are trained and calibrated by experts and multiple reliability checks are performed throughout the field phase. Statistical analyses are calculated according to a detailed statistical analysis plan. DISCUSSION: The DMS studies first performed in 1989, 1992 and repeated in 1997 and 2005 are the only cross-sectional oral health studies conducted in Germany on a population-based national representative level. Updated prevalence and trend analyses of key oral diseases are, therefore, of major epidemiological and health services research interest. TRIAL REGISTRATION: German Health Services Research Data Bank VfD_DMSV_13_002152.

Certainty in Uncertain Times: Dental Education during the COVID-19 Pandemic-A Qualitative Study.

BACKGROUND: The restrictions concerning social contact due to the COVID-19 pandemic implied a rethinking of teaching methods at universities in general, and for practice-oriented teaching such as dental education in particular. This qualitative study aimed to assess aspects of feelings of certainty and uncertainty during this specific education process, incorporating the perspectives of teaching staff and dental students. METHODS: Qualitative methods based on interviews were used for data collection. Dental students from different academic years (second, third, fourth, and fifth) and teaching staff responsible for the content and implementation of courses within the dental curriculum were recruited. The data analysis was performed by qualitative content analysis. RESULTS: A total of 39 dental students and 19 teaching staff participated. When students and staff dealt positively with this specific situation, certainty was achieved. The availability of presentations and clear communication enhanced feelings of certainty. The participants often felt unsure about how to handle such a challenging situation and felt insecure when planning for the semester. The students missed contact with other students and argued that the information policy on their dental studies was not transparent enough. In addition, dental students and teaching staff were nervous about the risk of infection from COVID-19, especially in practical courses with patient contact. CONCLUSIONS: The COVID-19 pandemic situation leads to a rethinking of dental education. Feelings of certainty can be strengthened by clear and transparent communication as well as training in online teaching methods. To reduce uncertainty, it is crucial to establish channels for information exchange and feedback.

The influence of diagnoses on patient satisfaction during inpatient stays: A prospective study.

The aim of this study was to assess patient satisfaction relating to inpatient stays. In this prospective observational study, adult patients with oncological (oral cancer, medication-related osteonecrosis of the jaw) and non-oncological (mandibular fracture) diagnoses, and who had undergone surgery, were contacted 4 weeks after discharge. Two validated questionnaires were used: EORTC QLQ-C30 for quality of life and IN-PATSAT32 for patient satisfaction. For quality of life, the mandibular fracture group had a lower impairment of physical functioning (M = 83.59, SD = 24.44; p = 0.029) in comparison with both other groups (M = 68.84, SD = 26.24; M = 59.33, SD = 24.43, for oral cancer and osteonecrosis, respectively). Regarding patient satisfaction, patients with oral cancer were slightly more satisfied with doctors' availability (M = 48.91, SD = 24.11; p = 0.583) compared with the other groups (M = 36.54, SD = 19.11; M = 46.67, SD = 20.86, for mandibular fracture and ostenecrosis, respectively). Patients with an unplanned inpatient stay following an acute event tended to be less satisfied than patients with a planned inpatient stay. Within the limitations of the study it seems that knowledge of these influencing external factors and their effects can support physicians and nursing staff in providing improved patient care.

Oral cancer awareness campaign in Northern Germany: successful steps to raise awareness for early detection.

PURPOSE: Oral cancer is an underestimated health problem, and its existence and the relevant prevention measures are not sufficiently known by the general population. The project thus aimed to develop, implement and evaluate an oral cancer campaign in Northern Germany, and to increase problem awareness on various levels: draw public attention to the tumour by media coverage increase awareness of early detection opportunities for the target group, and raise awareness of carrying out early detection measures by the professional groups involved. METHODS: For each level, a campaign concept was developed and documented in terms of content and timing. The identified target group was elderly educationally disadvantaged male citizens ≥ 50 years. The evaluation concept for each level included pre-, post- and process evaluations. RESULTS: The campaign was carried out from April 2012 to December 2014. The issue of awareness within the target group was significantly increased. Media coverage showed that regional media adopted the topic of oral cancer and placed it on their published agenda. Furthermore, the continuous involvement of the professional groups over the course of the campaign led to an increased awareness of oral cancer. CONCLUSION: The development of the campaign concept with a comprehensive evaluation showed that the target group was successfully reached. The campaign was adapted to the required target group and specific conditions, and was also designed to be context sensitive. It is, therefore, recommended that the development and implementation of an oral cancer campaign on a national level be discussed.

Evaluation of prevention behaviour and its influencing factors with respect to cancer screening.

PURPOSE: Every year, about 4.6 million people are diagnosed with cancer in Europe. However, based on preclinical changes and using appropriate examination procedures certain cancers can be detected in symptom-free patients at an early stage and treatment initiated. In Germany, various cancer screening examinations are currently offered to the relevant age groups and sexes free of charge. Participation rates are affected by a number of factors and barriers. The study aimed at identifying potential obstacles and barriers to uptake, taking into account demographic and socio-economic variables. MATERIALS AND METHODS: Data collection was conducted in the context of routine examination appointments at the City of Kiel Occupational Health Department from September 2013 to September 2014 using an anonymised questionnaire. In addition to recording socio-demographic data and tobacco consumption, the questionnaire also catalogued participation in statutory health insurance cancer screening examinations using the "stages of change" from the Transtheoretical Model. Eight potential barriers to participation were recorded. RESULTS: The results are based on 718 completed questionnaires. It was found that women, older age, and non-smoking status were associated with a higher probability of participating in cancer screening. It was also found that various barriers affecting (regular) participation were perceived significantly different according to the individual stages of change. This influence of the stages was moderated by gender. CONCLUSION: The results showed interesting trends in the different barriers and how they are influenced by socioeconomic factors and the stages of change. Especially the stages require different gender-specific approaches to mobilisation for cancer screening.

Early detection of oral cancer: a key role for dentists?

PURPOSE: The majority of suspected malignant changes in the oral mucosa are detected by dentists in private practice. Statements regarding the effectiveness of visual examination of the oral cavity for early detection are not necessarily transferable between different health care systems. Our clinical-epidemiological and methodological aim was thus to conduct a prospective regional study in dental practices under everyday conditions, assess the frequency and type of oral mucosal changes, and evaluate the dental examination methodology. METHODS: A prospective observational study was conducted, combining a feasibility study of early detection of oral cancer and its documentation with phase I 'modelling' to conceptualize complex interventions in health services research. Dentists in private practice continuously recruited patients over 6 months and used two different sheets for the documentation of suspicious lesions. Statistical analysis involved descriptive statistics and tests for differences (Welch test) or association (Chi-squared test). RESULTS: Twenty-five dentists (mean age: 50 years, 24% females) participated in this study. Eleven dentists achieved the overall aim of recruiting 200 patients. Around 4200 patients (mean age: 52 years, 57.5% females) participated. The prevalence of suspicious lesions was 8.5%. CONCLUSION: It became apparent that a study in cooperation with dentists in private practice to generate clinical-epidemiological data on the early detection of oral mucosal lesions under everyday conditions can be carried out successfully. Further studies with a corresponding level of evidence should be carried out to be able to draw conclusions about the effectiveness of the early detection measure under everyday practice conditions.

Health policy analysis on barriers and facilitators for better oral health in German care homes: a qualitative study.

OBJECTIVES: To assess possible health policy interventions derived from the theoretical domains framework (TDF) by studying barriers and facilitators on the delivery of oral healthcare and oral hygiene in German care homes using a behavioural change framework. DESIGN: Qualitative correlational study to evaluate a national intervention programme. SETTING: Primary healthcare in two care homes in rural Germany. PARTICIPANTS: Eleven stakeholders participating in the delivery of oral healthcare (hygiene, treatment) to older people, including two care home managers, four section managers, two nurses/carers and three dentists. INTERVENTIONS: Semistructured interviews conducted in person in the care homes or by phone. A questionnaire developed along the domains of the TDF and the Capabilities, Opportunities and Motivations influencing Behaviours model was used to guide the interviews. Interviews were transcribed and systematised using Mayring's content analysis along the TDF. RESULTS: 860 statements were collected. We identified 19 barriers, facilitators and conflicting themes related to capabilities, 34 to opportunities and 24 to motivation. The lack of access to professional dental care was confirmed by all stakeholders as a major limitation hampering better oral health. PRIMARY OUTCOME: A range of interventions can be discussed with the methodology we utilised. In our interviews, lack of dentists willing to treat patients at these facilities was the most discussed barrier for improving oral health of nursing home residents. SECONDARY OUTCOMES: Dentists highlighted the need for better incentives and facilities to deliver oral healthcare in these institutions. Differences with urban settings regarding access to healthcare were frequently discussed by our study participants. CONCLUSIONS: Within our sample, greater capacitation of care home staff, better financial incentives for dentists and increased cooperation between the two stakeholders should be considered when designing interventions to tackle oral health of care home residents in Germany.

Development of the German Speech Intelligibility Index for the treatment of oral cancer patients.

OBJECTIVES: This study aimed at 1) adapting the well-established Speech Handicap Index (SHI) to German, 2) testing the suitability of the instrument for assessing speech-related quality of life, 3) comparing it to the German Voice-Handicap-Index (VHI), in order to support treatment of oral cancer patients who experience posttreatment speech difficulties that affect their quality of life. MATERIAL AND METHODS: Participants completed a web-based survey that employed a 2 (experienced problem: speech/articulation-related vs. voice-related) x 2 (SHI vs. VHI) between-subject experimental design, enabling it to distinguish between the experiences of voice and intelligibility impairments, and to determine the discriminatory ability of the two instruments. RESULTS: The German SHI reliably assessed speech intelligibility and articulation-related Quality of life. While voice impairments were equally well assessed by both, VHI: M 2.48, SD 0.65; SHI: M 2.52, SD 0.63; only the latter appropriately registered intelligibility handicap in speech impairments (VHI: M 2.05, SD 0.70; SHI: 2.68, SD 0.73). The responsivity of the SHI in capturing the experienced handicap was significantly greater in the speech/articulation-impairment condition (p = .001). CONCLUSION: The German SHI is a reliable and responsive measure for speech intelligibility and articulation-related quality of life that should be chosen in preference to the VHI.

Effects of high-frequency speech therapy on speech-related quality of life and objective speech intelligibility of oral cancer patients.

To analyze objective and subjective progression of speech intelligibility in oral cancer patients undergoing high-frequency speech therapy during early rehabilitation. Oral cancer patients in the Department of Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany, participated in the study from March 2016 to November 2017. Speech intelligibility was analyzed preoperatively (t1), post radiation (t2), and post speech therapy (t3). Objective measures were the Munich Intelligibility Profile (Online) and the Frenchay Dysarthria Assessment-2 (FDA-2). Subjective measures were the Speech Handicap Index (SHI), the speech subscale of the EORTC QLQ-C30&HN35, and the WHO-5 Index II. For nine patients with complete data, progression analyses showed a non-existent-to-low intelligibility impairment at t1 (means/SDs: e.g. FDA-2: 8.96/0.11, SHI: 17.5/15.15), increasing towards t2 (means/SDs/p-values for difference from t1: e.g. FDA-2: 7.40/0.80/0.000, SHI: 21.7/14.24/0.213), and then decreasing towards t3, without ever reaching the initial level (means/SDs/p-values for difference from t1: e.g. FDA-2: 8.22/0.60/0.005, SHI: 23.5/15.85/0.481). The objective changes in intelligibility were significant; the subjective changes were not. Overall, the ability to speak intelligibly after oral cancer treatment follows a typical pattern. Therefore, high-frequency speech therapy in the early rehabilitation phase might be recommendable. It might help patients to adapt to their situation after surgery, and facilitates compensating for possible functional deficits.

Oral health improvement for nursing home residents through delegated remotivation and reinstruction (MundZaRR Study): study protocol of a cluster-randomised controlled trial.

INTRODUCTION: Oral health and oral health-related quality of life (OHrQL) of residents in German long-term residential care (LRC) are poor. We will develop an evidence-based catalogue of interventions ('Oral Health Toolbox') and provide care-accompanying reinstruction and remotivation of nursing staff by dental assistants (DA). We hypothesise that such intervention will significantly improve OHrQL, daily oral hygiene/care behaviour and is cost-effective. METHODS AND ANALYSIS: A scoping review will be used to identify possible intervention components. Mixed methods will be used to identify barriers and enablers of oral hygiene and care in German LRC. The result will be the 'Oral Health Toolbox', a two-phased instrument supporting both initial intervention allocation to improve oral health/hygiene and reinstruction/remotivation. A two-arm clustered, randomised controlled trial (ratio of 1:1 via block randomisation) will be performed in LRC in Rhineland-Palatinate, Germany. Each nursing home represents a cluster. Based on a feasibility study, considering clustering and possible attrition, we aim at recruiting 618 residents in 18 clusters. In the intervention group, dentists will assign one or more intervention component from the box (phase 1). During follow-up, nursing staff will be reinstructed and remotivated by DA, who use the box to decide how to maintain the intervention (phase 2). In the control group residents will receive care as usual. The primary outcome, OHrQL, will be measured using the General Oral Health Assessment Index. Secondary outcomes include pain condition, general health-related quality of life, caries increment, oral/prosthetic hygiene and gingival status, incidence of dental emergencies and hospitalisations, and cost-utility/effectiveness. The endpoints will be measured at baseline and after 12 months. For our primary outcome, a mixed-linear model will be used within an intention-to-treat analysis. A process evaluation using mixed methods will be conducted alongside the trial. ETHICS AND DISSEMINATION: Ethical approval by the University of Kiel was granted (D480/18). TRIAL REGISTRATION NUMBER: NCT04140929.