Oral Care in Continuing Care Settings

Collaborating to Improve Policies & Practices

Purpose: To examine the integration of oral health care for frail and dependent older adults into a variety of continuing care settings in rural Nova Scotia (i.e., 3 long-term care and an adult day hospital in Eastern Nova Scotia).

Logo - Brushing Up on Mouth CareGoal: To inform policies and programs to promote better mouth care practices for seniors living in long-term care and to develop strategies for improved staff training and institutional care planning.

Project objectives

Objective 1 - Gathering Information
To document internal and external factors related to the provision of oral care and oral disease prevention for older adults in four rural continuing care settings.

What we did: We spoke directly with older adults in the Tri-Facilities as well as people involved in their care. We examined a broad range of documents related to personal care in the Tri-Facilities. The information and feedback we collected was used to plan further steps in the project.

Objective 2 - Developing the ‘Brushing Up on Mouth Care’ Program
To work with care providers and other stakeholders in each of the 4 settings to design a set of actions to integrate oral care into organizational policy and practices.

What we did: A one-day workshop was held to design a set of actions that would integrate mouth care into organizational policy and personal care practices in each of the three long-term care settings. Participants included a variety of health professionals, educators, government and seniors' representatives and most importantly, administrators and front-line care staff from the Tri-Facilities.

Objective 3 - Implementing the ‘Brushing Up on Mouth Care’ Program
To implement an oral care action strategy in each facility and to explore experiences of the health care team and relevant stakeholders.

What we did: The "Brushing Up on Mouth Care" program was implemented in the 3 long-term care facilities for a period of 12-months. Concepts arising from the workshop were developed and reviewed in each of the facilities as they were introduced. The program involved education and training for nursing staff and care providers, oral health toolkits and care cards for all residents, and guidelines for oral assessment and care planning. Feedback from the care staff and managers was used to expand and improve ideas. These "back and forth" discussions helped ensure that the following "Brushing up on Mouth Care" features were user-friendly and relevant:

  • Care cards
  • Toolkits
  • Assessments (daily and annual) & care planning tools
  • Information sheets
  • Posters
  • Oral health education sessions and videos for care staff

Objective 4 - Evaluating the ‘Brushing Up on Mouth Care’ Program
To evaluate the process, outcomes and changes associated with the action plan, and to recommend revisions to organizational policies and practices based on evaluation findings.

What we did: The evaluation plan was designed so that the research team could see how well the 'Brushing Up on Mouth Care' program was being used at the 3 long-term carefacilities. Feedback from each site was gathered at various points throughout the year. A variety of methods were used to gather information including work-life surveys, diary studies, oral care records, interviews with site managers, evaluation surveys, and researcher field notes.

Team List


  • Mary McNally
    Faculty of Dentistry, Dalhousie University

  • Sheila Martin
    CDHA, Eastern Shore Tri-Facilities

  • Debora Matthews
    Faculty of Dentistry, Dalhousie University

  • Joanne Clovis
    Faculty of Dentistry, Dalhousie University

  • Ruth Martin-Misener
    School of Nursing, Dalhousie University

  • Paige Moorhouse
    CDHA, and Geriatric Medicine, Dalhousie University

  • Christopher Wyatt
    Faculty of Dentistry, University of British Columbia

  • Paul Allison
    Faculty of Dentistry, McGill University

  • Michael Leiter
    Centre for Organizational Research & Development, Acadia University


  • Donna Dill
    Continuing Care, Nova Scotia
    Department of Health

  • Bernie LaRusic
    Nova Scotia Group of IX Seniors

  • Judith Limkilde
    Nova Scotia Community College

  • Janet Munn
    Oral Hygiene Education Consultant

  • Janet Simm
    Nova Scotia Association of Health Organizations

  • Susan Stevens
    Continuing Care, Nova Scotia Department of Health

  • Valerie White
    Secretariat, Nova Scotia Department of Seniors


  • Sandi Berwick
    Dietitian, Eastern Shore Tri-Facilities

  • Sandra Crowell
    Atlantic Health Promotion Research Centre, Dalhousie University