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| Explanation of theme | Supporting quotes |
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| Barrier themes | | |
| Repulsion/fear | Sometimes care providers are repulsed by certain aspects of oral care such as halitosis, or a resident spitting/coughing on them. Care staff are fearful of providing oral care for a variety of reasons (e.g., drop or break dentures, cause the resident to gag or aspirate, get bitten). | “So I had to clean them; oh it was gross… I don’t know how she even handled it but I guess it’d been like that and she had just gotten used to it.”
“You have to be careful because if you want to stick your finger in or anything close they can bite you.” |
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| Resident disability/dementia/resistance | Oral care provision is more complicated when a resident is disabled or has dementia. Often residents cannot express themselves when they are confused or suffering from oral pain or discomfort and this may be interpreted as resistant behaviour. | “If you have a [resident with] dementia that might have some of their own teeth and can’t tell you he’s a got a toothache, you know what he’s going to do… they’re going to act out. …They become agitated and they can’t express it.”
“Sometimes it’s hard to do oral care with people with dementia because they don’t want you around their mouth; they don’t know exactly what you’re doing.”
“I mean somebody who’s got advanced dementia there’s no sense, just work with them and hope for the best.” |
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| Resident attitude/indifference | Often residents appear to not care or are unaware of the importance of oral health. Many residents would not have gone to the dentist for regular check-ups throughout their lives and therefore oral care is not a priority for them. | “People years ago didn’t go to a dentist unless it really bothered them and they had an abscess and then they went to the family doctor and he gave them antibiotics and then he pulled the tooth out.”
“A lot of residents just don’t want to be bothered [with oral care]… it’s just not something that’s important to them.”
“I think he wouldn’t say a word if you didn’t get to his teeth.” |
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| Current oral health status of resident | If a resident comes into a facility with poor oral health, it is more difficult to provide them with adequate oral care, especially if they have sensitivity, discomfort, or pain. | “[Resident Name] has very few teeth and has had over the years very poor mouth care, therefore he’s got infections in his gums and his teeth are rotten.”
“Yes it makes you wonder if they have a bad history their whole life of bad mouth care. And that’s why their teeth are so bad, or is this decline just recent, like within the last five years or whatever.” |
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| Lack of time | “Visible” activities (dressing, combing hair, washing, etc.) take priority when there is a time crunch (e.g., in the morning). Staff indicated that if they had more time, oral care would likely get more attention. | “If somebody’s in a hurry… It’s a wham, bam, thank you, ma’am, the teeth can be left.”
“I think the people that have their own teeth probably don’t get the attention. Now as far as I’m concerned, they need more attention because they have their own teeth, but I think they’re the ones that get neglected because of the fact that it takes longer to do natural teeth than it does dentures.” |
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| Facilitator themes | | |
| Resident ability | It can be helpful when residents are aware of their oral care and remind staff to brush their teeth. Having the resident provide the cue often ensures their teeth will be done. | “We have two [residents] that will actually ask, will you brush my teeth?”
“[Name of resident] is very insistent on having her teeth done after breakfast and before she goes to bed and her teeth are done faithfully.” |
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| Resident relationship with care provider | Having a good relationship with a resident can make oral care provision easier. The care provider is familiar with likes/dislikes and routines and the resident is more comfortable around them. | “You know what [the residents] want…. they sort of trust you… they feel, they don’t care if you see them without their teeth [in].” |
| Proper tools and products | Oral care provision is easier when the necessary tools are available and on-hand. Using the proper tools for specific care needs is also important (e.g., denture brushes for dentures, child size toothbrushes for residents with small mouths). | “Having everything there right where you can get it; you know your toothbrush, toothbrushes and things; just having it right close.”
“I wish we had those little toothbrushes back… [they] curved like this, so every time you used them it would get right in around their gums and everything else; it brought a lot of stuff out.” |
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| Education themes | | |
| Oral health education | Additional oral health care training may be beneficial for care providers who are currently in the workforce as well as family members or volunteers. | “A lot of these [care providers] have been doing this for 25 years, they never took a course and were just grandfathered in… it’s really hard for you to get across to them that just because you’ve been doing that that way doesn’t mean you were doing it the right way. So a lot of people figure you’re making waves if you say something.”
“Sometimes family members need to be educated; and just to be aware of what we’re trying to do like promote good oral care; sometimes they say “If mom or dad won’t open their mouth then don’t make them”. [Then] there’s nothing I can do.” |
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| Education tools | Tools suggested that would be helpful with oral health education and awareness (apart from formal education). | “Well we have hand-washing posters all over the place, why not oral care posters?”
“So if there was posters [about oral care] in each of the elders rooms, in their bathrooms, right by their sink then you’re there with the teeth or with the elder, you’re going to read it.”
“If this could be one of the subjects that is brought up at every care conference, also, every time we do rounds. Now, rounds is for a wing, a whole wing in general, so if oral care could be brought up then and discussed, just like I said, keep it fresh, keep it going, keep it on everybody’s mind.” |
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| Care provider training programs | Care providers should receive standardized, in-depth training on oral care provision. | “So that’s where the education has to come in—that everybody realizes what oral care is and what it entails.”
“It’s always good when we have new young ones coming in because they’re fresh out of the course and they’ve learned from the book the right way; so I always like to see them coming in.” |
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