Patient and clinician perspectives on implant dentistry decision aid content: Results from an enhanced Delphi study.

PURPOSE: To investigate patient and clinician perspectives on what is considered important to include in a decision aid for replacement of a missing tooth with an implant. METHODS: An online modified Delphi method with pair comparisons technique was used to survey participants (66 patients, 48 prosthodontists, 46 periodontists, and 31 oral surgeons) in Ontario, Canada from November 2020 to April 2021 regarding the importance of information provided during an implant consultation. Round one included 19 items derived from the literature and informed consent protocols. The decision to retain an item was based on group consensus, defined as at least 75% of participants identifying the item as "important" or "highly important." After analysis of round one results, a second-round survey was sent to all participants to rank the relative importance of the consensus items. Statistical testing was completed using the Kruskal-Wallis one-way analysis of variance test and post hoc Mann-Whitney U tests with a significance level set at p ≤ 0.05. RESULTS: The first and second surveys had response rates of 77.0% and 45.6%, respectively. In round one, all items except purpose of steps reached group consensus. In round two, the highest group ranked items were patient responsibilities for treatment success and follow-ups after treatment. The lowest group ranked items were cost factors and restorative steps. Significant differences between the stakeholder groups were found on several items, including diagnosis (p ≤ 0.00), non-implant options (p ≤ 0.00), and cost (p ≤ 0.01). In general, patients' opinions were significantly different than clinicians' opinions on the relative importance of items. CONCLUSIONS: Clinicians and patients feel that multiple items are important to include in a decision aid for implant therapy; however, differences exist between patients and clinicians on the relative importance of items.

Dentistry's social contract and dental students' moral inclusiveness.

BACKGROUND: Under dentistry's social contract with the public, dental professionals have a social responsibility to address the oral health needs of the population at large. However, dental education places little emphasis on such moral commitments. By ascertaining dental students' stance regarding these notions, we may be able to inform changes in dental education. This paper thus explores dental students' comprehension of dentistry's social contract using the concepts of moral inclusion, moral community and empathy. METHODS: A cross-sectional online survey collected information from undergraduate dental students at the Faculty of Dentistry, University of Toronto (N = 430). Moral inclusion was assessed through the breadth of students' moral community by computing a "moral inclusion score" (MIS) from Likert scale responses to statements that asked students about their duty of care for different population groups, wherein a higher MIS indicated a broader moral community and in turn greater moral inclusiveness. Empathy was assessed using Likert scale responses to statements that gauged the extent to which students understood the effect of social determinants on people's health. Association of the MIS with environmental, institutional and student-related factors was also investigated using non-parametric tests and linear regression. RESULTS: The survey yielded a response rate of 51.4% (n = 221). Overall, students in this sample were morally inclusive and displayed empathy. Regression results showed that the MIS was most strongly associated with choosing a small town/rural area as a future practice location (ß = 4.76, 95% CI: 0.52, 9.01) and viewing patients as consumers (ß = -3.71, 95%CI: -7.13, -0.29). CONCLUSION: Students in this sample made morally inclusive choices, which implied that they had a basic understanding of the obligations under dentistry's social contract. Improving knowledge and experience with regards to addressing the social and economic determinants of oral health and access to oral health care may positively influence students' perceptions of their professional duties under the social contract.

Public and Professional Perceptions of the Scope of Practice of Oral and Maxillofacial Surgeons.

PURPOSE: To investigate and compare the general public's, general dentists', and primary care physicians' level of knowledge of the scope of practice of oral and maxillofacial surgeons (OMSs). We hypothesized that there is a generalized lack of knowledge of the scope of practice of oral-maxillofacial surgery, with the general public being the least informed and the general dentists the most educated. METHODS: A cross-sectional survey study was conducted via a mail-out survey that was delivered to a random sample of the general public, general dentists, and primary care physicians in Ontario, Canada. A total of 1800 participants were selected. The survey consisted of a demographic screener along with 24 clinical scenarios in which the participants could select all the specialists they thought were capable of completing the treatment. Inferential statistics were computed using a chi-square test to compare responses between the groups and identified any significant differences between subjects for each of the 24 scenarios with P value set at 0.05. RESULTS: Total response rate of 50.1% (n = 902) was achieved. The majority of health professionals (100% dentists, 95.5% primary care physicians) have heard of oral-maxillofacial surgery, in contrast to only 73.7% of the general public (P < .001). There was a general lack of awareness of oral-maxillofacial surgery scope of practice by all groups wherein OMSs were selected less than 50% of the time in 10 (general dentists), 14 (primary care physicians), and 16 (general public) of 24 clinical scenarios. CONCLUSION: Greater than 25% of the general public are unaware of OMS. More concerning, the general public and health professionals as a whole are unfamiliar with the full scope of practice of OMSs. For enhancing access to care by qualified specialists, educational programs highlighting key aspects of oral-maxillofacial surgery should be developed and distributed to all populations.

Ontario Dentists' Practice of Sedation and General Anesthesia: Barriers to Access and Use.

BACKGROUND: To investigate, among Ontario dentists, (1) self-reported barriers to access to sedation and general anesthesia (GA) services and (2) their current use of sedation and GA. METHODS: Of Ontario dentists practising, 3001 were randomly selected to complete a 16-question survey by mail or online in 2011. Mixed analysis of variance (ANOVA) followed by independent-sample t tests or 1-way ANOVA evaluated the relation between dentists' views and demographic variables including sex, clinical experience and size of primary practice. RESULTS: Of the participants (n = 1076; 37.9% response rate), 69.7% were male, 84.4% were general practitioners, mean time in practice was 20.6 years (0.5-42 years) and 42.2% were in cities of over 500 000 people. Most dentists (60.2%) provided anesthesia services, although 38.2% indicated lack of training and the belief that there is no patient demand (25.3%) as reasons not to use anesthesia in their offices. Nitrous oxide was used 17.5% of the time for all dental procedures except implants. Barriers to referral of patients for anesthesia services included high costs associated with sedation/GA (72.2%) and patient fear of anesthesia (33.5%). CONCLUSION: This study identified a perceived lack of patient demand, lack of dentist training, high costs of sedation/GA and patient fear of sedation/GA as primary barriers to use of sedation/GA in Ontario dental practices. The use of various anesthesia modalities is diverse, with 60.2% of dentists providing sedation/GA.

Developing a coding taxonomy to analyze dental regulatory complaints.

BACKGROUND: As part of their mandate to protect the public, dental regulatory authorities (DRA) in Canada are responsible for investigating complaints made by members of the public. To gain an understanding of the nature of and trends in complaints made to the Royal College of Dental Surgeons of Ontario (RCDSO), Canada's largest DRA, a coding taxonomy was developed for systematic analysis of complaints. METHODS: The taxonomy was developed through a two-pronged approach. First, the research team searched for existing complaints frameworks and integrated data from a variety of sources to ensure applicability to the dental context in terms of the generated items/complaint codes in the taxonomy. Second, an anonymized sample of complaint letters made by the public to the RCDSO (n = 174) were used to refine the taxonomy. This sample was further used to assess the feasibility of use in a larger content analysis of complaints. Inter-coder reliability was also assessed using a separate sample of letters (n = 110). RESULTS: The resulting taxonomy comprised three domains (Clinical Care and Treatment, Management and Access, and Relationships and Conduct), with seven categories, 23 sub-categories, and over 100 complaint codes. Pilot testing for the feasibility and applicability of the taxonomy's use for a systematic analysis of complaints proved successful. CONCLUSIONS: The resulting coding taxonomy allows for reliable documentation and interpretation of complaints made to a DRA in Canada and potentially other jurisdictions, such that the nature of and trends in complaints can be identified, monitored and used in quality assurance and improvement.

Ontario Dentists' Estimation of Patient Interest in Anesthesia.

Objective: To investigate Ontario dentists' perceptions of patient interest in sedation and general anesthesia (GA) during treatment and patient fear and avoidance of dental treatment. Methods: Using the Royal College of Dental Surgeons of Ontario roster, we randomly selected 3001 practising Ontario dentists, from among those who listed an email address, to complete a 16-question survey by mail or online. Demographic information (e.g., gender, size and type of primary practice, and years of experience) was collected as well as dentist reports of patient interest in sedation/GA and level of fear regarding treatment. Analysis included sample t-tests to compare Ontario dentist responses with patient responses to a 2002 national survey. Results: 1076 dentists participated (37.9% response rate), comprised of 69.7% males, 84.4% general practitioners, 0.5­42 years of practice (mean 20.6 years), and 40.6% from cities with a population larger than 500,000. Dentists underestimated patients' interest in sedation/GA, with dentists and patients reporting patients "Not interested" as 66.8% and 43.9%, respectively, and "Interested depending on cost," 19.8% v. 42.3%. Dentists also underestimated patient interest in sedation/GA for specific dental procedures including scaling, fillings/crowns, root canal therapy and periodontal surgery (p < 0.01). Dentists overestimated patient fear levels ("Somewhat afraid," 19.9% v. 9.8%; "Very afraid," 10.6% v. 2.0%; "Terrified," 6.0% v. 3.5%) and the proportion of patients avoiding dental care (13.3% v. 7.6%). Conclusion: Dentists underestimate patients' preference for sedation/GA and overestimate their fear and avoidance of dental care. The significant disparities between the views of dentists and patients may affect the availability and provision of sedation and general anesthesia in Ontario dental practices.

Knowledge, practices, and opinions of ontario dentists when treating patients receiving bisphosphonates.

PURPOSE: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe but extremely rare complication of prolonged treatment with bisphosphonates (BPs). Improper treatment or misdiagnosis can have serious repercussions. In some cases, the treatment of BRONJ can require jaw resection, prolonged use of antibiotics, and long hospitalizations. This study aimed to measure the awareness of dentists in the Province of Ontario, Canada about BRONJ and to identify any gaps in their knowledge of the condition and its treatment. In particular, the study aimed to answer questions about the dentists' knowledge of the current guidelines and their opinions and practices related to performing surgical dental procedures in patients taking BPs. MATERIALS AND METHODS: The study involved sending a Web-based questionnaire to a random sample of dentists in Ontario, Canada (n = 1,579). Information about their awareness of BPs, their experiences treating patients presenting with ONJ, their experiences with different surgical procedures in patients taking intravenous or oral BPs, and their awareness of the BRONJ guidelines suggested by the American Association of Oral and Maxillofacial Surgeons was collected. RESULTS: A response rate of 30% was achieved. Sixty percent of responding dentists had a good knowledge of BP and BRONJ; however, only 23% followed the guidelines for surgical treatment of a patient taking BPs, and 63% would refer patients if they were taking BPs. Approximately 50% of responding Ontario dentists were not comfortable treating patients with BRONJ at their current knowledge. CONCLUSION: The finding shows that although 60% of Ontario general dentists and specialists have a good knowledge about BRONJ, most are not comfortable performing oral surgery in patients taking BPs. Those who are comfortable have higher knowledge scores, suggesting greater educational efforts should be made to promote the knowledge of dentists regarding BP, ONJ, and BRONJ.

Time loss due to dental problems and treatment in the Canadian population: analysis of a nationwide cross-sectional survey.

BACKGROUND: The purpose of this study was to quantify time loss due to dental problems and treatment in the Canadian population, to identify factors associated with this time loss, and to provide information regarding the economic impacts of these issues. METHODS: Data from the 2007/09 Canadian Health Measures Survey were used. Descriptive analysis determined the proportion of those surveyed who reported time loss and the mean hours lost. Linear and logistic regressions were employed to determine what factors predicted hours lost and reporting time loss respectively. Productivity losses were estimated using the lost wages approach. RESULTS: Over 40 million hours per year were lost due to dental problems and treatment, with a mean of 3.5 hours being lost per person. Time loss was more likely among privately insured and higher income earners. The amount of time loss was greater for higher income earners, and those who reported experiencing oral pain. Experiencing oral pain was the strongest predictor of reporting time loss and the amount of time lost. CONCLUSIONS: This study has shown that, potentially, over 40 million hours are lost annually due to dental problems and treatment in Canada, with subsequent potential productivity losses of over $1 billion dollars. These losses are comparable to those experienced for other illnesses (e.g., musculoskeletal sprains). Further investigation into the underlying reasons for time loss, and which aspects of daily living are impacted by this time loss, are necessary for a fuller understanding of the policy implications associated with the economic impacts of dental problems and treatment in Canadian society.

Exploring students' perspectives from two Canadian dental schools toward online learning experiences.

OBJECTIVES: The utilization of online teaching and learning in dental education has grown during the past two academic years. In addition to its numerous advantages, the modality also has its limitations. The objective of this qualitative study was to explore the perceptions of oral health sciences students at the University of British Columbia (UBC) and the University of Toronto (UofT) regarding their experiences with online learning over the course of 2 pandemic-impacted years. METHODS: Interpretive Description was used as a methodology to guide semi-structured data collection. Individual interviews and focus groups were conducted with graduate and undergraduate dental and dental hygiene students at UBC and UofT. Qualitative data were coded and analyzed using a thematic approach. RESULTS: A total of 31 interviews and 4 focus groups were conducted. Online teaching and learning demonstrated many advantages, including flexibility, sustainability of curricular content, and promoting inclusivity in the classroom. Students indicated that due to online learning, there were opportunities to gain resources in practicing self-care and additional time to connect with family. Reported limitations of online classrooms included the loss of attentiveness, challenging content, and logistical challenges. Isolation and physical symptoms experienced in online classrooms with prolonged screen times were described as potential threats. CONCLUSIONS: The results of this study call for developing a structured and sustainable blended approach that balances the limitations of online classrooms with the interaction and engagement of in-person classrooms and patient care experiences. Based on the students' perspectives toward online learning, a road map was provided to dental educators to consider when designing future dentistry curricula.

Dental treatment needs in the Canadian population: analysis of a nationwide cross-sectional survey.

BACKGROUND: Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed. METHODS: A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need. RESULTS: Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. CONCLUSIONS: It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk.

How do dental students perceive the role of dental professionals?

OBJECTIVES: To explore dental students' perceptions of the role of dental professionals as healthcare providers and/or businesspersons. METHODS: A cross-sectional online survey collected information from undergraduate dental students at the Faculty of Dentistry, University of Toronto (N = 430). PPR was assessed through a visual analog scale (VAS) question, with the two ends labeled as "Healthcare Provider" (0) and "Business Person" (100), which asked respondents to point where they perceived dental professionals to be. Association of students' PPR with environmental, institutional and student-related factors was investigated using Chi-square and Spearman's correlation tests and logistic regression. Additionally, information on students' professional attitudes was gathered using: (i) the same VAS question, which asked students what they themselves aspired to be; and (ii) level of agreement with two sets of Likert-type questions highlighting healthcare provider and businessperson attitudes. RESULTS: The survey yielded a response rate of 51.4% (n = 221). The majority of respondents perceived dental professionals as healthcare providers and aspired to be healthcare providers themselves. Results of multivariable logistic regression suggested that perceiving dental professionals as businesspersons was significantly associated with perceiving future patients as consumers. Those who strongly agreed with healthcare provider statements had lesser odds of perceiving dental professionals as businesspersons. CONCLUSION: In this sample of students, perceptions of professionalism appear to be congruent with the normative role of dental professionals as healthcare providers. Dental education should prepare graduates who strongly identify with this role even in the presence of dental care market pressures.

Dental student's perceptions and experience treating adults with developmental disabilities.

OBJECTIVES: The objective of this study was to investigate the perceptions and experiences of dental students with regards to treating adults with developmental disabilities (AWDDs). METHODS: Semi-structured interviews were conducted with three groups of participants: experts who extensively work with AWDDs (n = 3), students who had no clinical training to treat AWDDs (n = 3), and students who had completed their clinical training to treat AWDDs (n = 8). One-on-one interviews were conducted in-person or via video call with each participant. Interviews were transcribed, coded, and analyzed for themes. RESULTS: Experts described their motivations for working with AWDDs. Students in both groups identified the challenges of working with AWDDs and highlighted the impact of the informal curriculum as well as the increased importance of clinical training. Students who had received clinical training described the clinical rotation as a transformative learning experience that instilled a sense of health advocacy. There was alignment of themes between all three groups in terms of skills desired, acquired, and required to work with AWDDs; however, the students who had received clinical training and the experts differed on their opinion of the relative importance of the skills they developed. CONCLUSIONS: The alignment of perceptions between students and experts is promising and demonstrates the successes of the existing curriculum. The misalignment between students and experts highlights areas in the curriculum that can be improved through adjustments and augmentation.

What influences attitudes toward professionalism in dental students?

OBJECTIVES: To explore dental students' attitudes toward professionalism and the environmental, institutional, and student-related factors that may be associated with these attitudes. METHODS: A cross-sectional online survey, conducted in 2020, analyzed data from a convenience sample of undergraduate dental students at the Faculty of Dentistry, University of Toronto. Attitudes toward professionalism were assessed using Likert scale statements related to the American Dental Education Association professionalism values of "Fairness," "Responsibility," "Respect," and "Service-mindedness." Codes ranging from 1 to 5 were assigned for the different levels of agreement and an "attitudes toward professionalism score" (ATPS) was computed by summing the codes for all the statements. Greater agreement with the statements or a higher ATPS indicated more positive attitudes toward professionalism. Association of the ATPS with environmental, institutional, and student-related factors was investigated using non-parametric tests and linear regression. RESULTS: The survey yielded a response rate of 51.4% (n = 221). The majority of respondents agreed with all professionalism statements. Results showed that the ATPS was significantly associated with and decreased for students who viewed their future patients as consumers (ß = -3.41, 95% confidence interval [CI]: -5.21, -1.60), experienced unprofessional faculty behavior (ß = -2.45, 95% CI: -4.88, -0.01), and chose to pursue dentistry for financial benefit (ß = -2.55, 95% CI: -4.63, -0.47). CONCLUSION: This sample of dental students generally had positive attitudes toward professionalism and numerous factors were associated with these attitudes. Enhancing the instruction and reinforcement of professional attitudes may be important to students' application of professionalism in decisions regarding clinical practice.

Children's Perceptions of Dental Experiences and Ways to Improve Them.

This qualitative study explored children's perceptions of their dental experiences and their acceptability of the CARD™ (Comfort, Ask, Relax, Distract) system, adapted for the dental setting as a means to mitigate dental fear and anxiety (DFA). A purposive sample of 12 participants (7 males) aged 8-12 years receiving dental care at the Paediatric Dental Clinic, University of Toronto, was recruited. Virtual one-on-one interviews were augmented with visual aids. Participants were oriented to and asked about their perceptions of various dental procedures. Data were deductively analyzed, according to the Person-Centered Care framework (PCC). Four themes were identified: establishing a therapeutic relationship, shared power and responsibility, getting to know the person and empowering the person. Children emphasized the importance of clinic staff attributes and communication skills. They expressed a desire to engage more actively in their own care and highlighted the positive influence of pre-operative education and preparation. Participants found the CARD™ system to facilitate opportunities for self-advocacy in their dental care.

Emergency Department Use for Dental Problems among Homeless Individuals: A Population-Based Cohort Study.

OBJECTIVES: To evaluate emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). METHODS: A random sample of 1,189 homeless was recruited from shelters and meal programs. Emergency department visits for non-traumatic dental problems (ICD-10-CA codes K00-K14) were identified using participants' health insurance number, during 2005-2009. Age- and sex-matched controls were selected from low-income neighborhoods. RESULTS: Homeless and matched controls had 182 and 10 ED visits for dental problems, respectively. Homeless people were more significantly more likely (OR=2.27, p=.007) to make ED visit for dental problems compared with controls. Over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. CONCLUSION: The high rate of ED visits for dental problems by people who are homeless suggests that access to dental care is inadequate. The large number of repeat visits indicates that ED settings are ineffective for treatment of dental problems.

Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

The accuracy of International Classification of Diseases coding for dental problems not associated with trauma in a hospital emergency department.

OBJECTIVES: Emergency department (ED) visits for nontraumatic dental conditions (NTDCs) may be a sign of unmet need for dental care. The objective of this study was to determine the accuracy of the International Classification of Diseases codes (ICD-10-CA) for ED visits for NTDC. METHODS: ED visits in 2008-2099 at one hospital in Toronto were identified if the discharge diagnosis in the administrative database system was an ICD-10-CA code for a NTDC (K00-K14). A random sample of 100 visits was selected, and the medical records for these visits were reviewed by a dentist. The description of the clinical signs and symptoms were evaluated, and a diagnosis was assigned. This diagnosis was compared with the diagnosis assigned by the physician and the code assigned to the visit. RESULTS: The 100 ED visits reviewed were associated with 16 different ICD-10-CA codes for NTDC. Only 2 percent of these visits were clearly caused by trauma. The code K0887 (toothache) was the most frequent diagnostic code (31 percent). We found 43.3 percent disagreement on the discharge diagnosis reported by the physician, and 58.0 percent disagreement on the code in the administrative database assigned by the abstractor, compared with what it was suggested by the dentist reviewing the chart. CONCLUSION: There are substantial discrepancies between the ICD-10-CA diagnosis assigned in administrative databases and the diagnosis assigned by a dentist reviewing the chart retrospectively. However, ICD-10-CA codes can be used to accurately identify ED visits for NTDC.

Is accessing dental care becoming more difficult? Evidence from Canada's middle-income population.

OBJECTIVE: To explore trends in access to dental care among middle-income Canadians. METHODS: A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages. RESULTS: By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978. CONCLUSIONS: This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.

Improving residents' oral health through staff education in nursing homes.

This study assessed the efficacy of oral care education among nursing home staff members to improve the oral health of residents. Nursing home support staff members (NHSSMs) in the study group received oral care education at baseline between a pretest and posttest. NHSSMs' oral care knowledge was measured using a 20-item knowledge test at baseline, posteducation, and at a 6-month follow-up. Residents' oral health was assessed at baseline and again at a 6-month follow-up using the Modified Plaque Index (PI) and Modified Gingival Index (GI). Among staff members who received the oral care education (n = 32), posttest knowledge statistically significantly increased from the pretest level (p < .05). Thirty-nine control residents of the nursing homes and 41 study residents participated. Among residents in the study group, PI decreased at 6 months compared to baseline (p < .05), but there was no statistically significant difference in their GI measurements between baseline and 6-month follow-up (p= .07).