Original Study - Brief Report| Volume 22, ISSUE 6, P1190-1193.e2, June 2021

Mouth Care in Assisted Living: Potential Areas for Improvement

Published:December 29, 2020DOI:



      Poor oral care may lead to systemic disease, and there is evidence that assisted living (AL) residents lack quality oral care; in AL, poor care may be due to staff knowledge and attitudes, as well as organizational barriers to providing care.


      Determine AL staff knowledge and attitudes regarding mouth care and barriers to changing care.


      Self-administered repeated-measures questionnaires completed before and after oral care training.

      Setting and Participants

      A total of 2012 direct care staff and administrators from 180 AL communities.


      Nine knowledge questions and 8 attitude and practice intention questions, and open-ended questions regarding training and obstacles to providing oral care.


      Overall, 2012 participants completed pretraining questionnaires, and 1977 completed posttraining questionnaires. Baseline knowledge was high, but staff were not uniformly aware of the systemic-oral link whereby mouth care affects pneumonia and diabetes. Almost all staff reported learning a new technique (96%), including for residents who resist care (95%). Suggested areas to improve mouth care included having more hands-on experience. The primary perceived obstacles to care centered around residents who resist care and a lack of time.

      Conclusions and Implications

      Based on reports of having benefitted from training, AL staff overwhelmingly noted that new knowledge was helpful, suggesting the benefit of skills-based training, especially in dementia care. Mouth care in AL has been sorely understudied, and merits additional attention.


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