Celebrating the impact of health research

Success story in oral health - The inconvenient tooth: making room for influential voices to inform research

Mary McNally
Faculty of Dentistry and Atlantic Health Promotion Research Centre, Dalhousie University

Debora Matthews
Faculty of Dentistry and Atlantic Health Promotion Research Centre, Dalhousie University

Joanne Clovis
Faculty of Dentistry, Dalhousie University

Mark Filiaggi
Faculty of Dentistry, Dalhousie University

Sandra Crowell
Atlantic Health Promotion Research Centre, Dalhousie University

Martha Brillant
Faculty of Dentistry, Dalhousie University

Karen McNeil
Atlantic Health Promotion Research Centre, Dalhousie University


Bringing knowledge users together with knowledge creators helps inform research priorities and direction and ensures that research findings can be applied in practice. Making such connections, through a knowledge translation (KT)/knowledge exchange (KE) approach, has resulted in important developments in our research that are helping to ensure that, as people age, their oral health can be maintained.

Responding effectively to changing oral health needs

Canadians are both living longer and maintaining more of their natural teeth. These are welcome trends but are resulting in new patterns of oral disease and significant challenges for oral health care. A decade ago, we began to examine these trends in Nova Scotia. Like the rest of Canada, oral health care services in Nova Scotia typically fall outside of mainstream healthcare, isolating oral health in terms of research, clinical care and health services and policy. Good oral health is a key feature of optimal general health and quality of life. Eating, speaking and socially interacting with comfort and confidence are important goals for oral health at any age. But with no oral health database, little understanding of care needs and few standards or policies to guide care and promote oral health at later stages of life, we recognized that we had to find ways to identify and bridge these gaps.

Knowledge users, including seniors, clinicians, policy makers, personal and professional care providers, administrators, educators, health promoters and health–service funders, profoundly influenced our research and helped to create a shared awareness of its importance. The following three vignettes illustrate the surprising directions research can take when we listen to the voices of those who are most affected by the research.

That horse is out of the barn

It turned out that our own conception of the target audience for our work was too limited – something we wouldn't have known without the participation of community members.

At that time, nearly 10 years ago, we knew that half a century of modern dentistry was resulting in more seniors retaining their teeth into old age. At the same time, we knew very little about the oral health status and treatment needs accompanying this trend and even less about how goals focused on optimizing oral health would inform the arrangement, delivery and support of oral health education and services. So one of our first research priorities was to address the lack of epidemiological information about the oral health of older adults in Canada.

We held interdisciplinary workshops that included engagement with seniors and seniors' organizations to begin to build capacity for carrying out this research, with a view to informing health services and policy. We were clearly focused on seniors over the age of 65 until given pause by a voice from the community: "That horse is already out of the barn. You need to look at those who will be seniors, so we can make plans for them."

Outcome: We re–framed our research question to include adults aged 45 and older, in addition to those at the latter end of the age spectrum. This has led to knowledge that informs both present and future health service needs of older Nova Scotians. Given that Nova Scotia currently has the oldest population in Canada, the trends we are seeing now are informative to a national audience and key to identifying research priorities.

I want all my teeth out

Sometimes we got a message that stopped us in our tracks. In tandem with the epidemiological research described above, we undertook a province–wide environmental scan that included a health–services evaluation (from the perspectives of seniors and multiple levels of care providers) as well as best practices and policy scans (involving government, education and continuing care sectors) to inform oral health service action planning. As we were identifying research priorities, we were taken aback by the poignant message of a nurse manager from the continuing care sector: "...at this point I think I want an advanced directive to ensure all my teeth come out before I enter a nursing home. At least I know dentures may be easier to get out of my mouth to be cleaned."

Given the advances in dental health over the last half century, this was a disturbing commentary from someone who was intimately aware of the system. It is not entirely clear whether the nurse manager quoted was primarily concerned with the difficulty associated with receiving care or the consequences of dental disease. Either way, she identified a troubling problem that became a key focus of our research.

Outcome: We entered into a collaborative partnership with three long–term care facilities to create "Brushing up on Mouth Care", a comprehensive, hands–on education and resource program focused on daily mouth care for dependent older adults. End–users and administrators were directly involved in the processes that led to the creation of this open access web–based resource, which includes oral health toolkits, education resources and videos and assessment and care–planning guidelines.

Mouth care is off the radar

While all this work was ongoing, one perplexing question kept coming up: why personal care providers seemed well–equipped to undertake many difficult and even unpleasant tasks associated with personal care, yet mouth care was apparently "off the radar".

Educators in personal–care provider programs provided an answer: the lack of adequate resources available for training students. Unlike other domains of personal care, there were no laboratory models or hands–on resources to provide an opportunity for students to practice. The same educators also told us that new graduates are an exceptional means of creating heightened awareness about updated standards of practice among older practitioners in the field.

Outcome: We developed a unique university–college partnership that has led to the introduction of Brushing up on Mouth Care resources to more than half the personal care providers and all of the practical nurses trained in Nova Scotia each year. Eleven community colleges have also introduced mannequins in their personal care laboratories to enable students to practice techniques.

These vignettes offer striking examples of how stakeholder voices can pave the way forward in research and knowledge exchange and provide concrete examples of far reaching impact. They truly only scratch the surface in demonstrating the value of these voices and demonstrate how a field that has traditionally been at the margins of mainstream healthcare can be informed by both beneficiaries and end users of research.


Key collaborating stakeholders: Nova Scotia's Capital District Health Authority, Eastern Shore Tri–Facilities Long–term Care Centres; Nova Scotia Community College, School of Health and Human Services; Northwoodcare Incorporated; Health Association of Nova Scotia; Nova Scotia Department of Health and Wellness, Continuing Care Branch; Nova Scotia Department of Seniors; Nova Scotia Group of IX Seniors' Organizations; Nova Scotia Dental Association

Funding: Nova Scotia Health Research Foundation, Canadian Institutes of Health Research (CIHR)

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