The population of nursing home or institutionalized elderly residents in Mississippi is growing as a result of the Baby Boomer influx. Unlike previous generations of nursing homes residents, these residents have retained at least part of their natural dentition because of advances in dental care. Studies on the oral care available for institutionalized elderly patients have shown that nursing staff in nursing homes have inadequate knowledge of dental hygiene procedures. This study examined nursing staff's attitudes toward oral care, their perceptions of the importance of oral care, and their knowledge of oral healthcare according to the recommendations for its practice. A survey instrument designed to provide demographic data and both objective knowledge and subjective attitudes was employed. This instrument was reviewed by dental health care professionals and approved by the Institutional Review Board before deployment in the field.

Initially, comparisons between public-pay rural and urban nursing homes were planned to determine whether differences exist in nursing staff's practice, attitudes, and knowledge depending on the population. Mississippi is predominantly a rural state and has only a few urban centers. This did not preclude the identification of rural and urban nursing staff for inclusion in this research. However, no statistically significant differences in any of the categories examined in the survey instrument were found. Thus, Mississippi is a very homogeneous state with regard to many of the self-reported responses concerning the attitudes, practice, and knowledge of nursing staff with regard to dental hygiene.

The nursing staff reported assisting 88% of their patients with oral brushing twice daily, as recommended by the American Dental Association (ADA). However, only 19% of this same population received assistance with flossing and 4% with oral swabbing, which does not meet the standard of care.

Most respondents reported an appreciation for dental care and felt that they had the support of their administrators to take the time to provide basic oral care. However, most reported that they provided what would be considered less than optimal care for their patients, particularly the dentate population. It was not clear whether this oversight was a result of a lack of time, knowledge, or personal attitudes on the part of the staff.

The survey revealed that the most significant gaps in the nursing staff's understanding of oral care were evident in their self-reported knowledge and objective evaluation of knowledge. Over 83% of the nursing staff felt that they had good to excellent knowledge of oral health. However, the staff correctly answered only 64% of the specific questions on basic dental care. Indeed, the highest correct response rate for individual topics was 87% for denture care. This identifies an important gap that must be addressed because more nursing home patients are likely to retain their natural dentition.

It is also important to note that the nursing home staff in Mississippi have at least high school diplomas, and the majority have some training beyond this basic level. This indicates that these individuals are among the more skilled members of the workforce in a state with a high number of unskilled workers without a high school education. Even so, the knowledge of dental health is lacking. In part, this must be attributed to failures in the training programs themselves, which include both formal classes and service programs. There should be a renewed emphasis on the part of dental professionals on increasing their profile with nursing schools, certification programs, and nursing homes.