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Gerontologist. 2014 Feb;54 Suppl 1:S25-34. doi: 10.1093/geront/gnt145.

Changing the culture of mouth care: mouth care without a battle.

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*Address correspondence to Sheryl Zimmerman, School of Social Work and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590. E-mail:



Culture change aims to fundamentally improve care provision in a manner consistent with individual preferences. However, few studies of culture change have focused on the quality of daily care, despite the fact that system-wide efforts are important to assure the effectiveness, adoption, and sustainability of person-centered care to meet daily needs. This paper describes a new culture change practice, Mouth Care Without a Battle. The focus on mouth care is predicated on the important association between person-centered support for oral hygiene and quality of life.


Mouth Care Without a Battle is a person-centered approach to quality mouth care for persons with cognitive and physical impairment. It was developed by an interdisciplinary team of clinician researchers based on literature review, consultation with experts, environmental scan of existing programs, and testing in nursing homes. Building from the success of Bathing Without a Battle, Mouth Care Without a Battle was evaluated in terms of changed care practices and outcomes, developed into a training program, and packaged for dissemination as a digital video disk (DVD) and website.


The development and evaluation of Mouth Care Without a Battle demonstrate attention to the areas necessary to establish the evidence-base for culture change, to ultimately empower and support staff to provide care to achieve quality outcomes.


As illustrated in this paper, it is beneficial to build the evidence base for culture change by attending to care processes and outcomes benefiting all residents, ability to implement culture change, and costs of implementation.


Culture change; Dementia; Mouth care; Outcomes; Quality improvement

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