Oral health is an integral component of overall health and quality of life. Previous studies show that oral health status of residents in long-term care (LTC) facilities is poor, however, it is not clear how best to address this problem. Objectives: This study explored factors influencing the implementation of a comprehensive oral health care program for elders in LTC. Methods: An ethnographic case study was used to investigate the development and ongoing maintenance of an oral health program implemented within a single administrative group of seven LTC facilities. The program assesses oral health, and provides dental treatment and daily oral hygiene care for the residents, supplemented by educational instructions for the nursing staff. The five dental professionals involved were interviewed individually and observed, and administrative documents explored to identify factors influencing implementation of the program within each facility. Results: Three themes contribute centrally to the success of the program: 1) organizational structure and culture of LTC to accommodate dental personnel; 2) coordination of expectations with implementation activities; and 3) support from both internal and external contributors. Conclusion: The analysis highlights the complexity of a LTC environment and the need for ongoing negotiations between dental personnel and facility administrators and staff to create an environment of mutual support and acceptable responsibilities.

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