Oral Health Education Program Reaches Patients on Inpatient Mental Health Unit

People admitted to an inpatient mental health unit at Windsor Regional Hospital in Ontario are receiving oral health education from a registered dental hygienist without leaving the ward, according to an implementation evaluation published in Frontiers in Oral Health. The program, developed by the Windsor Family Health Team for primary care, was adapted for the hospital setting and evaluated using established implementation science frameworks. The findings show that upstream oral health services, focused on education, prevention and promotion rather than clinical treatment, can be integrated into a psychiatric inpatient environment and reach patients who face substantial barriers to accessing dental care.

In Canada, access to healthcare does not ordinarily depend on ability to pay, but oral healthcare has been the persistent exception to that principle. People living with serious mental illness are among those least likely to access oral healthcare. While oral health services have been integrated into existing healthcare settings before, this has mostly taken the form of clinical treatment. The upstream work of education, prevention and promotion in such settings is less well documented. The Oral Health Education Program, known as OHEP, was designed to bring these upstream services to people where they already receive care, and its delivery on the inpatient mental health unit offered a chance to examine how such an adaptation works in practice.

The evaluation drew on three complementary frameworks: the RE-AIM framework, Proctor’s implementation outcomes, and the updated Consolidated Framework for Implementation Research. Together, these allowed the research team to examine reach, adoption, acceptability, appropriateness and feasibility. Data came from patient questionnaires, a survey of unit staff, and an interview with the program’s Oral Health Educator. The study was originally designed as a prospective cohort evaluation, but too few participants completed follow-up questionnaires to support conclusions about change over time, a limitation the authors treat as a finding in its own right.

Enrolment figures illustrate both the program’s reach and the difficulty of retaining this population in research. Eighty-seven patients enrolled in the evaluation and three withdrew, leaving 84 participants. Follow-up response rates declined sharply: 35 patients responded at 7 days, 38 at 30 days, and only 15 at 90 days. The authors argue that this attrition is itself a finding, pointing to compounding gaps in policy, practice, and what counts as evidence. They frame it as an equity problem as much as a methodological one.

The demographic profile of participants underscores how much the program reached people adversely impacted by determinants of health. Among those enrolled, 9.5% identified as Indigenous, 52.4% reported an income below CAD $20,000, and 29.8% had been unhoused in the past year.

Staff adoption of the program was strong. Of 61 unit staff surveyed, 88.5% had referred a patient to the program, and an identical proportion, 88.5%, considered it well or very well integrated into the unit workflow. Satisfaction was even higher: 93.4% of surveyed staff were satisfied or very satisfied with the program’s implementation.

Patient acceptance was similarly encouraging. Almost all responding patients said they would recommend the program. While the low follow-up rates limit what can be concluded about longer-term effects on oral health knowledge or behaviour, the near-universal willingness to recommend the service among those who did respond indicates that the program was acceptable to the people it was designed to serve.

The evaluation also identified a clear constraint on capacity. The program was delivered two half-days each week, which limited how many patients could be seen.

The authors’ conclusion that attrition is itself a finding carries implications beyond this single program. For now, the evaluation demonstrates that upstream oral health education can be delivered where people with serious mental illness already receive care, and that both staff and patients view the integration favourably, even as the evidence on longer-term change remains limited by the very attrition the authors highlight.

Subject of Research: Implementation evaluation of an oral health education program delivered on an inpatient mental health unit in Canada

Article Title: Bringing oral healthcare to where people are: an implementation evaluation of an oral health education program on an inpatient mental health unit

Article References: Walls, N., Di Paolo, L., Ridsdale, J., Anzolin, R., Park, G., Commisso, E., & Reilly, M. (2026). Bringing oral healthcare to where people are: an implementation evaluation of an oral health education program on an inpatient mental health unit. Frontiers in Oral Health, 7, Article 1986995. https://doi.org/10.3389/froh.2026.1986995

Image Credits: AI Generated

DOI: 10.3389/froh.2026.1986995

Keywords: oral health, mental health, health equity, implementation science, integrated care, oral health promotion, inpatient care, dental hygienist, Canada, people-centred care, team-based care, health services research