Oral Health Program Part 1:

Beaumont Nursing and Rehabilitation

LIT Dental Hygiene
Students: Sarah Neel, Meghann Gutierrez, Kamesha McFadden

Needs Assessment
A. General Data
Description of Site:
Beaumont nursing and rehabilitation (BNR) is located at 1175 Denton Dr in
Beaumont, Tx approximately 3.8 miles from LIT. The facility was built in the 1970s and
this is their only location.
Beaumont nursing and rehabilitation offers several services including nursing and
rehabilitation, transitional care, Alzheimer's care, therapy, beauty care, dietary, daily
activities, and social services. Their primary funding is through federal and state,
accepting medicare, medicaid, and rarely private pay. The fee that is needed for primary
care is $4000 a month and that covers room, board, meals, laundry ,housekeeping and
nursing.
Description of Target Group:
BNR accept patients age ranging from 30-95 with the majority of these patients
being long term. The medical conditions that the patient needs to have to be accepted
into the facility and that are treated are most medical diagnosis along with dementia.
There is a total of 52 residents at this facility receiving care. The population has a even
female to male ratio with a majority of African American, fewer Caucasian, Asians, and
no Hispanics.
Description of Staff Population:
BNR staff also includes males and females of all ethnicities and tries to maintain
a 1:1 ratio of employees and patients. There are a total of 65 staff members ranging
from LVNs, RNs, CNAs, CMAs, speech therapist, physical therapist, housekeeping, and
administration. The staff members are staffed according to the needs of the residents.

Physicians go to the facility on a weekly basis.The responsibilities of the LVNs and RNs
are the charge nurses and they administer all the medications. CMAs also help in
administering medications. CNAs have direct care with the patients making sure they
are clean and that they brush their teeth. The LVNs and RNs must have a Vocational
license or a BSN in order to work at this facility. CNAs and CMAs must have a certificate
to practice in this facility.

Description of Services Provided:

The activity director coordinates all activities for the residents. They have a
monthly calendar with daily events planned from Sunday-Saturday, ranging from bingo,
bible study, personal daily inspirations, coffee and current event discussions, and a
snack and game social as well as special occasions such as Mardi Gras parties and
Black History and Soul Food Day. About 15-20 residents attend the different events that
they have.The daily routine for this facility would be administering of medications,
making sure hygiene needs are met daily, making sure the patients are fed, patient
entertainment, and putting patients to bed. BNR mission is to strive everyday to
enhance the quality of life for the seniors in their care.
Other Pertinent Data:
The community has .70mg/L of fluoride added to the city water.
B. Information Related to Dental Health:
BNR provides a dental exam and radiographs by a dentist every 3 weeks or as
needed and all treatment is done at the facility; therefore, no transportation is required.
The preventive measures utilized is the dentist coming on a regular basis, and the
nurses brushing the patients teeth and caring for their dentures. BNR provides
toothbrushes, toothpaste, mouthwash, and denture cream for their patients. No previous
Dental Programs has been conducted at this facility. The staff does not have additional
oral health training, but oral health is a priority because they provide the necessities
needed for optimal oral health of the patients.
C. Dental Health Status:
1. Dental Caries:

Data from the National Health and Nutrition Examination Survey from 2011-2012
showed among adults aged 20-64, 91% had dental caries and 27% had untreated tooth
decay. African Americans had the highest percentage of untreated tooth decay (42%)
followed by hispanics (36%), Caucasians (22%) and Asians (17%) adults aged 20-64.
About 1 in 5 adults aged 65 and over had untreated tooth decay. Dental caries is one of
the main causes of tooth loss for both young and older adults. (1)
2. Periodontal Disease:
Studies conducted by the CDC show one that 47.2% of adults aged 30 years and
older has some form of periodontal disease. It has been shown that periodontal disease
increases with age. An average of 70.1% of adults 65 years or older have periodontal
disease. Men have a higher percentage of periodontal disease at 56.4% where only
38.4% of women were infected with the disease. The prevalence of current smokers
with periodontal disease was 64.2% and 65.4% of those living below poverty line were
infected, and 66.9% of people with less than a high school education had some degree
of periodontal disease. (1)
3. Oral Hygiene
Data from the CDC shows that the trend in improved oral health status among
persons of 65 years and older is expected and more are keeping their natural teeth
longer. However, there are sharp differences by race and socioeconomic status.
Socioeconomic characteristics played a significant role in who received dental care.
Another challenge arises in providing dental care for older persons because their care is
often more complex than dental care for younger adults. This complexity comes from
the many changes associated with aging. Considering that caries and periodontal
diseases, the most common oral health problems, are cumulative, older persons often
endure the consequences of their oral health experience from earlier years, such as
missing teeth, large fillings, and the loss of tooth support. (1)
4. Oral Cancer
According to the data from the CDC shows that oral cancers are more common in
older adults particularly those over 55 years old who smoke and are heavy drinkers.
Being disabled, homebound, or institutionalized also increases the risk of poor oral
health. Oral and pharyngeal cancers, which is primarily diagnosed in the elderly are
diagnosed in some 31,000 Americans each year, and results in about 7,400 deaths
each year. The prognosis for these patients is poor. The 5 year survival rate for white
patient is 56% and for African American patients is only 34% (1)

D. Goals and Objectives

Goal:
The goal of our program is to provide an overall preventive dental health
programs for the target population of Beaumont Nursing and Rehabilitation (BNR).
Objective:
1. Increase the dental health knowledge of the residents at BNR by 10%
measured by a pre and post test.
2. Increase the dental health knowledge of the employees at BNR by 20%
measured by pre/post test.
3. Decrease the residents plaque score by 10%.
4. Establish a daily agenda of the quality of dental health at the BNR facility.
5. Implement a denture identification system for the residents of BNR.
E. Rationale for Program
Oral health is an important and often overlooked component of an older persons
general health and well-being, especially because more older people are keeping their
natural teeth than ever before. Oral health can affect general health in very direct ways.
Oral health problems can cause pain and suffering as well as difficulty in speaking,
chewing, and swallowing. (1) These problems can also be a complication of certain
medications used to treat systemic diseases, and also the treatment of systemic
diseases can be complicated by oral bacterial infections. (2)
Oral pain is a sign of an advanced problem in a tooth or in the gingival tissues.
Although pain may dissipate with time, professional attention is needed to effectively
manage the affected tooth or tissue. National data indicate that 7 percent of adults 65
years and older reported having tooth pain at least twice during the past 6 months. (2)
Oral health problems, whether from missing teeth, ill-fitting dentures, cavities,
gum disease, or infection, can cause difficulty eating and can force people to adjust the
quality, consistency, and balance of their diet. For example, edentulous people tend to
eat fewer raw vegetables, salads, and fresh fruits than people who have their own
natural teeth. To date, however, available data do not show that these changes result in
a diet of poor nutritional quality. (3) Edentulism can have obvious negative esthetic and
functional consequences. In 1993 one-third of non institutionalized adults 65
years of age and older reported having lost all their natural teeth. (1)
Oral hygiene is necessary to maintain oral health and quality of life. However, the
oral hygiene and the oral health care of older people in long term care facilities are poor.
This indicates that care is not in compliance with the available guidelines and protocols,

and stresses the importance of a clear evidence-based implementation strategy to

improve oral health care. (2)
The American Dental Association believes that education and prevention are the
ultimate keys to extending good oral health to those who dont have it. Responding to
the need to dramatically increase oral health literacy and access to preventive and
restorative care among underserved populations, the ADA in 2006 launched a pilot
project to produce community health workers whose training focuses on oral health.
These Community Dental Health Coordinators (CDHCs) work in underserved rural,
urban and Native American communities, bringing more people into the oral health
system. (4) The ADA appointed these people to help other social workers understand
and teach the importance of oral hygiene.
In conclusion, during the past several years, the oral health and use of dental
services among older adults have improved with the help of several organizations and
the fact that elderly people are living longer and also keeping their teeth longer.
Although this trend is expected to continue as the population of older adults grows and
increasingly maintains their natural teeth, continued improvement will also be dependent
on access to appropriate dental care and the increased significance of proper oral
health instructions contributing to maintaining natural teeth longer. (1)
F. Program Design
Activities:
Our oral health program is designed to help better educate the overall staff and
residents at BNR. Our lessons will be split into four different sessions first covering
basic oral health education such as plaque, periodontal disease, brushing and flossing
as well as stressing the importance of oral hygiene care. Our second session will focus
on xerostomia, root caries, and the significance of oral and systemic health. The third
session will cover oral cancer and proper screening methods to detect its signs. Our
final session will cover denture/partial care as well as implementing a denture
identification system for proper storage.
Session 1: At this session we will discuss plaque, periodontal disease, and the
importance of brushing and flossing.
Participants: Available staff and participating residents with some or all
natural teeth.

Pre-test that will allow us to assess the knowledge staff and residents
have prior to the lesson.

 Visual aid via handout will be provided about basic oral health and
methods for daily hygiene.

Have residents demonstrate their brushing and flossing technique and

then we will take the plaque score to assess how efficient their
technique was.

Then we will demonstrate how to properly brush and floss on ice tray
models using yarn.

Re-disclose and obtain a second plaque score to evaluate and

compare results to the first scores.

Stress the importance of good oral hygiene.

Give the residents and staff a post test and compare the results with
the pre-test.

Pass out bags with toothbrushes, toothpaste, floss and mouth rinse.
Session 2: At this session we will focus on xerostomia, root caries, and the
significance of oral and systemic health.
Participants: Available staff and residents that are on multiple medications.

Pre-test that will allow us to assess the knowledge staff and residents
have prior to the lesson.

Visual aid via handout will be provided about xerostomia, root caries
and the significance of oral and systemic health.

Discuss the side effects

With the help of the staff, the residents will do a word matching
activity over the causes of xerostomia and root caries.

Educate residence and staff on the benefits of fluoride and the variety
of options to prevent caries and xerostomia.

Give the residents and staff a post test and compare the results with
the pre-test.

Pass out Biotene samples at the end of the session.

Session 3: At this session we will cover oral cancer and proper screening
methods to detect its signs.
Participants: Available staff and residents with a high risk for oral cancer.

 Pre-test that will allow us to assess the knowledge staff and residents
have prior to the lesson.

Visual aid via handout will be provided about the signs, causes and
prevention about oral cancer.

Demonstrate the 7 examination steps to the residents to help them

detect early signs of oral cancer.
1. Tongue and floor of the mouth
2. Examine the roof of your mouth
3. Check your cheeks
4. Head and Neck
5. Lips
6. Neck Area
7. A Persistent Cough

Give the residents and staff a post test and compare the results with
the pre-test.

Pass out mini mirrors at the end of the session.

Session 4: At this session we will cover denture/partial care as well as
implementing a denture identification system for proper storage.

Participants: Available staff and residents with partials and dentures.

Pre-test that will allow us to assess the knowledge staff and residents
have prior to the lesson.

Visual aid hand out about partial and denture care.

Residents will practice cleaning their partials and/or dentures. We will
provide the staff with disposable mouth guards to practice cleaning to
better assist the residents.

We will provide labeled partial and cases to the residents.

Give the residents and staff a post test and compare the results with
the pre-test.

Pass out denture brushes, cleaning tablets and polydent.

G. Constraints and Alternative Strategies

 Constraints: There may be a lack of interest with the staff and/or residents
during each session.

Alternative Strategies: Stay enthusiastic during the presentation, keep

the residents involved by asking questions and have the residents
participate in the activities.

Constraints: There may be lack of participation with the staff and/or residents
during each session.

Alternative Strategies: Stress the importance of the information that is

given throughout the program and what the outcome benefits will be.
H. Resources

Personnel: Staff including Administrator, Activities coordinator, Nurses and Aids

as well with residents.

Location: Activity room located in the front entrance of building.

Equipment: Label maker
Supplies: Safety glasses, masks, gloves, plastic mouth mirrors, disposable
cups, disclosing tablets, tongue depressors, paper napkins, hand mirrors,
toothbrushes, toothpaste, floss, ice cube tray, yarn, mouth guard, plato, mouth
rinse, denture cleaning tablets, denture brushes, denture cases, polydent, and
Biotene.

Visual aids: pamphlets, handouts, flip chart, word matching activity.

I. Budget
Gloves/Mask- Provided by presenters
Pre/Post Test- Provided by presenters
Toothpaste- Provided by presenters
Floss- Provided by presenters
Toothbrushes- Provided by presenters
Disclosing solution- Provided by presenters
Mouthwash-Provided by presenters
Polydent- Provided by presenters
Biotene- $10
Ice trays-$4

 Play dough-$5
Denture brushes- Provided by presenters
Denture cleaning tablets- Provided by presenters
Denture cases- $15
Mini hand held mirrors- $20
Plaque score form- Provided by instructor
Disposable cups- $2
Pamphlets- $10
Activity sheets for residents- $2
Yarn-$4
Mouth guard mold-$10
Goodie/paper bags-$3
Estimated Total Cost- $85
J. Timetable
We will implement our oral health program over four weeks.

Session 1: Thursday, March 24, 2016 (3:30-4:30)

Session 2: Thursday, March 31, 2016 (3:30-4:30)
Session 3: Thursday, April 7, 2016 (3:30-4:30)
Session 4: Thursday, April 14, 2016 (3:30-4:30)

K. Evaluation
Formative:
1. Residents will be given a pre and post-test during all sessions to evaluate if their oral
health knowledge has increased by 10%.
2. Employees will be given a pre and post-test during all sessions to evaluate if their
oral health knowledge has increased by 20%.
3. Residents and staff will demonstrate proper oral hygiene procedures during first
session.
4. Resident plaque scores will be evaluated during session one, before and after
education and demonstration of proper oral hygiene techniques to determine if scores
have decreased by 10%.
5. Staff and residents will practice and demonstrate self, oral cancer screenings and
caregiver oral cancer screenings during the third session.

6. Residents with the help of staff will demonstrate proper denture care procedures
during second session.
7. Residents with the help of staff will label their denture cases by the means of a label
maker during the fourth session to help the site implement a denture identification
system.
Summative:
1. A pre-test and post-test will be given and evaluated to assess the knowledge of the
residents to see if their oral health knowledge has increased by 10%
2. A pre-test and post-test will be given and evaluated to assess the knowledge of the
staff to see if their oral health knowledge has increased by 20%
3. Have a final meeting with the site administrator for an oral health program evaluation
form completed and to discuss future plans to continue quality oral health care at the
site.