Oral Health Program Part 1

Lucas House Assisted Living

LIT Dental Hygiene
Students: Brittany Ryder, Victoria Sisco
Needs Assessment
A. General Data
1. Description of site:
Lucas House Assisted Living is a senior living community center located on 2910 Toccoa
Rd. Beaumont, TX 77703, and opened in 1981. Their goal is to provide quality care and
the support of a community that can help seniors maintain physical, mental, and
emotional health. The primary funding is through federal and state, medicare and private
pay. The fee that is needed for primary care averages at $4000 a month and that covers
room, board, meals, laundry, housekeeping and nursing. Funding for this site is obtained
from the residents monthly fees. (1)

2. Description of target group:

The target population of this program is six residents living at Lucas House Assisted
living that are eighty-five years and older. The residents care for themselves as much as
possible but when in need the nurse on duty helps assist with daily routines such as,
eating, bathing, hair care, shaving and teeth or denture care. (2)

3. Description of staff population:

The staff population consists of directors, registered nurses and certified nurse
assistants. There are about 20 nurses and nurses aides that care for the residents. The
registered nurse does an assessment on the residents when they are first admitted to
determine the needs of the residents. The certified nurse assistants assists the residents
with routine daily care when needed or requested.

4. Description of services provided:

The activity director, Gretta Greene coordinates all activities for the residents. They
have a monthly calendar with daily events planned throughout the weeks. For
example, activities include bingo, snack and game socials, as well as special
occasions such as Mardi Gras parades. Ten out of the twenty-seven participate in the
activities. Upon request the residents can be brought around town to run personal
errands. The daily routine for this facility includes administering of medications,
making sure the patients are fed and entertained and if they need assistance getting
them to bed.

5. Other pertinent data:

The average water fluoridation for the city of Beaumont is .065 mg/L (3)

B. Information Related to Dental Health

The nurse and nurses aides do not perform any oral screenings of any kind and only
assist when assistance is requested from the residents. Previous dental programs have not
been conducted. The staffs knowledge and awareness of dental health is limited. (2) The
dental health needs include maintenance and care of denture and partials.
C. Dental Health Status
1. Periodontal disease

Age % Destructive Periodontal Disease

65- 74 14.26%
75 and older 20.75%
The highest percentage of periodontal disease is between ages seventy-five and
older the least is between sixty- five and seventy-four (4)

Race %
White, non Hispanic 15.47
Black, non Hispanic 24.47
Mexican American 24.20
The highest percentage of race is seen in black, non Hispanic and the least is in
white, non Hispanic. (4)

Gender %
Male 20.61
Female 14.40
The highest percentage of gender is seen in males. (4)

Poverty Status (income compared to %

federal poverty level)
Less than 100% 31.96
100-199% 18.75
Greater than 200% 13.91
The highest percentage of SES is seen in less than 100% of poverty status. (4)

Education %
th
Less than 12 grade 28.24
12th grade 15.51
th
More than 12 grade 12.38
The highest percentage is seen in elderly that have completed less than a 12th
grade education. (4)

Smoking history %
Current smoker 32.01
Former smoker 19.25
Never smoked 14.08
The highest percentage is seen in current smokers and the lowest is in never
smoked. (4)

2. Oral Cancer: Elderly population ages seventy years and above.

 Gender %
Male .64%
Female .29%
The highest percentage seen with oral cancer is with males and the lowest is with
females. (4)

3. Dental Caries
Age %
65-74 93.25
75 or more 92.70
The highest percentage was seen between the ages 65-74 and the lowest was seen
with 75 and older. (4)

Sex %
Male 93.64
Female 92.49
The highest percentage with gender is seen with males and the lowest with females.
(4)

Race %
White, non-hispanic 94.86
Black, non-hispanic 80.20
Mexican American 83.82
The highest percentage seen within race is with white, non-Hispanic and the lowest
with black, non-Hispanic. (4)

The oral health of older Americans is very important and is getting more attention
and has improved. However there are certain factors that have an impact on the dental
health status of the elderly. For example these factors include, sex, age, social
economic status, and level of education. Being institutionalized also increases the risk
of poor oral health but could be improved by appropriate access to care. (5)

Goal:
Asses, develop, and enforce a dental health care program to educate the nurses and nursess aides
on how to properly clean and maintain their dentures and remaining permanent teeth to prevent
oral diseases of the residents.

Objectives:
Develop an oral health routine plan for the nurses and nursess aides to follow
during initial patient visit.
Educate the nurses and nurses aides to properly conduct an oral cancer
screening during patient assessment.
Demonstrate proper oral health techniques such as tooth brushing, flossing
and denture cleaning.
 Increase the dental knowledge of the nurse, and nurses aides by 20%.
Develop a written instruction manual to provide accurate and complete
implementation of the program.

Rationale:
Oral health is an important and often overlooked component of an older persons general health
and well being (6). Nearly 1 in 5 of adults aged 65 or older have lost all of their teeth. Having
missing teeth or wearing dentures can affect nutrition, because people without teeth or with
dentures often prefer soft, easily chewed foods instead of foods such as fresh fruits and
vegetables (7). Quality dental prostheses (dentures) can help persons who have lost some
or all of their natural teeth improve their quality of life by restoring lost function and esthetics
(6). Among elderly nursing home residents in 1995-97, 80 percent of those who had lost all of
their natural teeth had both dentures; however, 18 percent did not usually use them (6). Dry
mouth can be a particularly harmful problem for older adults. More than 400 commonly used
medications, including antihistamines, diuretics, and antidepressants, can cause dry mouth. Dry
mouth can also be a sign of certain diseases and conditions, such as diabetes, Parkinsons
disease, and Sjogrens syndrome (8). Having a dry mouth can cause difficulty chewing,
speaking, and swallowing. It also increases the risk of developing cavities and soft tissue
problems. Dry mouth may also decrease the ability to wear dentures (6).
To further assist the residents that cannot leave the home, the nurses and nurses aids should be
educated in proper oral health and maintenance. According to the pretest, the nurse has limited
knowledge about how to provide proper oral health care (2). In general nurses show limited
dental knowledge related to oral health which makes them incapable of providing the appropriate
care by early detection and prevention of oral disease. Nurses, including registered nurses,
licensed practical nurses, make up the largest proportion of health care professionals. Therefore,
it is essential that these health care providers are familiar with the various risk factors to manage
oral care and make appropriate referrals and intervention decisions as recommended (9).
Program Design:
A.Activities
Thepurposeofourhealthcareprogramistoeducatetheresidentsandnursesonproperoral
health.Theactivitieswillincludedentalprosthesiscare,oralcancerscreening,oralassessment,
teachingbasicdentalhealthandoralhygienepractices.Theactivitysessionswillbeperformed
onaweeklybasisatTheLucasHouse.Thediscussionswillbepresentedinthefollowing:

1.Session1(week1)
a.AdministratorsandManager
Presentationoftheoverviewoftheoralhealthprogramasitrelatestotheoralhealthof
thenursinghomeresidents.
1. Discusstheneedforpreventivedentalhealthoralprogramforthepatients.
2. Assessthedentalknowledgeofthehomehealthnursesandresidentsbyshowingthe
writtenpretestandposttest.
 3. Explaintheimportanceofgoodoralhygieneandhowtodevelopadailyoralhygiene
routine.
4. Explaintheimportanceofselfscreeningforearlydetectionoforalcancer.
5. Explaintheimportanceofkeepingdentalprosthesesclean.

Thesessionwillincludetheadministrationandmanagersandwillrequireanhour.

2.Session2(week1)
a.HomeHealthAides
Presentationoftheoverallhealthinformation,preventativeandmaintenancemethods.
Thissessionwillincludeapretesttoevaluatethedentalknowledgeofthenursesand
nursesaides.
1. Pretestwillbegiventodeterminethedentalknowledgeofeachindividual
2. Discussandreviewbasicoralhealthdependingontheindividualdentalknowledge.
3. Differentiatehealthy,soft/hardtissuescomparedtodiseasedbyusingvisualaids.
4. Demonstratepreventivemethods,suchas,brushandflossingbyusingatypodont.

Thesessionwillincludethenursesandnursesaidesandwillrequireanhouranda
half.

3.Session3(week2)
a.HomeHealthAides
Presentationwillbegiventothehomehealthaidesandthetopicswillincludescreenings
fororalcanceranddentalprosthesescleaningandmaintenance.
1. Reviewthetopicdiscussedintheprevioussession.
2. Demonstratehowtoprovideoralcancerscreenings.
3. Demonstratedenturecleaningusingadentalbrushandcleaner.
4. Demonstratedenturecleaningwiththeultrasoniccleaner.

Thesessionwillincludethehomehealthaidesandwillbehourandhalf.

4.Session4(week3)
a.Nurse,nursesaides
Observenurseand/ornursesaideswhiletheyprovideanoralhealthassessment,oral
cancerscreening,patienteducation,oralhygieneanddenturecleaningtotheresidents.
1. Observenurseandnursesaidesperformoralassessment
2. Observenurseandnursesaidesperformoralcancerscreening
3. Observenurseandnursesaidesprovidepatienteducationandoralhygiene
instruction
4. Iftheresidentsarewearingdenture(s),observethenursesand/ornursesaidesclean
thedenture(s).
 Thesessionwillincludethenurseandnursesaidesandwillrequireanhour.

5.Session5(week4)
a.Administrators,manager,nurse,nursesaides.

Assessmentoftheoralhygieneprogram.
1. Posttestwillbegiventoreassessthenursesandnursesaidestodeterminetheiroral
healthknowledge.
2. Reviewprevioussessions
3. Askforquestionsandfeedbackregardingoralhealthprogram

Thesessionwillrequireadministrators,nursesandnursesaidesandwillrequirean
hour.

B.ConstraintsandAlternativeStrategies

1.Constraint:Theresidentsandnursesandnursessaidesmaynotbeinterestedinpresentation.

Alternative:1.Havethemparticipateinhandsonactivities.2.Includevisualaidsalongwiththe
presentationtokeeptheirattention.3.Keeptheresidentsandnursesengagedbyasking
questions.

2.Constraint:Theresidentsmaynotbeabletoaffordtokeepupwithdentalneedsandregular
dentalvisits.

Alternative:1.Gatheralistofalldentalclinicsthatassisttheunderprivilegedorindigent
population.2.GatheralistofalldentalofficesthatacceptMedicaid/Medicareaspayments.3.
Stresstothestafftheimportanceofinformationresidentsoftheimportanceofdentalneedsand
services.

3.Constraint:Theresidents,nurses,andnursesaidesmaynotwanttoattendthepresentation
duetovariousschedules.

Alternatives:1.Haveofficemanagermakeannouncementsaboutdatesandtimesof
presentation.2.Makeflyersandgivetoofficemanagertopostthathasthescheduleddates.

C.Resources
Thefollowingresourceswillberequiredfortheimplementationoftheoralhealthprogram:
1. Personnel:session1administratorsandmanager,session2and3homehealthaides,
session4familycaregivers,nurse,nursesaides,session5administrators,manager,
nurse,nursesaides

2. VisualAides:
a. PowerPointshowingdifferencesbetweenhealthandunhealthyoralcavity
b. Flipcharttohelpdemonstrateproperbrushingandflossing
c. Typodontandtoothbrush

3. Supplies:
a. Toothbrush,toothpaste,floss(12kits),Denturebrushanddenturecleaner(12kits)
b. Disclosingsolution,plaquescoreforms,cups,ultrasoniccleaner,denturesample,
gloves,cottonswabs,napkins,gauze,tonguedepressorprovidedbyLITDental
HygieneClinic

4. Evaluationforms:
a. Pretest
b. Posttest(sametestasthepretest)
c. Administratorevaluatorform

5. Supplements:
a. Outlineoftheprogramplanprovidedbytheclinicians
b. Brochuredevelopedbytheclinicians

D. Budget
Theestimatedcostforthedentalhealthprogramisasfollows:
a. Toothbrushkits $75.00
b. Plasticcups $5.00
c. Gloves $30.00
d. Denturecleaner $5.00
e. Denturebrushes $30.00
f. Ultrasoniccleaner(donatedbyLITDentalHygieneclinic)
g. Gauze,tonguedepressor,papernapkins,cottonswabs,anddisclosingsolution
(donatedbyLITDentalHygiene)

E. TimeTable
Alloftheneededresourceswillbeutilizedforeachsession.Therewillbefivetotal
sessionsoverafourweekperiodoftime.Thescheduleisasfollows:
Session1weekofMarch2731
Session2weekofApril37
Session3weekofApril1014
 Session4weekofApril1721

F. Evaluation
A. ProcessEvaluation(formative)
1. Weeklymeetingwiththemanagertoevaluatethemasteryoftheskilland
progressoftheoralhealthprogram.
2. Weeklyreviewoftheoralhealthprogramtechniquesanddenture/partialcleaning
toassuremasteryoftheskill.
3. Weeklyreviewoforalcancerscreeningtoassureknowledge
4. Aweeklyreviewofthedentalknowledgeretainedofthenursesandnursesaids
B. ProductiveEvaluation(summative):
1. Apretestandposttestwillbegiventothenursesandnursesaidestoasses
andcomparetheirlevelofknowledgeindentalhealthcare.
2. Aquestionnairewillbegiventotheadministratorsandmanagertoassesthe
qualityiftheoralhealthprogram
3. Anannualcheckupwiththeadministratorwillbeconductedtoassurethe
nursesandnursesaidesarepracticingtheoralhealthprogram.
4. Provideawritteninstructionmanualtotheadministratorabouttheoralhealth
program.
5. Anannualcheckupwiththeadministratortoverifytheuseoftheoralcancer
screeningduringpatientassessment.
References

1. Enlivant where senior living thrives. Retrieved from:

www.enlivant.com/why-enlivant

2. Personal interview with Gretta Green (2/7/17)

3. Annual water qualify report. Retrieved from:

http://beaumonttexas.gov/wp-content/uploads/pdf/water/water_quality_report_15.pdf

4. Periodontal disease in seniors (age 65 and older). Retrieved from:

https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/GumDisease/Periodontaldisea
seSeniors65over.htm

5. Oral health for older Americans. Retrieved from:

https://www.cdc.gov/OralHealth/publications/factsheets/adult_oral_health/adult_older.ht
m?_ga=1.250673286.1433711351.1473737148

6. The oral health for older Americans. Retrieved from:

https://www.cdc.gov/nchs/data/ahcd/agingtrends/03oral.pdf

7. Facts about older American oral health. Retrieved from:

https://www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm

8. Oral health and older adults. Retrieved from:

https://www2c.cdc.gov/podcasts/media/pdf/HealthyAging_OralHealth.pdf

9. Oral & Dental Health Knowledge and Attitude among Nursing. Retrieved from:
www.scholink.org/ojs/index.php/wjer/article/download/602/563