o  Twomainreasonsforinadequatedentalhealthincludelackofawarenessaboutinsuranceandlackofknowledgeabouttheneed(Lee,Seok-Joo,Albert&Nelson,2014).

o  Educatingpatientsonoralhealthisalowcostsolutionresultinginlessdiseaseandpain(Olmstedetal.,2013).

o  Ongoingeducationontheimportanceoforalhygieneandfollow-updentalservicesispivotaltomaintainingoralhealth(O’Connor2012).

o  Itisstronglyrecommendedthatanoralassessmentbeconductedbythenurseduringfirstpatientcontact(O’Connor,2012).

o  Thisbaselineassessmentidentifiestheneedforfurthercarebyadentist,andinitiateslong-termmonitoring(Daly&Smith,2015).

o  ItisrecommendedthattheassessmentbeconductedusingastandardizedOralHealthAssessmentTool(OHAT)toaccuratelyassessthepatient'scurrentoralstatusandfactorsthatplacethepatientatriskfororaldisease.(Johnson&Chalmers,2011).

o  DesiredOutcome:TheresidentsofHenryStreetSettlementwilldecreasetheirOralHealthAssessmentTool(OHAT)totalscoresbytheendofthesix-monthperiod.

o  MeasurementStrategy:ThetotalscorecalculatedusingtheOHATaftersixmonthsoftheeducationalprogramwillbecomparedtothetotalscoreontheinitialassessment.

o  ExpectedOutcome:OurpracticeimprovementwillbedeemedsuccessfuliftheresidentsshowadecreasedscoreintwoormorecategoriesontheOHAT.

o  ThepracticechangethatbestaddresstheprobleminourpopulationatHenryStreetsettlementare:DentalEducationbythenurse,andtheuseofanOralHealthAssessmentTool(OHAT)tohelpassesstheneedsoftheclient.Themajoritywhowillservicefromourpracticechangearelow-incomeclientswhodonotseekregulardentalcare.

o  ForTheimplementationofourstudy,thefollowingisneeded:• Nursingstaffwillfacilitatechangeprocessandimplementation.• Funds:acquiredthroughdonationand/oraFederalgrant.• Participation:includesclientsofallageswithintheHenryStreetSettlement.• EducationalProgram:Anurseexpert,orchampion,willprovideaDentaleducation

programonceamonthfor1hour.Aftertheeducation,clientswillbeevaluatedwiththeOHAT.

• Followingthescreeningreferralswillbemadetoadentistifneeded,furthereducation,andfollowupappointmentscheduled.

ForresidentsofallageslivingwithintheHenryStreetSettlement,willtheimplementationofadentaleducationalprogramandtheuseofanoralhealthassessmenttoolbythenurseonamonthlybasisimprovetheoralhealthoftheclientsoveraperiodof6monthscomparedtothesameindividualspriortotheimplementationoftheprogram?

o  Thescholarlydatabasessearchedtogatherevidenceincluded:EbscoHost,CINAHL,MedlineandPUBMED.

o  KeywordsUsed:dentalhygiene,education,oralhygiene,dentalhealth,thelowereastside,HenryStreetSettlement,nurseadvocate,earlyprevention,lowincome,poverty,communitynursing,dentaleducationprograms,oralhealthtool.

o  Delimitationsusedwere:peer--reviewedarticles,withinthepastfiveyears,writteninEnglish,andU.S.-basedarticles

DentalEducationisimportantinthemaintenanceofdentalhealth,forallages

o  Evidenced-basedpracticerecommendationstoimprovedentalhealthincludeusingdentalhealtheducation:

•  Traditionaldentaleducationprovidedtoparentsbydentistisnotsufficientenoughtoimprovechildhooddentalhealth(Blinkhorn&Blinkhorn2014).

•  Generalhealthpractitioners,notjustdentistneedtobeinvolvedwithchildhooddentalcare(Blinkhorn&Blinkhorn2014).

•  Parentsshouldbeinformedbyallpractitionersabouthealthydentalpracticestoimprovetheirchildren’soralhealth

o  Dentaleducationmaterialssuppliedtoclientsshouldbeinaneasytoreadformat,providedinmultiplelanguages:

•  Clientsarereluctanttoreadeducationalmaterialbecausematerialsweretoowordy,notinthereader’sprimarylanguage,lackedinstructions&usedconfusingillustrations(Blinkhorn&Blinkhorn,2014).

o  Simultaneoususeofdentalhealtheducationanddentalhealthassessmenttools,correlateswithimprovementindentalhealth:

•  TheOralHygieneIndexsimplified(OHI-S)andPlaqueindex(PI)dentalassessmenttoolswereusedtomeasuretheleveloforalhealth(Chandrashekar,Suma,Kiran,&Manjunath2012).

AgencyforHealthcareResearchandQuality(2008)DentalExpendituresinthe10LargestStates,2007RetrievedFromhttp://meps.ahrq.gov/mepsweb/data_files/publications/st299/stat299.shtml

AmericanAcademyofPeriodontology(2015)GumDiseaseandothersystemicdiseases.Retrievedfromhttps://www.perio.org/consumer/other-systemic-diseasesCentersforDiseaseControlandPrevention.(2013)OralCancerRetrievedfromhttp://www.cdc.gov/oralhealth/oral_cancer/index.htmCentersforDiseaseControlandPrevention.(2008)OralHealthStatusandAccesstoOralHealthCareforU.S.AdultsAged18–64:NationalHealthInterviewSurvey.RetrievedFrom

http://www.cdc.gov/nchs/data/series/sr_10/sr10_253.pdf-x2013;64:NationalHealthInterviewSurvey,2008%5BPDF-430KB%5D</a>NationalCancerInstitute(2014)SEERStatFactSheets:OralCavityandPharynxCancer.Retrievedfromhttp://www.who.int/mediacentre/factsheets/fs318/en/NationalInstituteofDentalandCraniofacialResearch(2014)OralCancerIncidence(NewCases)byAge,Race,andGenderRetrievedfromhttp://www.nidcr.nih.gov/DataStatistics/

FindDataByTopic/OralCancer/OralCancerIncidence.htmNewYorkDepartmentofHealth(2006)Theimpactoforaldiseaseinnewyorkstate.Retrievedfromhttps://www.health.ny.gov/prevention/dental/docs/impact_of_oral_disease.pdfWorldHealthOrganization(2012)Oralhealth.Retrievedfromhttp://www.who.int/mediacentre/factsheets/fs318/en/O'ConnorL.(2012).Evidence-basedgeriatricnursingprotocolsforbestpractice.Oralhealthcare.4thed.NewYork(NY):SpringerPublishingCompany.409-418.JohnsonV.B.&ChalmersJ.(2011)Oralhygienecareforfunctionallydependentandcognitivelyimpairedolderadults.JohnA.HartfordFoundationCenterofGeriatricNursing

Excellence.61Lee,W.,Seok-Joo,K.,Albert,J.M.,&Nelson,S.(2014).Communityfactorspredictingdentalcareutilizationamongolderadults.JournalOfTheAmericanDentalAssociation(JADA),

145(2),150-158.doi:10.14219/jada.2013.22Northridge,M.E.,Chenchen,Y.,Chakraborty,B.,Greenblatt,A.P.,Mark,J.,Golembeski,C.,&...Lamster,I.B.(2015).ACommunity-BasedOralPublicHealthApproachtoPromote

HealthEquity.AmericanJournalOfPublicHealth,105S459-S465.doi:10.2105/AJPH.2015.302562Olmsted,J.L.,Rublee,N.,Zurkawski,E.,&Kleber,L.(2013).PublicHealthDentalHygiene:AnOptionforImprovedQualityofCareandQualityofLife.JournalOfDentalHygiene,

87(5),299-308.Bress,L.E.(2013).ImprovingOralHealthLiteracy-TheNewStandardinDentalHygienePractice.JournalOfDentalHygiene,87(6),322-329.Chandrashekar,B.R.,Suma,S.,Kiran,K.,&Manjunath,B.C.(2012).TheuseofschoolteacherstopromoteoralhygieneinsomesecondaryschoolstudentsatHyderabad,Andhra

Pradesh,India:Ashorttermprospectivepilotstudy.JournalOfFamily&CommunityMedicine,19(3),184-189.doi:10.4103/2230-8229.102319Daly,B.,&Smith,K.(2015).Promotinggooddentalhealthinolderpeople:roleofthecommunitynurse.BritishJournalOfCommunityNursing,20(9),431-436.doi:10.12968/bjcn.

2015.20.9.431Blinkhorn,A.,&Blinkhorn,F.(2014).Preventingdentaldecayinyoungchildrenrequiresallprimaryhealthcareprofessionalstoworktogether.JournalOfPaediatrics&ChildHealth,

50(6),423-424.doi:10.1111/jpc.12469

REFERENCESLITERATUREREVIEW

IMPLEMENTATION

BACKGROUND

CONCLUSION

MAJOREBPRECOMMENDATIONS

o  Mostpeopleareunawareoftheimportanceofregulardentalvisitsandfurthermoretheimportanceofmaintainingoralhealth.Itisoftenattributedtolackoffundsandeducation.

o  Dentaleducationisimperativetohavethemostrecentandaccurateinformationonhowtomaintainoralhealth.Byprovidingeducationonproperoralhygienepractices,onecanavoidnumeroushealthconditions.

o  Improvingoralhealthimprovestheoverallhealthinanindividual.

o  ThroughimplementationoftheOralHealthAssessment(OHAT),weasnurseshopetoimprovetheoralhealthoftheindividualsthatarepartoftheHenryStreetSettlementwithina6-monthtimeframe.

PICO

o  FinancialImpact

•  In2010,$108billiondollarswasspentondentalcareservices.(CDC,2011)

•  42%couldnotaffordtreatmentordidnothaveinsurance.Fearofdentalcareisalsopresent,10percentfearedgoingtothedentist.(CDC,2008)

•  In2007,42%ofdentalexpenseswerepaidoutofpocket,16%healthcareperiod.Medicaidpaidonly4.3%ofdentalexpenditures,whileprivateinsurancepaid42.8ofdentalcosts.

o  MorbidityandMortality•  TheNationalInstituteofDentalandCraniofacialResearch(2009)reportsthat

10.5outof100,000personswilldeveloporalcancer.

•  TheAmericanAcademyofPeriodontology(2015)reportsapproximately50%,equatingto64.7millionAmericanadultshaveperiodontitis.Severeperiodontal(gum)diseasewasfoundin15–20%ofmiddle-agedadults

•  Mortalityrateswere2.5deathsper100,000.1.1%ofpeopledeveloporalcancerintheirlifetimes.

o  ImpactonthePatient

•  Oraldiseaseconsistsofbutisnotlimitedtooralcancer,periodontitis,Dentalcaries,variousinfectiousdiseases,andtempo-mandibulardiseases..

•  Researchshowsthatmenwithgumdiseasewere49%morelikelytodevelopkidneycancer,54%morelikelytodeveloppancreaticcancer,and30%morelikelytodevelopbloodcancers.(AAP,2015)

•  Only13percentofadultsover40seekscreeningfororalandpharyngealcancers.(NYDOH,2010)

EVALUATION

SEARCHSTRATEGY

Source:CDC

Source:AAPD Source:CareerProfilesSource:DentistryIQ