o Two main reasons for inadequate dental health include lack of awareness about insurance and lack of knowledge about the need (Lee, Seok-Joo, Albert & Nelson, 2014). o Educating patients on oral health is a low cost solution resulting in less disease and pain (Olmsted et al., 2013). o Ongoing education on the importance of oral hygiene and follow-up dental services is pivotal to maintaining oral health (O’Connor 2012). o It is strongly recommended that an oral assessment be conducted by the nurse during first patient contact (O’Connor, 2012). o This baseline assessment identifies the need for further care by a dentist, and initiates long-term monitoring (Daly & Smith, 2015). o It is recommended that the assessment be conducted using a standardized Oral Health Assessment Tool (OHAT) to accurately assess the patient's current oral status and factors that place the patient at risk for oral disease. (Johnson & Chalmers, 2011). o Desired Outcome: The residents of Henry Street Settlement will decrease their Oral Health Assessment Tool (OHAT) total scores by the end of the six-month period. o Measurement Strategy: The total score calculated using the OHAT after six months of the educational program will be compared to the total score on the initial assessment. o Expected Outcome: Our practice improvement will be deemed successful if the residents show a decreased score in two or more categories on the OHAT. o The practice change that best address the problem in our population at Henry Street settlement are: Dental Education by the nurse, and the use of an Oral Health Assessment Tool (OHAT) to help assess the needs of the client. The majority who will service from our practice change are low-income clients who do not seek regular dental care. o For The implementation of our study, the following is needed: • Nursing staff will facilitate change process and implementation. • Funds: acquired through donation and/or a Federal grant. • Participation: includes clients of all ages within the Henry Street Settlement. • Educational Program: A nurse expert, or champion, will provide a Dental education program once a month for 1 hour. After the education, clients will be evaluated with the OHAT. • Following the screening referrals will be made to a dentist if needed, further education, and follow up appointment scheduled. For residents of all ages living within the Henry Street Settlement, will the implementation of a dental educational program and the use of an oral health assessment tool by the nurse on a monthly basis improve the oral health of the clients over a period of 6 months compared to the same individuals prior to the implementation of the program? o The scholarly databases searched to gather evidence included: Ebsco Host, CINAHL, Medline and PUBMED. o Keywords Used: dental hygiene, education, oral hygiene, dental health, the lower east side, Henry Street Settlement, nurse advocate, early prevention, low income, poverty, community nursing, dental education programs, oral health tool. o Delimitations used were: peer--reviewed articles, within the past five years, written in English, and U.S.-based articles Dental Education is important in the maintenance of dental health, for all ages o Evidenced-based practice recommendations to improve dental health include using dental health education: • Traditional dental education provided to parents by dentist is not sufficient enough to improve childhood dental health (Blinkhorn & Blinkhorn 2014). • General health practitioners, not just dentist need to be involved with childhood dental care (Blinkhorn & Blinkhorn 2014). • Parents should be informed by all practitioners about healthy dental practices to improve their children’s oral health o Dental education materials supplied to clients should be in an easy to read format, provided in multiple languages: • Clients are reluctant to read educational material because materials were too wordy, not in the reader’s primary language, lacked instructions & used confusing illustrations (Blinkhorn & Blinkhorn,2014). o Simultaneous use of dental health education and dental health assessment tools, correlates with improvement in dental health: • The Oral Hygiene Index simplified (OHI-S) and Plaque index (PI) dental assessment tools were used to measure the level of oral health (Chandrashekar, Suma, Kiran, & Manjunath 2012). Agency for Healthcare Research and Quality (2008) Dental Expenditures in the 10 Largest States, 2007 Retrieved From http://meps.ahrq.gov/mepsweb/data_files/publications/st299/ stat299.shtml American Academy of Periodontology (2015) Gum Disease and other systemic diseases. Retrieved from https://www.perio.org/consumer/other-systemic-diseases Centers for Disease Control and Prevention. (2013) Oral Cancer Retrieved from http://www.cdc.gov/oralhealth/oral_cancer/index.htm Centers for Disease Control and Prevention. (2008) Oral Health Status and Access to Oral Health Care for U.S.Adults Aged 18–64: National Health Interview Survey. Retrieved From http://www.cdc.gov/nchs/data/series/sr_10/sr10_253.pdf - x2013;64: National Health Interview Survey, 2008 %5BPDF - 430 KB%5D</a> National Cancer Institute (2014) SEER Stat Fact Sheets: Oral Cavity and Pharynx Cancer. Retrieved from http://www.who.int/mediacentre/factsheets/fs318/en/ National Institute of Dental and Craniofacial Research( 2014) Oral Cancer Incidence (New Cases) by Age, Race, and Gender Retrieved from http://www.nidcr.nih.gov/DataStatistics/ FindDataByTopic/OralCancer/OralCancerIncidence.htm New York Department of Health (2006) The impact of oral disease in new york state. Retrieved from https://www.health.ny.gov/prevention/dental/docs/impact_of_oral_disease.pdf World Health Organization (2012) Oral health . Retrieved from http://www.who.int/mediacentre/factsheets/fs318/en/ O'Connor L. (2012). Evidence-based geriatric nursing protocols for best practice. Oral health care. 4th ed. New York (NY): Springer Publishing Company. 409-418. Johnson V.B. & Chalmers J. (2011) Oral hygiene care for functionally dependent and cognitively impaired older adults. John A. Hartford Foundation Center of Geriatric Nursing Excellence. 61 Lee, W., Seok-Joo, K., Albert, J. M., & Nelson, S. (2014). Community factors predicting dental care utilization among older adults. Journal Of The American Dental Association (JADA), 145(2), 150-158. doi:10.14219/jada.2013.22 Northridge, M. E., Chenchen, Y., Chakraborty, B., Greenblatt, A. P., Mark, J., Golembeski, C., & ... Lamster, I. B. (2015). A Community-Based Oral Public Health Approach to Promote Health Equity. American Journal Of Public Health, 105S459-S465. doi:10.2105/AJPH.2015.302562 Olmsted, J. L., Rublee, N., Zurkawski, E., & Kleber, L. (2013). Public Health Dental Hygiene: An Option for Improved Quality of Care and Quality of Life. Journal Of Dental Hygiene, 87(5), 299-308. Bress, L. E. (2013). Improving Oral Health Literacy - The New Standard in Dental Hygiene Practice. Journal Of Dental Hygiene, 87(6), 322-329. Chandrashekar, B. R., Suma, S., Kiran, K., & Manjunath, B. C. (2012). The use of school teachers to promote oral hygiene in some secondary school students at Hyderabad, Andhra Pradesh, India: A short term prospective pilot study. Journal Of Family & Community Medicine, 19(3), 184-189. doi:10.4103/2230-8229.102319 Daly, B., & Smith, K. (2015). Promoting good dental health in older people: role of the community nurse. British Journal Of Community Nursing, 20(9), 431-436. doi:10.12968/bjcn. 2015.20.9.431 Blinkhorn, A., & Blinkhorn, F. (2014). Preventing dental decay in young children requires all primary health care professionals to work together. Journal Of Paediatrics & Child Health, 50(6), 423-424. doi:10.1111/jpc.12469 REFERENCES LITERATURE REVIEW IMPLEMENTATION BACKGROUND CONCLUSION MAJOR EBP RECOMMENDATIONS o Most people are unaware of the importance of regular dental visits and furthermore the importance of maintaining oral health. It is often attributed to lack of funds and education. o Dental education is imperative to have the most recent and accurate information on how to maintain oral health. By providing education on proper oral hygiene practices, one can avoid numerous health conditions. o Improving oral health improves the overall health in an individual. o Through implementation of the Oral Health Assessment (OHAT), we as nurses hope to improve the oral health of the individuals that are part of the Henry Street Settlement within a 6-month time frame. PICO o Financial Impact • In 2010, $ 108 billion dollars was spent on dental care services. (CDC, 2011) • 42% could not afford treatment or did not have insurance. Fear of dental care is also present, 10 percent feared going to the dentist. (CDC, 2008) • In 2007, 42% of dental expenses were paid out of pocket, 16 % healthcare period. Medicaid paid only 4.3 % of dental expenditures, while private insurance paid 42.8 of dental costs. o Morbidity and Mortality • The National Institute of Dental and Craniofacial Research (2009) reports that 10.5 out of 100,000 persons will develop oral cancer. • The American Academy of Periodontology (2015) reports approximately 50 %, equating to 64.7 million American adults have periodontitis. Severe periodontal (gum) disease was found in 15–20% of middle-aged adults • Mortality rates were 2.5 deaths per 100,000. 1.1 % of people develop oral cancer in their lifetimes. o Impact on the Patient • Oral disease consists of but is not limited to oral cancer, periodontitis, Dental caries, various infectious diseases, and tempo-mandibular diseases. . • Research shows that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers. (AAP, 2015) • Only 13 percent of adults over 40 seek screening for oral and pharyngeal cancers. (NYDOH, 2010) EVALUATION SEARCH STRATEGY Source: CDC Source: AAPD Source: Career Profiles Source: Dentistry IQ
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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
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