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 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 very important for the maintenance and improvement 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 has shown to not be sufficient enough

to improve childhood dental health (Blinkhorn & Blinkhorn 2014).

· To improve dental health, general health practitioners, not just dentist need to be involved with

childhood dental care (Blinkhorn & Blinkhorn 2014).

·Parents should be informed about healthy dental practices to promote within their children’s oral

health by all practitioners.

o Dental education materials supplied to clients should be in an understandable, in an easy to

read format, provided in multiple languages, etc:

· In a study done by Blinkhorn & Blinkhorn (2014) clients were shown to be reluctant to read

educational material because:

Ø Materials were too wordy and not in the reader’s primary language.

Ø Materials lacked instructions of how conduct dental care, and provided unhelpful/

confusing illustrations.

o Simultaneous use of dental health education and dental health assessment tools, correlates with

improvement in dental health:

· In a study done by Chandrashekar, B. R., Suma, S., Kiran, K., & Manjunath, B. C. (2012), the Oral

Hygiene Index simplified (OHI-S) and Plaque index (PI) dental assessment tools were used to measure

the level of oral care/ health.

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 Oral disease consists of but is not limited to oral cancer, periodontitis,

Dental caries, various infectious diseases, and tempo-mandibular

diseases.

o In 2010, there was an estimated $ 108 billion dollars spent on dental care

services. (CDC, 2011)

o The National Institute of Dental and Craniofacial Research (2009) reports

that 10.5 out of 100,000 persons will develop oral cancer.

o Mortality rates were 2.5 deaths per 100,000. 1.1 % of people develop oral

cancer in their lifetimes.

o 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.

o 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)

o 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)

o 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 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 ProfilesSource: Dentistry IQ

Source: Chalmers J, Johnson V, Tang JH, Titler MG. Evidence-based protocol