Amanda Stout

Suki Misra
Brenda Garcia

Oral Health Program Development

Needs Assessment

A. General Data
Description of site:

Mid county Senior Center is a senior activities center located at 914 Boston Avenue in
Nederland Texas. It was established and coordinated in May 2008. There is a maximum capacity
of 80 patrons but currently the center only has 24 members. This facility offers the highest
standards of care as well as compassion toward the elderly with emphasis on socialization
among this organization’s current members. The goal is to get the elderly out and involved in
society, helping them to realize they still have a place in our community despite their feelings of
belonging in an age full of technology and youth (1). This organization gets these individuals
involved in quilt making as well as socialization and volunteer work without the community.
Numerous individuals within this program have lost loved ones due to old age as well as many
friends throughout the years, so Mid county Senior Living gives them the opportunity to get out
of the house and come to a place where they can interact with individuals going through the
same emotional ailments (1).

Description of Target Group:

There is a total of 24 members of our target group consisting of elderly individuals as well as
the director of the program Diane LaPointe and Assistant to the director Heather Kaiser. Our
target population is men and women with age ranges of 65 and up that have periodontal issues
and oral diseases due medication use. Out of the 24 members only 15 wear dentures, and the
full 24 are on some type of medication for medical issues. There are more females in
comparison to males as well as the majority of the patrons being of Caucasian ethnicity (1).

Description of Staff Population:

The staff population includes the Director, Diane Lapointe as well as the assistant to the
director Heather Kaiser. Diane Lapointe has been a resident of Port Arthur for over 40 years and
has earned a Bachelors in Education from Lamar University with a minor in communication.
Heather Kaiser is a registered nurse. These individuals provide a structured and safe
environment for the members within this facility as well as assist the patrons with any needs
while visiting the Senior center. Diane Lapointe and Heather Kaiser are both certified in CPR and
the center has safety protocols and procedures in place in case of an emergency (1).
Amanda Stout
Suki Misra
Brenda Garcia

Description of Services Provided:

Mid County Senior Living Center provides numerous activities throughout the week for the
elderly, these include bingo, pool, dominoes and quilt making. The activities vary depending on
the day and the participation of the patrons. Some days feature educational topics that are
delivered from local institutions such as the Lamar School of Nursing about various topics. The
members of the Mid County Senior Living Center also participate in quilting, dominoes, and
bingo. The director runs and supervises all of the programs that become available to the
members and communicates with the public and different organizations in order to provide
learning opportunities to the members of this establishment (1). The patrons of this facility are
provided one meal a day around 11:00 AM contributed on behalf of Meals on Wheels (2). The
facility also provides snacks throughout the day and an outlet for the patrons to give back to
their community by knitting caps and beanies to donate to both Cancer victims and survivors
(1). The facility also has internet capabilities and adequate space for activities and socialization
(1).

Other Pertinent Data:

The average water fluoridation for Nederland, Texas is 0.7milligrams per liter (mg/L). This level
of fluoride helps in preventing tooth decay and promotes good oral health (3).

Information Related to Dental Health:

The facility has running water which has the allotted fluoride amount needed to sufficiently
assist in aiding to mineralize the teeth (3). The facility also provides educational topics from the
local dental community, although it has been a few years since the last guest speaker was there
(1).

Dental Health Status

Periodontal Disease:

According to a recent report by the CDC, 47.2% of adults ages 30 years and older have some
type of periodontal disease. There is research to prove that periodontal disease increases with
age. An estimated 70.1% of adults 65 years and older have periodontal disease. Periodontal
disease in more common in men and women. Men, having a higher chance at 56.4% vs women
at 38.4%. It is also more common in those living below the federal poverty level (65.4%) due to
lack of access to dental care. Periodontal disease is also greater for those individuals with less
than a high school education (66.9%), and individuals who currently smoke.(64.2%) (4).
Amanda Stout
Suki Misra
Brenda Garcia

Xerostomia:

Data from the ADA website it is reported that 0.9%- 64.8% experience xerostomia. The
prevalence of this condition varies on certain medical ailments such a radiation treatment,
medically induced xerostomia and aging. Saliva is a mixture of secretions from the major
salivary glands and in healthy individuals the salivary flow ranges from 0.5 to 1.5 liters. When
this number is compromised due to medications and their side effects or other causes it can
result in potential decay and oral infections within the oral cavity. The website also states that
reduced salivary flow can interfere with chewing or swallowing certain foods which may result
in malnutrition. Medicated induced xerostomia is the most frequent cause of hyposalivation.
According to the Surgeon Generals Report on Oral Health in America, more than 400 over the
counter and prescription medications can contribute or exacerbate oral dryness, including
antihistamines, antihypertensive medications, decongestants, pain medications and so on (5).

Oral Hygiene:

Good oral hygiene habits are beneficial to the older adult. This includes: using powered tooth
brushes, fluoride treatments, healthy dietary intake, daily mouth rinses, daily mouth rinses and
especially non-alcoholic mouth rinses for those patients who suffer from xerostomia (5).

Denture Care:

According to the ADA website more than 35 million Americans are edentulous and 90% of those
edentulous population have dentures. 178 million Americans are missing at least one tooth and
13% of current smokers are edentulous, compared to just 5% of people who never smoked (6).

Additional Information:

According to the National Cancer Institute, 10.5:100,000 people will develop oral cancer. The
chances of oral cancer increases as adults get older and becomes more rapid with age. Oral
cancer is more common in Hispanic and Black men than women. It reaches its maximum peak
from ages 60-70 years old. Since these findings are more common in the elderly, it is important
to assess the patrons and demonstrate to them as well on how to perform oral cancer
screenings on themselves (7).
Amanda Stout
Suki Misra
Brenda Garcia

Goal: The goal of our program is to provide a preventative oral health care program and
educate the patrons of Mid County Senior Living Center on how to properly care for their oral
health.

Objectives:

Increase the patrons of Mid County Senior Centers’ knowledge by 10% using the pre and
post test.

Educate the patrons of Mid Country Senior Center how to perform a self head and neck
exam on themselves

Educate the patrons of Mid County Senior Center how to properly care for dentures and
demonstrate oral health techniques for both edentulous and non-edentulous patients.

Increase the knowledge of the patrons of Mid Country Senior Center on xerostomia and
different oral health care aids that can assist in xerostomia such as biotene, alcohol free mouth
rinses etc.

Rationale:

The oral health of the elderly is often overlooked or neglected. Other times, it may not be
considered a priority for the elderly as compared to other medical issues they may be having (8).
Studies have shown that older adults are living longer and retaining natural teeth for a longer
period of time as well (4). Therefore, it is of great importance to provide oral health education to
the elderly and focus on their specific needs. There are certain oral health issues such as
Periodontal disease, root caries, missing teeth, xerostomia, dentures, effects of systemic disease
and medications on oral tissues and oral cancers that are common in aging adults (8). As dental
healthcare professionals we know that oral health is imperative to achieve optimum overall
health therefore we need to spread awareness about how to take care of our oral health.

America’s Tooth Fairy is a program that teaches families why oral health is important and how to
take care of their mouth. They also supply basic oral health care products for daily care and
provide funding to low-income families can do not have access to regular dental care. Thus, it has
similar goals like our oral health program with the objective of spreading awareness to the
population and educating them on how to take care for their oral needs (9).
Amanda Stout
Suki Misra
Brenda Garcia

Similarly, Smiles Across America provides preventive services like dental education, fluoride
varnishes and sealants. They distribute over 500,000 units of dental products every year to
population that is lacking in preventive care. This relates to our oral health program in the way
that we are planning to provide information and samples of products to our elderly group. This
will be catered to their specific needs such as denture cleaning aids, salivary substitutes like and
others to help them take care and improve their oral health (10).

Wisdom Tooth Project is designed to connect older adults or their caregivers for relevant dental
health information that applies to their specific needs. It also directs older adults to affordable
care through links to local services (10). This relates to our oral health program because we plan
to provide our group of elderly participants with information for our dental clinic. By doing that
they will have access to regular dental exam, oral cancer screening and obtain affordable hygiene
care such as cleanings, patient education on numerous topics. Additionally, our referral program
will be helpful in connecting patients with local providers to seek care for other dental issues not
provided at our clinic. This will help in establishing a dental home for our participants.

Program Design:

Activities

The purpose of our Oral Health Program is to teach the patrons of Mid County Senior Center
the importance of oral health. Due to their age, they are at risk for numerous oral health issues
caused by aging and need to be aware on the methods to assist them in both attaining and
maintaining optimal oral health. Our discussions will include teaching the basics on both
brushing and flossing, along with information about certain oral health aides that can assist
them in this process. We will demonstrate and educate them on oral cancer screenings and the
importance of doing so at home, as well as xerostomia, and denture care.

Interview (week 1)

Involves the program director and the assistant.

Discussion and interview with Diane Lapointe and Heather Kaiser.

Discuss the purpose of the oral health program involving the elderly and oral health.

Assess the facility and target population.

Discuss the importance of oral health care in older adults.

This session will require 30 minutes and involve the director of the program and her assistant.

Session 1 (week 2)
Amanda Stout
Suki Misra
Brenda Garcia

Home Health Aids:

In this session we will provide a presentation over basic health information and the importance
of good oral hygiene. A pretest will be given to the patrons in order to measure their
knowledge over general oral health.

Pretest will be given to patrons of Mid County Senior Center to measure basic dental
knowledge.

Discuss with patrons the importance of good oral health

Discuss with the patrons what gum disease and periodontitis is

Have patrons brush on typodont and assist them in modifying their technique

Explain what plaque score is and use disclosing tablet to demonstrate plaque left on the teeth

This session will require an hour and will involve the patrons of the facility.

Session 2 (week 3)
Patrons of Mid Country Senior Center
In this session we will discuss Periodontitis, dental caries, root caries and medically induced
Xerostomia. We will explain the effect these topics have on the oral cavity and medications that
can cause xerostomia.

Discuss and visual present using patient education books and pamphlets on what periodontal
disease is.

Explain what caries and root caries are and how to prevent.

Explain what xerostomia is and medications that cause it

Educate patrons on fluoride and its benefits.

We will inform the patrons about saliva substitutes and alcohol free mouth rinses.

This session will require an hour and will involve the home health aids.

Session 3 (week 4)
Presentation will include head and neck exam demonstration and denture cleaning will be
assessed.
Amanda Stout
Suki Misra
Brenda Garcia

Review brushing, flossing and plaque score, basic health information.

Demonstrate head and neck exam and discuss oral cancer screening.

Demonstrate denture cleaning using denture brushes and denture cleaner.

This session will require an hour and will involve the patrons of the Mid Country Senior Center.

Session 4 (week 5)
In this final session we will administer a post-test and have the patrons of Mid Country Senior
Center demonstrate procedures learned and review overall health discussions.

Administer post-test

Review overall health information given to patrons of Mid County Senior Center.

Observe patrons perform head and neck assessment.

Observe patrons perform proper brushing, flossing and denture care technique.

Ask for feedback.

This session will require an hour and will involve the patrons of Mid Country Senior Center.

Constraints and Alternative Strategies:

Constraint: The staff and the residents may not seem interested in the lesson.

Alternative: Explain to the patrons of Mid Country Senior Center the importance of
keeping goo oral hygiene and how it can affect them systemically. Also have visual aides and
goody bags to keep our audience engaged and interested.

Constraint: The patrons of Mid County Senior Center may not want to participate

Alternative: Have the patrons involved by asking questions and rewarding them with
goodies such as oral health care aids, toothbrushes and toothpaste as well as incorporating a
game into the educational lesson.
Resources:

Location- The main socialization room located at the Mid Country Senior Center
Amanda Stout
Suki Misra
Brenda Garcia

Supplies: Disclosing tablets, toothbrushes, floss, cups, swabs, denture cleaner/brushes,

pamphlets, mouth wash(alcohol free), gloves, masks, PPE, pre and post- test, typodont, patrons
of the center, patient education flip books, xylitol gum, mirrors, pencils, tongue depressors,
polydent, zipbloc bags.

Budget:

*Gloves/Mask-provided by presenters
*Pre/Post test- provided by presenters
*Toothpaste- provided by presenters
*Floss-provided by presenters
*toothbrushes-provided by presenters
*Mouthwash-provided by presenters
*polydent- provided by presenters
*Biotene- provided by presenters
*Denture brushes-provided by presenters
*Denture cleaning tablets- provided by presenters
*mirrors-provided by presenters
*Plaque score form: provided by instructor
*Disposable cups: $2
*Pamphlets: $10
*Zipblock bags: $4
*Estimated total cost: $30

Timetable:
Session 1: February 5th 2019
Session 2: April 16th 2019
Session 3: April 23rd 2019
Session 4: April 25th 2019

Evaluation:

Formative:
Amanda Stout
Suki Misra
Brenda Garcia

Pre-test will be given at session 2 and post test at session 5 to determine any improvement and
knowledge in their overall oral health.

Patrons will demonstrate proper oral hygiene procedures during sessions 2-5
Patrons will demonstrate and practice self oral cancer screenings during the 4 th session
Patrons will demonstrate proper denture care and procedures during fourth session.

Summative:

A pre-test and post-test will be given and evaluated to assess the knowledge of the patrons and
see if their oral health knowledge had increased by 10%

Questionnaires will be given to the Director and Assistant of Mid County Senior Living to assess
the success of the oral health program.

Appendix:

Pre-test and post-test , program evaluation and lesson plans.

Pre/Post Test

1. What is Plaque?
a. Debris from food
b. Sugar
c. Bacteria

2. How often should you brush your teeth?

a. 1 per day
b. 1 every other day
c. 2 per day
d. 2 times a week

3. How long should you brush your teeth for?

a. 15-30 seconds
b. 1 minute
c. 5 minutes
d. 2 minutes
4. How often should you floss your teeth?
Amanda Stout
Suki Misra
Brenda Garcia

a. 1 per day
b. 1 every other day
c. Before dental visits only
d. 1 every week

5. How often should dentures be brushed?

a. 1 per day
b. 1 per month
c. 2 per day
d. Every six months

6. How often should dentures be removed?

a. Daily
b. Weekly
c. Monthly
d. Yearly

7. Best tool(s) to use for cleaning dentures?

a. Soft bristle brush
b. Over the counter denture cleaners
c. Both a and b
d. Toothpaste

8. How can Dry mouth or Xerostomia be treated?

a. Take frequent sips of water
b. Saliva substitutes
c. Chew sugar free gum or hard candy
d. All of the above

9. Root cavity or decay can spread to inside of tooth and can cause toothache/infection?
a. True
b. False

10. Regular dental visits are important even if you have lost all your teeth?
a. True
b. False
Amanda Stout
Suki Misra
Brenda Garcia

Answer Key:

1. C
2. C
3. D
4. A
5. A
6. A
7. C
8. D
9. A
10. A
Amanda Stout
Suki Misra
Brenda Garcia

References:

2. (2018). Retrieved February 19, 2019, from Meals on wheels America:

https://www.mealsonwheelsamerica.org/learn-more
5. Bartels, C. L. (n.d.). Xerostomia. Retrieved February 26, 2019, from Oral cancer foundation:
https://oralcancerfoundation.org/complications/xerostomia/
1. LaPointe, D., & Kaiser, H. (2019, February 5). Midcounty Senior Living. (A. R. Stout, B. J.
Garcia, & S. Misra, Interviewers)
3. Nederland Town Of 2017 Drinking Water Quality Report. (n.d.). Retrieved February 19, 2019,
from Nederlandco.org: http://nederlandco.org/wp-content/uploads/2017/06/2017-Consumer-
Confidence-Water-Report.pdf
7. Oral Cancer Incidence (New Cases) by Age, Race, and Gender. (2018, July). Retrieved February
26, 2019, from https://www.nidcr.nih.gov/research/data-statistics/oral-cancer/incidence
6. Oral Health Topics Dentures. (2016, August 30). Retrieved February 26, 2019, from American
Dental Association : https://www.ada.org/en/member-center/oral-health-topics/dentures
4. Periodontal Disease. (n.d.). Retrieved February 26, 2019, from Centers for Disease Control
and Prevention: https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html
8. Oral health in the elderly patient and its impact on general well-being: a nonsystematic
review. (2015 Feb 11). Retrieved February 26, 2019, from National Center for Biotechnology
Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334280/
9. America's Tooth Fairy. (2018). Retrieved February 26, 2019 from America's Tooth Fairy:
https://www.americastoothfairy.org/
10. Pleis, Donna(2019). 3 Organizations Currently Furthering Oral Health Education. Retrieved
February 26, 2019, from https://www.colgate.com/en-us/oral-health/basics/dental-visits/3-
organizations-currently-furthering-oral-health-education-1114