I.

Needs Assessment
A. General Data
1.Description of Site
The Arboretum of Winnie is located on Highway 124
in Winnie Texas. The arboretum was founded in 2000
by TAG Management Services as a nursing,
rehabilitation, and physical therapy center. TAG is a
Texas family, caring for Texas families. Their primary
office is in Victoria, Texas. They provide services in 8
facilities across the state. The funding for this facility
is Medicare, Medicaid, private pay, insurance, and
managed care.
2. Description of Target Group
Our target group will be approximately 6-10 nursing
home residents. They will be people who are
performing their own oral hygiene. (1)
3. Description of Staff Population
Certified Nurses Aids (CNAs) are responsible for the
oral hygiene of the residents. The CNAs brush the
teeth of residents whom are unable to brush their
own. They also report any suspicious areas to the
social worker for referral to the dentist. There are
approximately 8-10 CNAs on staff on each day. Their
education level is a certificate degree.
4. Description of Services Provided
The activities director is responsible for the activities
of the entire facility. The director provides a monthly
calendar listing the activities available to the
residents. Our oral care program will be listed on this
monthly calendar. There are other activities such as
health awareness programs and social activities. The
calendar includes dates and time of games & other
activities that give residents the opportunity to
mingle with others.
5. Other Pertinent Data
The community water is fluoridated at .80mg/L. This
water system adjusts the natural fluoride

concentration upward to the optimal level for the

prevention of dental caries. (3)

B. Information Related Dental Health

1. Services Provided
A dentist comes into the facility every 3-4 weeks.
The dentist is employed by Mid-Cities Dental
Management Inc. The services provided are teeth
cleanings, extractions, fillings, root canals, crowns,
as well as full dentures. (2)
2. Preventive Measures Utilized
Tooth brushing is the only preventive measure
utilized by patients and CNAs.
3. Supplies Available
The supplies available to the residents are
toothbrushes and toothpaste.
4. Description and Results of Previous Dental
Programs
This will be the first oral health program at this
facility.
5. Staffs Knowledge and Awareness of Dental
Health
The CNA program does not include dental health
education, but nurses possibly receive continuing
education through the facility on dental health.
C. Dental Health Status
1. Dental Caries
Nearly one-third of all adults in the United States
have untreated tooth decay. In addition, nearly a
quarter of all adults have experienced some

facial pain in the past six months. In Texas 39.4%

of adults age 65 and older have lost 6 or more
teeth due to decay and periodontal disease. (4)
2. Periodontal Disease
One in seven adults aged 35 to 44 years has
periodontal disease; this increases to one in
every four adults aged 65 years and older. (4)
3. Oral Hygiene
Painful conditions that affect the facial nerves are
more common among the elderly and can be
severely debilitating. These conditions can affect
mood, sleep, and oral-motor functions such as
chewing and swallowing. Neurological diseases
associated with age; such as Parkinson's disease,
Alzheimer's disease, Huntington's disease, and
stroke also affect oral sensory and motor
functions, in addition to limiting the ability to care
for oneself. (4)
4. Malocclusion
About 25 percent of adults 60 years old and older
no longer have any natural teeth. Interestingly,
toothlessness varies greatly by state. Roughly 42
percent of Americans over age 65 living in West
Virginia are toothless, compared to only 13
percent of those living in California. Having
missing teeth can affect nutrition, since people
without teeth often prefer soft, easily chewed
foods. Because dentures are not as efficient for
chewing food as natural teeth, denture wearers
also may choose soft foods and avoid fresh fruits
and vegetables. (4)
5. Oral Cancer
Oral cancers are most common in older adults,
particularly those over 55 years who smoke and are
heavy drinkers. Oral and pharyngeal cancers, which

are diagnosed in some 31,000 Americans each year,

result in about 7,400 deaths each year. These
cancers are primarily diagnosed in the elderly.
Prognosis is poor. The five-year survival rate for white
patients is 56 percent and for African American
patients is only 34 percent. (4)
6. Utilization of Dental Services
Residents have access to the mobile dental service
that comes to the facility every 3-4 weeks. CNAs
report any needed dental service to the social
worker on staff. The social worker then schedules
the needed procedures. (1)
7. Additional Information
Most older Americans take both prescription and
over-the-counter drugs. Over 400 commonly used
medications can be the cause of a dry mouth.
Reduction of the flow of saliva increases the risk for
oral disease, since saliva contains antimicrobial
components as well as minerals that help rebuild
tooth enamel attacked by decay-causing bacteria.
Individuals in long-term care facilitiesabout 5
percent of the elderlytake an average of eight
drugs each day. (4)

Goal Statements
1. To provide the knowledge and skills in maintaining optimal
oral health for the residents and staff of The Arboretum of
Winnie Nursing Rehabilitation Center.
Objective Statements
1. Decrease the plaque score of residents by 15% through oral
hygiene skill development.
2. To increase dental health knowledge of staff by 20% as
measured by pretest and post-test.

3. To increase dental health knowledge of residents by 20% as

measured by pretest and post-test.
4. To develop a dental health resource list of oral health
brochures and dental care facilities for the staff.
5. To assess the success of the over all program by providing a
questionnaire to the program director.

Rational
Older Americans make up a growing percentage of the U.S.
population; according to the 2000 U.S. Census, nearly 35 million are 65
years or older. By 2050, that number is expected to increase to 48
million. Oral diseases and conditions are common among these
Americans who grew up without the benefit of community water
fluoridation and other fluoride products. Older Americans with the
poorest oral health are those who are economically disadvantaged,
lack insurance, and are members of racial and ethnic minorities. Being
disabled, homebound, or institutionalized also increases the risk of
poor oral health. (3, 4)
Retention of teeth throughout the lifespan is desirable;
however, dental care and maintenance become more complex and
present additional challenges in long-term care and assisted living
facilities. (5)
The Surgeon Generals Report identified frail elders and
nursing home residents among the population most vulnerable to poor
dental care. Aging populations have fewer financial resources and
often do not retain dental insurance upon retirement. Elderly
individuals are faced with a variety of age related functional disabilities
directly and indirectly affecting their oral health. (5)
Most residents of The Arboretum are older adults. Our target
group is able to perform basic dental hygiene skills. The facility only
provides the residents with toothbrushes and toothpaste. Our program
will provide the residents with floss and proper instructions.

In conclusion, older adults suffer from many disadvantages

ranging from no dental insurance to health issues that limit their ability
to properly care for their own oral health. Dental health education is an
ongoing process necessary through out life.

Program Design
A. Activities
In this program we are providing oral health education to the
staff and residents of The Arboretum of Winnie. This program will
be performed 4 times spaced a week apart. We are posting a
flyer on the bulletin board and the program will be listed on the
monthly calendar. The following activities will be presented.
1. Session 1 (Week 1):
a. Residents
Introduction of brushing techniques to the residents.
1. Pass out pretest to determine oral health
knowledge of residents.
2. Demonstrate the proper technique of brushing
on a typodont.
3. Define and explain plaque.
4. Pass out posttest to evaluate the increase of
knowledge of the residents.

2. Session 2 (Week 2):

a. Staff
Introduction of flossing using the correct technique to
the staff. Educate staff on denture cleaning. Discuss
oral cancer signs and symptoms to the staff.
1. Demonstrate the proper technique of flossing
and show the staff easy flossing aids to make
available to the residents.
2. Demonstrate proper denture cleaning and care.
3. Demonstrate oral cancer exam using a poster
provided.

4. Describe atypical findings that should be

reported to the dentist. Be able to recognize
oral atypical findings.
3. Session 3 (Week 3):
a. Residents
Introduction of periodontal disease to the residents.
Provide
pamphlets to residents and explain the
added risk of systemic diseases such as diabetes to
the periodontium.
1. Discuss periodontal disease and distribute
pamphlets to the residents.
2. Determine risk factors if any among the
target group.
3. Pass out diabetes pamphlets if needed.
4. Session 4 (Week 4)
a. Staff
Provide list of available resources to the staff. Give list of
websites that we ordered free pamphlets from. Provide
information regarding the LIT Dental Hygiene Clinic.
1. Provide a copy of each pamphlet used in the oral
health program.
2. Provide a list of websites that we ordered the
pamphlets from.
3. Discuss services available to the residents through
the Dental Hygiene Clinic at LIT.
4. Provide flyers from the Hygiene Clinic.
B. Constraints and Alternative Strategies
1. Constraints: Lack of interests on the part of the
residents.
Alternative: Provide free samples of toothbrushes,
toothpaste, and floss.
2. Constraints: Residents unable to show up due to illness.
Alternative: Speak to staff on days that residents are
unable to attend oral health program.
3. Constraints: Staff unable to attend oral health program.

Alternative: Provide pamphlets and written information

regarding
that days session.
4. Constraints: Residents refusing to use disclosing tablets.
Alternative: Discuss the importance of daily plaque
removal and how disclosing tablets are used to
access plaque accumulation.
C. Resources
The following resources will be required for implementation
of the program:
1. Personnel: Program Planners.
2. Equipment:
3. Supplies: Toothbrushes, Toothpaste, Floss, Disclosing
Tablets, Gloves, Mask, Eye wear.
4. Visual Aids: Typodont, Oral Cancer Poster, Videos
5. Pamphlets: Oral Cancer, Periodontal Disease, and
Diabetes.

D. Budget
The estimated cost for the dental health program is as
follows:
1. Toothbrush Kits..Donated by Colgate
2. Bags for Toothbrush kits...Donated by Colgate
3. Cups and Napkins..$5.00
4. Gloves and Masks...$6.00
5. Pamphlets and PostersFree from NIDCR
6. Denture Brushes/Tablets..Donated by Colgate

E. Timetable:
All resources will be obtained prior to each session. There will be
4 sessions spanning a 4-week period. The projected week of
implementation will be as follows:
Session 1: March 26th
Session 2: April 7th
Session 3: April 14th
Session 4: April 21st
Evaluation
A. Process Evaluation (Formative)

1. An assessment of brushing techniques in an effort to

modify as needed for optimal plaque control.
2. An assessment of flossing techniques in an effort to
modify as needed for optimal plaque control.
3. An assessment of denture cleaning techniques in an
effort to modify as needed for optimal plaque control.
4. A weekly review for each group of the information
which was presented during the previous session will
be conducted to promote optimal understanding and
retention of information.
5.The success and individual comprehension of each
presentation will be assessed through a question and
answer session upon the completion of each session.
B. Product Evaluation (Summative)
1. An evaluation of plaque scores to determine
comprehension of brushing techniques.
2. A pretest and post-test will be given to the staff to
asses and compare their level of dental health
knowledge.
3. A pretest and post-test will be given to the residents
to asses and compare their level of dental health
knowledge.
4. A review of the oral health brochures list to ensure
accurate information is being provided.
5. The success of the overall program will be evaluated
by a questionnaire given to the director upon the
conclusion of the oral health program.
Appendix
Plaque Score
Lesson Plan
Pretest/Posttest
Program evaluation
Etc.

Reference Page
1. Social Worker, personal communication, February 12, 2015
2. Mid-Cities Dental Management,(2010) Retrieved from
www.manta.com/c/mrOvs40/mid-cities-dental-management-inc
3. Oral Health Maps for Water Fluoridation, (2006) Chambers County,
(Data File). Retrieved from http://apps.nccd.cdc.gov/gisdoh/adult.aspx
4. Centers for Disease Control and Prevention, (2013) Oral Health for
Older Americans, Retrieved from
http://www.cdc.gov/oralhealth/publications/factsheets/adult_oral_health
/adult_older.htm
5. Hardgraves, V. M. & Mitchell, T. V., (December 2014). The Journal of
Dental Hygiene, volume number 88 (No. 6). Retrieved from
www.adha.org/jdh Vol. 88 No. 6 December 2014 The Journal of Dental
Hygiene