Cherrisa Pham

Paula Philpott
Armando Chavez
OH Program Part 1

General Data
I. Description of Site and Client Population/Target Group
Atria Collier Park is an assisted senior living organization that is located on 4650
Collier St. in Beaumont, Texas. Atria senior living is a privately held management
company that operates monthly rental apartments for seniors. Atria senior living began in
1996 and the purposes of this organization is to recognize the challenges of aging as they
are dedicated to encourage a fulfilling lifestyle and promote independence. This
organization provides many entertaining, educational, and useful activities for all
residence. Atria senior living is a private pay senior housing and there are no funds
involved. (1).
There are about 10-20 seniors in a group and they range from ages 60-95 years in
need of personal care, medication assistance, and incontinence management.(1). The
agency provides a caring and safe environment to help enhance and promote the seniors
quality of life to have a better future. Their diet is completely based upon their standard
health. Our goal as dental health care providers is to educate and promote a complete
nutritional plan towards an achievable overall health.

II. Description of staff population

There are thirteen resident service aides, eight medication aides, six engage
life department/drivers, four maintenance employees, one culinary director, sixteen
combined wait/kitchen staff, and seven administrative staff members. Fifty-six staff
members, thirty have college degrees ranging from AAS to BS. The facility has assisted
living, which is maintained by the nurse (the Resident Service Director) and the
independent residents care for themselves with home health or other services. (3).

III. Description of Services Provided

The program director of two years, Mrs. Roxanne Johnson, is the coordinator of
the “Engage Life” activities at Atria Senior Living. Atria Collier offers an “Engage Life”
program that creates a fulfilled calendar with more than 200 engaging opportunities for
residents to enjoy. Every day of each week there are events that begin at 9:30 until 6:00
in the evening and each member are encouraged to be involved and remain as active as
possible. (1) Examples of events are: Personal Achievement, Health & Fitness,
Entertainment & Fun, Civic Engagement, Lifelong Learning, Creative Expression,
Inspiration & Spirituality, Connection, and Atria Story Wise. The senior living services
also provides a 24 hour availability of the staff that includes Beauty & Barber Services,
 Housekeeping, Laundry, Physical Therapist, Speech Therapist, and Nurse on Call (1).
Atria Senior Living plans are to recognize the challenges of aging, we are dedicated to
encouraging a fulfilling lifestyle and promoting independence. (1).

IV. Pertinent Data

Water fluoridation for the city of Beaumont, Texas is currently 0.70 ppm. The
National Health Surveillance System (NHOSS) has the information about the level of
local water fluoridation by state and country. (2). Community water fluoridation is one of
the most practical, cost-effective, equitable, and safe measures communities can take to
prevent tooth decay and improve oral health. (3, 4).

Information related to Dental Health

According to the program director, patients with physical and mental disabilities
who are incapable of providing for themselves have nurse aides available to assist the
seniors in caring for their oral health, however, there are many residents who can
independently care for themselves.

Dental Health Status

I. Dental Caries
The rate of dental caries are high among elderly residents. Periodontal disease or
tooth decay are the most frequent causes of tooth loss. Older Americans continue to
experience dental decay on the crowns of teeth and on tooth roots. In fact, older adults
may have new tooth decay at higher rates than children. (6).

II. Periodontal Disease

Periodontal disease is a gum disease that affects the gum tissue which can destroy
the surrounding bone structure. One out of every two American adults aged 30 and over
has periodontal disease. Also, older Americans take over 400 commonly used
medications which can be the cause of a dry mouth that contributes into periodontal
destruction. (6).
III. Table 1: Seniors, Prevalence of Periodontal Disease
Prevalence of periodontal disease among seniors with teeth, age 65 and over years of age,
by selected characteristics: United States, National Health and Nutrition Examination
Survey, 1999–2004
Characteristic Percent with periodontal disease*
Age
65 to 74 years 10.20
75 years and over 11.03

Sex
Male 12.97
Female 8.56

Race and Ethnicity

White, non-Hispanic 8.99
Black, non-Hispanic 23.92
Mexican American 17.23

Poverty Status (Income compared to Federal Poverty Level)

Less than 100% 17.49
100% to 199% 11.59
Greater than 200% 8.62

Education
Less than High School 16.56
High School 8.30
More than High School 8.90

Smoking History
Current Smoker 13.80
Former Smoker 9.20
Never Smoked 11.12

Overall 10.58
Data Source: The National Health and Nutrition Examination Survey (NHANES) has been an
important source of information on oral health and dental care in the United States since the early
1970s. Tables 1 through 4 present the latest NHANES (collected between 1999 and 2004) data
regarding periodontal disease in seniors.

IV. Oral Hygiene

Potential physical, sensory, and cognitive impairments associated with aging may
make home oral health care and patient education/communications challenging. (7).
Many seniors at Atria Senior Living do not have access to dental care and with the
prevalence of seniors who have the inability to care for themselves, they are incapable to
 follow instructions on how to properly to care for their oral health. However, several of
seniors are free of limitation to follow proper instructions. (5).
V. Utilization of Dental Services
Twenty three percent of older adults ages 65 and older have not seen a dentist in
the past 5 years. A barrier to receive dental services is the inability to afford care. Two-
thirds of seniors with annual incomes below $35,000 in 2013 reported they could not
afford care such as crowns, implants, or bridges. (8, 9). There is a need for dental
treatment among the residents at Atria Senior Living and there is a lack of access to care
due to the cost of dental treatment. (3).

Goals and Objectives

VI. Goal Statement: To develop, coordinate, and implement a community health program to
educate seniors of Atria Senior Living about important knowledge and skills in
maintaining optimal oral health.
*Objective 1: To increase dental knowledge of the senior residents of Atria Senior Living
by 20% with pre and post-test.
*Objective 2: To decrease dental plaque and debris of the senior residents by 20%
*Objective 3: To implement a daily oral hygiene routine for senior residents of Atria
Senior Living.
*Objective 4: To incorporate oral hygiene procedures into living skills class for the senior
residents of Atria Senior Living with the competency tests at 15%.

Review of Literature/Rationale for Program

With older Americans living longer, oral health education is as important in

nature with seniors as well as the younger generation. In 2011, the population of the
United States was 278 million and 12.6% was 65 years of age or older. By 2016, the
population increased to 323 million and 15.3% was 65 years of age or older.
Furthermore, by 2050, it is anticipated that Americans aged 65 or older will number
nearly 89 million people, or more than double the number of older adults in the United
States in 2010. (1).
The oral health program will be implemented to the seniors of Atria Senior Living
whose ages range from 60-95 years. (2). Many seniors are suffering from periodontal
disease due to the lack of oral health knowledge and our oral health program’s goal is to
provide oral health instructions in an order to obtain adequate knowledge and skills
toward an optimum health. In addition, our health program will focus on alerting non-
dental health personnel on the significance of oral health and various oral diseases seen in
senior citizens. (6).

Program Design
 I. Activities
The oral health program is focused on educating the residents of Atria senior
living on how to properly care for their oral cavity. The educational sessions will consist
of teaching basic oral hygiene skills and dental knowledge along with mental/physical
activities. The sessions will be implemented weekly at Atria Senior Living and will be as
followed:
Session 1: April 12, 2018 (Maximum 1 hour) (Plaque and Brushing)
A. Senior Residents of Atria Collier Park
- Explain the importance of the oral health program for residents
- Give pretest (basic knowledge assessment)
- Explain the importance of plaque removal to prevent periodontal disease
- Disclose patient and take plaque score
- Explain the importance of proper brushing technique
- Demonstrate proper brushing technique
- Address available resources that can be used by the residents
- Fun Activity (as a whole to improve cognitive thinking and dexterity)
Session 2: April 20, 2018 (Maximum 1 hour) Periodontitis and Flossing
A. Senior Residents of Atria Collier Park
- Discuss Periodontitis
- Discuss an effective method to prevent periodontitis (Flossing)
- Discuss other flossing aids (Tufted floss, Floss holder, Interproximal Brush)
- Demonstrate and assist patient with floss aids – relating to their physical abilities
- Disclose patient and take plaque score
- Fun Activity (as a whole to improve cognitive thinking and dexterity)
Session 3: April 26, 2018 (Maximum 1 hour)
(Nutritional Counseling and Caries Process)
A. Senior Residents of Atria Collier Park
- Disclose patient and take plaque score
- Discuss nutrition in relation with caries
- Flip book (Caries Process)
- Fun Activity (as a whole to improve cognitive thinking and dexterity)
Session 4: May 3, 2018 (1 hour) (Maximum 1 hour) Evaluation
A. Senior Residents of Atria Collier Park
- Disclose patient and take plaque score
- Evaluate plaque score
- Give Post Test to assess dental knowledge
- Review ALL sessions
- Answer any questions or concerns
- Fun Activity (as a whole to improve cognitive thinking and dexterity)

II. Constraints and Alternative Strategies

1. Constraint – There may be a lack of interest on the part of the residents due to their
lack of life skills.
 Alternative Strategies – Provide visual aids and incorporate images in the presentation
to interest the seniors.
2. Constraint - There may be a lack of financial resources from the residents to be able
to purchase recommended oral health aids
Alternative Strategies – Provide samples for the residents to try so they know that oral
health aids are good investments for healthy oral cavity.
3. Constraint – There may be a difficulty with scheduling the session on particular days.
Example: change in schedule due to student requirements.
Alternative Strategies – Plan with program director accordingly to avoid confusion of
schedules.
4. Constraint – There may be hearing and visual impairments within the group of
seniors.
Alternative Strategies – Speak clearly and loudly will help the seniors understand the
purpose of our presentations. Use large and vivid visual aids will help seniors with visual
impairments.
5. Constraint – The location given to present our presentation does not have enough
movement or activity to recruit participants.
Alternative Strategies – Plan with program director to seek options of a possible
location such as the media room.

III. Resources
-- The following resources will be required for implementation of the programs:
A. Personnel: Program Director, Staff, Senior Residents
B. Visual aids:
a. Flip book to demonstrate proper brushing and flossing
b. Typodont and toothbrush provided by clinicians
c. Bulletin boards used as enhancement in visual aids
d. Dental care pamphlets
C. Supplies:
a. Toothbrush, toothpaste, mouth rinse, floss, and floss aids (10-15 kits)
b. Dry mouth Lozenges & Biotene Gel Samples
c. Cups, disclosing solution, gloves, cotton swabs/tips, paper napkins, gauze,
typodonts, mask, mirrors, tongue depressors, plaque score sheets, pre and post
tests
D. Evaluation Materials
a. Pre-test forms
b. Post-test forms
c. Plaque score sheets
d. Director evaluation sheets
E. Extras:
a. Bingo game set
b. Dental care pamphlets/brochures
c. Sitting volley ball (beach ball and pool noodles)
 d. Connect Four
IV. Budget
-- The estimated total cost of our oral health program will consist of:
 15 Tooth brush - Donated by LIT Dental Hygiene
 15 Toothpaste - Donated by LIT Dental Hygiene
 Floss/Floss aids - Donated by LIT Dental Hygiene
 Safety Glasses – Provided by Presenters
 Gloves – Provided by Presenters
 Masks – Provided by Presenters
 Cups - Donated by LIT Dental Hygiene
 Dislosing Solutions – Provided by Presenters
 Cotton tip applicators - Donated by LIT Dental Hygiene
 Mouth rinses - Donated by LIT Dental Hygiene
 Paper napkins - Donated by LIT Dental Hygiene
 Tongue depressors - Donated by LIT Dental Hygiene
 Hand mirrors – Provided by Presenters
 Typodonts – Provided by Presenters
 Pre/Post tests - Donated by LIT Dental Hygiene
 Plaque score sheets - Donated by LIT Dental Hygiene
 Biotene gel samples – Donated by LIT Dental Hygiene
 Estimated Total: $0.00
V. Timetable
-- This oral hygiene program will last four weeks and the days we plan to implement will
be as followed:
A. Session 1: April 12, 2018 (Plaque and Brushing)
B. Session 2: April 20, 2018 (Periodontitis and Flossing)
C. Session 3: April 26, 2018 (Nutritional Counseling and Caries Process)
D. Session 4: May 3, 2018 (Evaluation)

Evaluation
I. Formative Evaluation
a. A weekly evaluation of plaque scores will be conducted for the residents in an
attempt to modify brushing and flossing techniques as needed for optimum plaque
control.
b. A weekly consultation with the program director will be made to ensure proper
implementation of the program in meeting the educational needs and also to
address any concerns.
c. A weekly review will be conducted for the residents about the information that
was presented during the previous sessions to promote better understanding and
memorization.
d. After each session, a quiz for the residents by asking questions to assess if they
understood the presentations.
II. Summative Evaluation
a. A pretest and posttest will be administered to the residents to evaluate and
compare their level of dental knowledge in oral health care information.
b. A questionnaire will be given to the administrative of activities to evaluate the
effectiveness of the oral health program.
c. We will assess all plaque scores from each session and compare the scores to help
evaluate the effectiveness of the oral health program.
d. An additional pamphlets will be provided for the residents.
Pre Test

1. How many times should you brush your teeth a day?

a. Once
b. Twice
c. Three Times
d. NONE

2. How long should you brush your teeth?

a. 30 Sec.
b. 1 min
c. 2 min
d. I don’t know

3. Should you floss after you eat?

a. Yes
b. No

4. All are signs and symptoms of periodontitis EXCEPT?

a. Sensitivity
b. Recession
c. Bad breath
d. Whitening

5. Is Periodontitis Irreversible or Reversible?

a. Irreversible
b. Reversible

6. How much water should you drink a day?

a. 3 cups
b. 5 cups
c. 8 cups
d. 12 cups

7. Which is a better nutrient choice to eat as a snack?

a. Candy
b. Soda
c. Cake
 d. Cheese

Post Test

8. How many times should you brush your teeth a day?

a. Once
b. Twice
c. Three Times
d. NONE

9. How long should you brush your teeth?

a. 30 Sec.
b. 1 min
c. 2 min
d. I don’t know

10. Should you floss after you eat?

a. Yes
b. No

11. All are signs and symptoms of periodontitis EXCEPT?

a. Sensitivity
b. Recession
c. Bad breath
d. Whitening

12. Is Periodontitis Irreversible or Reversible?

a. Irreversible
b. Reversible

13. How much water should you drink a day?

a. 3 cups
b. 5 cups
c. 8 cups
d. 12 cups

14. Which is a better nutrient choice to eat as a snack?

a. Candy
b. Soda
c. Cake
 d. Cheese

References

1. Atria Collier Park website: https://www.atriaseniorliving.com

2. Interview: Roxanne Johnson, Director of Atria Senior Living
3. Water fluoridation: https://nccd.cdc.gov/DOH_MWF/Default/WaterSystemDetails.aspx
4. Water fluoridation: http://www.dshs.texas.gov/epitox/fluoride.shtm
5. The Oral Health of Older Americans:
https://www.cdc.gov/nchs/data/ahcd/agingtrends/03oral.pdf
6. Half of American Adults have Periodontal Disease: https://www.perio.org/consumer/cdc-
study.htm
7. Oral Health Topics: https://www.ada.org/en/member-center/oral-health-topics/aging-and-
dental-health
8. Oral Health in Older Adults:
https://www.researchamerica.org/sites/default/files/Oral%20Health%20in%20Older%20America
ns.pdf
9. Older Americans Need Access To Dental Care: http://www.pewtrusts.org/en/research-and-
analysis/fact-sheets/2016/07/older-americans-need-better-access-to-dental-care
 Appendix
- Pretest and Post test
- Lesson Plans (Sessions 1 to 4)
- Assessment survey/questionnaire
- Plaque Score sheets
- Brochure
- Program evaluation (Activities Director)
 Lesson Plan
Session One: Plaque and Brushing
I. Introduction
This session focused on ten residents of Atria Collier Park and each members of
the group will perform the lesson in the exercise room. The goals for this session is to
watch each residents demonstrate basic oral hygiene skills such as brushing while
increasing knowledge about what is plaque. This session is expected to last up to 1 hour
maximum.
II. Objectives
a. Cognitive:
i. The residents will recognize what plaque is and where plaque accumulates
in the oral cavity.
ii. The residents will be able to know how long to brush their teeth
iii. The residents will discuss the benefits of brushing.
b. Psychomotor:
i. The residents will demonstrate proper oral hygiene techniques of plaque
removal (mechanical brushing) by the end of the session.
ii. The residents will identify where plaque is left on the teeth.
c. Affective:
i. The residents will understand the importance of oral hygiene.
ii. The residents will gain motivation from the lesson to have good oral
hygiene.
III. Content
a. The major subject matter is plaque
i. Explanation of Plaque (Flip Book)
ii. How plaque affects the oral cavity
b. Brushing
i. Bass brushing method
ii. Demonstrate brushing method on typodont
iii. Residents practice brushing method on typodont
c. Projects
i. Pre-test
ii. Disclosed tablets
 iii. Plaque score
d. Activity
i. Ping Pong ball toss (dexterity enhancement)
IV. Method of Teaching
a. Initiating Activities:
i. Introduction of each group members (Dental Hygiene Students)
ii. Introduction of the lesson’s plan by showing plaque accumulation using our
flip book
iii. A pre-test given to evaluate resident’s current knowledge related to the Oral
Health Program.
b. Development of Activities:
i. Define Plaque: A sticky colorless deposits of bacteria that is constantly
forming on the tooth surface.
ii. Each group member will disclose the residents and discuss where the plaque
are seen.
iii. Each group member will explain proper brushing method to reduce plaque
accumulation.
c. Culminating Activities:
i. Review with the residents about the current lesson on plaque and brushing.
ii. Ask residents what they have learned during the session.
iii. Ask residents if they have any questions.
iv. Review plaque score with each residents.
V. Materials and Resources
a. Materials needed for session include:
i. Toothbrushes
ii. Toothpastes
iii. Typodont
iv. Gauze
v. PPE (masks, gloves, eyewear)
vi. Flipbooks
vii. Disclosing solution
viii. Mirror
ix. Ping Pong Balls
x. Napkins
xi. Bibs
b. The lesson plan will be conducted in the exercise room of Atria Collier Park’s
second floor with three Dental Hygiene students, held on March 29th, 2018 at 9am.
VI. Evaluation and Assessment
a. A pretest will be given prior to the lesson plan discussion.
b. The procedures will employ to determine where the students are when the session
begins and ends is to have a pretest and perform plaque scores. We will evaluate
the results with our last session.
 c. We will assess how well we met our objectives by measuring their past and current
dental knowledge by grading the pre-test.

Lesson Plan
Session 2: Periodontitis and Flossing
I. Introduction
This session focused on ten residents of Atria Collier Park and each members of
the group will perform the lesson in the exercise room. The goals for this session is to
watch each residents demonstrate basic oral hygiene skills such as flossing. We will
review plaque and how it contributes to periodontitis. This session is expected to last up
to 1 hour maximum.
II. Objectives:
a. Cognitive:
i. The residents will recognize what is periodontitis
ii. The group members will explain the benefits of flossing
iii. The group members will explain the effects of bacteria in between teeth
and gums.
b. Psychomotor:
i. The group members will demonstrate proper oral hygiene technique
(flossing), using the “C-shaped” method.
ii. The residents will demonstrate correct flossing procedure
iii. The residents will identify where plaque is left on teeth from flossing
incorrectly.
c. Affective:
i. The residents will understand the importance of oral hygiene.
ii. The residents will gain motivation from the lesson to have good oral
hygiene.
iii. The group members will also suggest other beneficial floss aids
III. Content:
a. The major subject matter is Periodontitis
i. Explanation of Periodontitis (Flip Book)
ii. Progression and destruction
b. Flossing
i. Flossing method
ii. Demonstrate flossing method on typodont
 iii. Residents practice flossing method on typodont
c. Projects
i. Disclosed tablets
ii. Plaque score
d. Activity
i. Origami (dexterity enhancement)
IV. Method of Teaching
a. Initiating Activities
i. Introduction of each group members (Dental Hygiene Students)
i. Introduction of the lesson’s plan by showing the formation of periodontitis
and it’s destruction by using our flip book.
ii. We will use a typodont that shows severe bone loss along with our flip book
as a visual aid to catch the resident’s attention.
d. Development of Activities:
i. Define Periodontitis: An inflammation and infection of the ligaments and
bones that supports the teeth. It is a serious gum infection that damages the
soft tissue and destroy the bone and supporting teeth.
ii. Each group member will disclose the residents and discuss where the plaque
are seen.
iii. Each group member will explain proper flossing method to reduce disease
progression
iv. Each group member will engage with activities by asking questions
sporadically based on the pre-test that was given during the first session.
e. Culminating Activities:
i. Review with the residents about the current lesson on periodontitis and
flossing.
ii. Ask residents what they have learned during the session.
iii. Ask residents if they have any questions.
iv. Review plaque score with each residents.
V. Materials and Resources
a. Materials need for session include:
v. Typodont
vi. Disclosing Solution
vii. Flipbook
viii. Floss Aides
ix. PPE (masks, gloves, eyewear)
x. Gauze
xi. Mirror
xii. Napkin
xiii. Bibs
b. The lesson plan will be conducted in the exercise room of Atria Collier Park’s
second floor with three Dental Hygiene students, held on April 5th, 2018 at 9am.
VI. Evaluation and Assessment
 a. The procedures will help determine where the group members are when the session
begins and ends is to have a pretest and perform plaque scores.
b. We will assess and evaluate how well we met our objectives by measuring their
past and current dental knowledge and the resident’s plaque scores.

Lesson Plan
Session 3: Nutritional Counseling and Caries Process
I. Introduction
This session focused on ten residents of Atria Collier Park and each members of
the group will perform the lesson in the exercise room. The goals for this session is to
educate the residents about nutritional guidance in relation to caries process. This session
is expected to last up to 1 hour maximum.
II. Objectives:
c. Cognitive:
i. The residents will relate sugary food to the caries process
ii. The group members will list types of sugary foods
iii. The residents will understand how acid exposure affects the oral cavity.
iv. The group members will also suggest other healthier options to include to
their diets.
d. Affective:
i. The residents will understand the importance of oral hygiene.
ii. The residents will gain motivation from the lesson to have good nutritional
habits.
iii. The residents will show interest in their own health and oral health.
III. Content:
e. The major subject matter is Caries Process
i. Explanation of Caries Process (Flip Book)
f. Nutritional Counseling
i. The residents will understand the importance of how nutrition impacts the
oral cavity.
ii. The group members will provide a listing of sugary and non-sugary food
iii. The residents will identify food and beverages that are factors of the caries
process.
g. Projects
i. Disclosed tablets
ii. Plaque score
 h. Activity
i. Matching Food and Beverages with what is health and unhealthy
IV. Method of Teaching
i. Initiating Activities
i. Introduction of each group members (Dental Hygiene Students)
ii. Introduction of the lesson’s plan by showing caries process by using our flip
book.
iii. We will use food and beverages as a visual aid/activities for the residents to
understand which types of cariogenic food to avoid.
f. Development of Activities:
i. Define Caries Process: Dental caries is a transmissible bacterial disease
process caused by acids from bacterial metabolism diffusing into enamel
and dentine and dissolving the mineral.
ii. Each group member will assist the residents in identifying sugary food
items.
iii. Each group member will explain the effects of caries process in the oral
cavity.
iv. Each group member will engage with activities by asking questions
sporadically based on the pre-test that was given during the first session.
g. Culminating Activities:
i. Review with the residents about the current lesson on caries process and
nutritional counseling.
ii. Ask residents what they have learned during the session.
iii. Ask residents if they have any questions.
iv. Review plaque score with each residents.
V. Materials and Resources
j. Materials need for session include:
i. Typodont
ii. Disclosing Solution
iii. Flipbook
iv. PPE (masks, gloves, eyewear)
v. Gauze
vi. Mirror
vii. Napkin
viii. Bibs
ix. Food
x. Beverages
k. The lesson plan will be conducted in the exercise room of Atria Collier Park’s
second floor with three Dental Hygiene students, held on April 12th, 2018 at 9am.
VI. Evaluation and Assessment
l. The procedures will help determine where the group members are when the session
begins and ends is to have a pretest and perform plaque scores. We will assess and
evaluate how well we met our objectives by measuring their past and current dental
knowledge and the resident’s plaque scores.

Lesson Plan
Session 4