Part II- Oral Health Program

Pelican Bay Assisted Living Facility

Dates:
First Session: Tuesday, February 6th, 2018 at 1:30
Second Session: Tuesday, March 27th, 2018 at 1:30
Third Session: Tuesday, April 3rd, 2018 at 1:30
Fourth Session: Tuesday, April 10th, 2018 at 2:30

Program Design:
Session One (February 6th, 2018)
Our community program consists of four sessions specifically tailored to aid caregivers
in identifying oral cancer lesions and abnormal oral tissues. We also emphasized how
to properly clean dentures/partials to prevent fungal infections and improve oral health for their
patients. We began our first session by discussing the best meeting times with the Life
Enrichment Director and Program Director over the assisted living side of Pelican Bay. We
collectively decided we would meet at 1:30 and a few of the caregivers would come in early for
their afternoon shift to hear our oral presentation. We would then have the
caregivers from the morning shift stay after their shift to hear our oral presentation. We
discussed with the program director the need to teach the caregivers about oral cancer
screenings and care for dentures. We gave a pre-test to the program director to
distribute among the caregiver staff at Pelican Bay and a flyer to hang in the break room, so the
staff would be aware of the oral health program purpose along with the times and dates.

Session Two (March 27th, 2018)

We had a problem getting our pre-test back, therefore we had to give a secondary pre-
test to those that attended the first session of the program. During our second session there
was some confusion about who would attend the session. None of the caregivers that were
supposed to come early for their shift attended, so
we taught three caregivers from morning shift of the assisted living side how to do
an oral health screening and look for abnormal signs that could be cancerous or
concerning. Our teaching methods included the show-tell-do method and visual
aids. We showed the caregivers how to perform an oral cancer screening by using one of
our group members as a volunteer. We used gauze to show them how to roll the
tongue and check on the sides and base of the tongue for abnormal tissues. We explained that
the tongue is the most common site for oral cancer. We also gave brochures that showed the
caregivers eight steps to performing an oral health screening. Our group then went to the
memory care side of the building and taught three different caregivers the same topic using the
same methods. The first group of caregivers were not very compliant and did not want to
participate when asked to demonstrate an oral cancer screening. We made a goal to do one
oral cancer screening on a patient before session three. Our group did not feel very
confident the caregivers would complete these goals. The second group of caregivers
were more compliant with our presentation. Although they still did not want to
perform an example screening during the session, they appeared more compliant and willing to
complete the goal of performing one oral health screening before the next session. They were
identifying patients to screen and enthusiastic about helping their patients with this new tool.

Session Three (April 3rd, 2018)

From our previous session, only one caregiver met our goal of performing an oral health
screening. When asked what the barriers were to perform the screenings most of the
reaction was they forgot or did not want to add an extra step into their daily routine. We provided
pen lights in hopes of encouraging the staff to do oral cancer screenings. Our third session, we
had nine people total from the memory care and assisted living side of the facility including the
Director of the Memory Care side. The caregivers at Pelican Bay had a vast knowledge
of denture cleaning. We adjusted the way we presented the second session by having the
caregivers show us what they know about cleaning dentures and denture
care. After assessing their knowledge, we gave them extra information and tips about
cleaning dentures/partials. Some of this information included using an ultrasonic
to remove debris, filling the sink with water to avoid breaking the partial/denture if it falls into the
sinks or use a towel, and how to remove Pollident more effectively from a patient's gums using a
damp paper towel or soft toothbrush. The staff was concerned about patients throwing
dentures/partials in the trash because they roll them up in napkins. We gave denture cases with
a chain on them to give to these patients to help with this problem. We gave them short and
long acting denture cleaners, denture brushes,
and Biotene samples. Some of the caregivers were aware of how to use the denture
brushes. We explained how to use denture brushes and showed the caregivers how to clean a
denture with them. We also made it clear these were not to be used in the mouth in place of a
normal toothbrush. We suggested an ultrasonic cleanser to be purchased to use in the facility.
We showed caregivers how to put the denture/partial into a plastic bag then fill the bag with
water and the denture cleaner, then they can put the bag into the ultrasonic cleaner to help
loosen debris before scrubbing the denture/partial. The Memory Care Director was very excited
about this and looked into buying an ultrasonic cleaner before we finished our session. We used
a flipbook to talk about candidiasis infections and the need to take out dentures/partials to let
the tissues heal. The staff had a concern about patients who would not take out their dentures,
we explained to them having a denture on their tissues all the time is like wearing shoes all day.
Your feet need time to breath just like your tissues. The caregivers loved this analogy and felt
they could use it to relate to their patients.

Session Four (April 10th, 2018)

Our fourth session was an overview of oral cancer screening and denture care. We used
the staff in service day to present to the caregivers who were unable to attend our previous
sessions. We asked the staff who did not attend the sessions if anyone that had attended
had shared anything they learned, everyone said no. We reiterated the previous education from
sessions two and three. We presented the staff with a list of resources for the residents to
obtain low cost dental care. We concluded this session by asking if anyone was unclear about
what we were discussing. Most of the staff was unresponsive while the other half was more
interested in reduced cost dental care. The memory care side of the facility were
concerned about the oral hygiene of some of their residents and they would not stay open when
the staff was trying to brush their teeth. We suggested using two soft toothbrushes and tape
them together with the bristles facing each other. They can use this as a bite block and
more efficiently clean the patients mouth. We did a raffle for three boxes of whitening strips and
the staff enjoyed this. In the future prizes should be tailored to people who attended
the sessions. After our presentation was done, we passed out the post-test which was the same
as the pre-test. The entire group completed the test and it was collected as the left. Once the
staff had left and the only people left were the two directors, one from memory care and one
from assisted living, we asked them to write a short evaluation on the entire program from
session 1-4. They were happy to have the program and are open to having more oral health
education in the future.

Program Objectives:
*Teach common oral conditions found in elderly and denture patients
To teach the common oral conditions that are found in elderly and denture patients we
discussed looking for abnormal conditions. We explained different changes to look for and used
our phones to look up pictures.
* Demonstrate the proper method for an oral cancer screening
To demonstrate an oral cancer screening we used one of the group members as a volunteer
and a different group member to explain each step of the screening. We also used a handout
with 8 steps and pictures. The 8-step oral cancer screening also was printed in a flipbook for
the caregivers to see.
* Teach proper denture care
To teach proper denture care we demonstrated using Pollident tablets in water to clean it. We
had one of the caregivers do the demonstration. We discussed different ways to
clean and care for dentures.
* Teach proper oral hygiene care methods
To teach proper oral hygiene care methods we discussed what the staff was currently doing and
ways to adapt their techniques.
* Increase the oral health knowledge of the staff at Pelican Bay
To increase the oral health knowledge of the staff at Pelican Bay we
used demonstration and discussion. We also used visual aids in a flipbook and brochures.
Results:
* Teach common oral conditions found in elderly and denture patients
The caregivers on the assisted living side did not seem to understand as much as
the caregivers on the memory care side. When questions were presented, there was not any
participation in answering.
* Demonstrate the proper method for an oral cancer screening
The caregivers were completely against attempting any type of demonstration when we were in
session. There was some response to trying an oral cancer screening on residents after the
session.
* Teach proper denture care
The caregivers were very knowledgeable on denture cleaning and
care before the program started. They did engage in discussion and demonstration with much
more enthusiasm.
* Teach proper oral hygiene care methods
The caregivers had some knowledge on proper oral hygiene care methods for their residents.
Through discussion with question and answer session there was a significant improvement
* Increase the oral health knowledge of the staff at Pelican Bay
Oral health knowledge of the staff at Pelican Bay increased by 20%.

Evaluation:
Strengths- Some of our highlighted strengths during the community program include through
information, the ability to interpret the information into Spanish, and our ability
to adapt to the changing personalities of the staff. Our information was well researched, and we were
able to confidently answer any questions that the staff may have. There was also a language barrier
that we were able to easily overcome, making the entire staff feel included. The staff was also slightly
difficult to read, but our group quickly adapted in order to keep the staff as engaged as possible.

Weaknesses- Some of our weaknesses that we encountered during the community

program include staff compliance, stage fright, and the shift changes. The staff did not complete
the goals that we had set for them and were not compliant with our plans for the
lesson. I believe that this intertwines with the shift changes. The group that was at the end of
their shift seemed uninterested, while the group arriving appeared more enthused about
the program. In a written evaluation, it was noted that we were also slightly nervous at the beginning of
our sessions which may have been interpreted as low confidence.

Future Site:
Pelican Bay would be a good site for future programs because the caregivers need the oral care
education. There was a genuine interest in learning from most of
the caregivers. Something needs to be changed in coordination with the site for attendance of the
sessions though. The sessions were attended by some people that were about to get off
work and their attention was not on the information we were
giving. If there cannot be better cooperation from the site it will make future programs difficult to
implement.
Learning Value and Collaboration:
The experience of creating and presenting an oral health
program helped us grow as dental hygiene professionals. We were able to collaborate with our
classmates as well as other health care professional to present the importance of a thorough intraoral
exam. We worked together, acting as models while another student demonstrated how to perform
an intraoral exam. We were able to give the caregivers ideas on how to make
their patient's more compliant or how to use tools in order to complete intraoral examinations. In
the future, an opportunity to implement another oral health program may arise, so this experience will
make us more well prepared. As a group we also experience how beneficial it is to be
bilingual or have bilingual coworker, as this makes everyone receiving the information feel included.

Session One (February 6th, 2018)

Lesson Plan
Introduction
This lesson is focused on exchange of information between the students and the life enrichment
director/resident care director. The goal of the first session is to provide an overview of the oral health
program, provide a pre-test (staff complete within one week), discuss which times and dates would
 best fit both the students' and the caregivers' schedules. This will also be when answers to questions
that may arise with the program can be answered. This lesson is expected to last one hour.
II. Objectives
COGNITIVE: To increase the awareness of the caregivers for the oral health program schedule.
AFFECTIVE: To appreciate the quality of life good oral care has on the residents.
III. Content
Pre-Test
IV. Method of Teaching
a. Discussion
V. Materials and Resources
a. Pre-test
a. Flyer
a. Calendar for scheduling
VI. Evaluation and Assessment
a. Speaking with Life Enrichment Director to make sure our ideas for the program will meet
the needs of the staff
Session Two (March 27th, 2018)
Lesson Plan
VII. Introduction
The main focus of this session is demonstration and discussion of a specific oral education
topic between the students and the staff of Pelican Bay. This session is expected to last one hour, and
the Life Enrichment Director and caregivers will be expected to attend. The goal of the second
session is to provide education about general oral health conditions and to teach the staff how to
perform an oral cancer screening. Brochures from the National Institutes of Health will be provided
to help visualize and explain the procedure for an oral cancer screening. A flipbook will be used to
provide examples of irregular findings in the oral cavity. Then, using our materials, we will provide
an active demonstration of an intraoral examination. We have allotted time at the end of the session
for any discussion questions that may arise during the presentation. Student, Leslie Coleman will act
as a model for extraoral and intraoral examination.

VIII. Objectives
COGNITIVE: To increase the knowledge of caregivers in oral health care, specifically knowledge
that will help them identify irregular tissues that could possibly be oral cancer.
PSYCHOMOTOR:
AFFECTIVE:
The caregivers will understand the importance of being able to recognize abnormal tissue in
the oral cavity.
IX. Content
Oral cancer screening handout to take home and display as a reminder of the steps of an oral
screening process
Oral cancer flip book to display as a reminder of the different abnormalities found in the oral cavity

X. Method of Teaching
1. Presentation
2. Show-Tell-Do
3. Discussion

XI. Materials and Resources

1. NIH oral cancer screening brochure
2. Flip book with pictures of oral cancer lesions
3. Tongue depressors
4. Gauze
5. Light source
6. Gloves
7. Masks

XII. Evaluation and Assessment

1. Have the caregivers reiterate the steps to an oral cancer screening
2. Have the caregivers give examples of the different abnormalities that can be found in the oral
cavity
3. Answer any questions that arise to ensure that the caregivers understand the lesson
4. Obtain feedback from the caregivers
Session Three (April 3rd, 2018)
Lesson Plan
Introduction
This lesson is focused on a demonstration for the caregivers, provided by the students on how
to properly clean dentures. A rationale will also be explained on why it is important to have patients
remove their dentures overnight. The candidiasis infection process will be explained and pictures
from a flip book will be provided as a visual aid. During this session will address the concern of lost
dentures that was introduced by the administrators during the first session. The possible solution of
providing the residents with cases that have chains to put partials or dentures in will be presented.
These are to be worn around their neck during meal times or other times when dentures/partials are
removed and commonly thrown in the garbage. Ask and answer any questions that arise. The goal of
our third session is to provide detailed information about denture care and infections that can occur in
the oral cavity with extended wear and unhygienic practices. This lesson is expected to last one hour,
the Life Enrichment Director and the caregivers are expected to attend.

XIV. Objectives
 COGNITIVE
To increase the knowledge of the caregivers in cleaning and caring for dentures and partials.
PSYCHOMOTOR
The caregivers will be able to utilize denture cleaner to clean partials and dentures.
The caregivers will learn how to use a denture brush to clean partials and dentures.
AFFECTIVE
The caregivers will be able to assist the residents in the daily denture and partial care.
The caregivers will develop more confidence in their knowledge on denture care.
XV. Content
Use fake denture to demonstrate cleaning in water with Pollident
Flipbook with pictures of different oral cavity issues when wearing partial or denture
Give samples of denture cleaner and denture brushes
Give retainer cases with chains for denture/partial holders
XVI. Method of Teaching
1. Presentation
2. Show-Tell-Do
3. Discussion
XVII. Materials and Resources
1. Dentures
2. Denture brush
3. Cup
4. Water
5. Denture tablets
6. Flip book with pictures of oral lesions associated with non-compliant denture/partial care
7. Partial cases with chains

XVIII. Evaluation and Assessment

1. Discussion with Life Enrichment director to see her response to our presentation
2. Feedback from caregivers

Session Four (April 10th, 2018)

Lesson Plan
XIX. Introduction
This lesson is focused on exchange of information between us, the students, and the care
givers. The goal of our fourth and final session is evaluate how much information the care givers have
gained by giving a post-test. We will be evaluating their ability to implement an oral cancer screening
program and discuss with them how they plan to implement such program. We will review the
information we provided to the staff during previous sessions. This session is being conducted during
a staff in service, meaning that all staff members will be present. This will be the first time that the
night shift staff members will have received this information. This lesson is expected to last one hour,
the Life Enrichment Director and the caregivers are expected to attend. We also had the head of
assisted living and the head of memory care evaluate the program.

XX. Objectives
COGNITIVE
The care givers will be able to recognize abnormalities in the oral cavity.
The care givers will be able to explain the importance of identifying and reporting abnormal
tissues in the oral cavity.
PSYCHOMOTOR
The care givers will be able to implement the use of pen lights to look in the oral cavity and
evaluate the tissues while performing the normal basic dental hygiene duties.
AFFECTIVE
The care giver will appreciate the importance of being able to recognize abnormalities in the oral
cavity.
Content
We will review what we presented in previous sessions.
We will administer a post-test.
We will answer any remaining questions.
XXII. Method of Teaching
1. Discussion
2. Demonstration

XXIII. Materials and Resources

1. Dentures
2. Denture brushes
3. Cup
4. Water
5. Denture tablets
6. Flip books
7. Raffle tickets (donated by Pelican Bay)
8. White strips (donated by Michele Andrus)
XXIV. Evaluation and Assessment
1. Post-test
2. Feedback from caregivers, answer any questions.
3. End of program evaluation with directors of both Assisted living and Memory Care