Summer 2021 Newsletter
By Mark Foster, DNP, APRN, FNP-BC
Assistant Professor, School of Nursing
Arkansas State University
Importance of Oral Health
Adequate oral health is considered a crucial part of overall health and well-being (Llyas, Zahid, Rafiq, Bilal, & Ishaq, 2018). Oral health can be defined as having, “non-bleeding gums, free of infection, pain, xerostomia, halitosis, and sensitivity.” Oral health also encompasses the ability to smile, chew, taste, speak, swallow, and touch. This generally means that the person does not have any kind of oral disease. Poor oral health can also affect a person socially, physically, and psychologically (Llyas et al., 2018).
Despite what some may think, oral health is a crucial factor to overall general health. It has been proven that early oral hygiene practices lead to better overall oral health and general health (Llyas et al., 2018).
Llyas et al. (2018) conducted a study that examined the attitudes and beliefs regarding oral health. The researchers aimed to retrieve data from educated people as well as uneducated people. The results indicated that 55% of the educated participants knew what oral health was, but almost all of the uneducated participants were unaware of what oral health was. Seventy-three percent of the educated participants reported that bleeding gums are a sign of oral disease, while most of the uneducated participants said it is not. This study proved that uneducated individuals do not receive adequate information on oral health (Llyas et al., 2018).
The integration of medical care and oral health is important for people of all ages (Lee et al., 2018). Dental caries is the most chronic disease in the pediatric population, and it is found in 91% of the adult population. Medical professionals can take simple precautionary steps to examine the oral health of patients. The medical professional only needs gauze, tongue depressor, and light to conduct the quick, oral examination. This will help identify signs and symptoms of systemic disease and improve their quality of life (Lee et al., 2018).
It has been shown that there is a relationship between oral health and cardiovascular disease (Sanchez et al., 2017). Patients with periodontal disease are four times more likely to develop cardiovascular disease.
Sanchez et al. (2017) conducted a study in which they evaluated patients with cardiovascular disease, and the researchers asked questions about their perceptions toward oral health. The patients were asked questions regarding information given on oral health during their cardiac care, maintaining their oral health, and when oral health was important. The results showed that six (50%) of the patients reported they experienced bad breath, toothache, swollen gums, and painful teeth. Seven (58%) of the patients did not know that there was a connection between oral health and cardiovascular disease (Sanchez et al., 2017). This study validates that cardiac care professionals need to address oral health with all of their patients. This would allow the patients to receive adequate oral health education, care, and referrals (Sanchez et al., 2017).
Natural dentition in older adults is important for oral health despite the misconceptions (Muller, Shimazaki, Kahabuka, & Schimmel, 2017). Often, geriatric patients get assistance for activities of daily living and oral hygiene gets neglected. This can lead to caries which can result in tooth loss and reduced quality of life. One functional indicator is to examine the plaque and denture plaque indices. This buildup is linked to the patient’s ability to maintain oral hygiene (Muller et al., 2017).
Oral Health in Nursing Curriculum
As previously noted, the practice of oral health is critical to maintaining one’s overall health and hygiene (Opacich, 2014). Contrary to belief, the responsibility of oral health practice and education does not solely rely upon dentists and dental students. Nurses are very involved in an individual’s oral health. It’s important for nurse practitioner programs to educate students on the early signs of caries, how to educate patient caregivers, and providing preventative oral health care services (Kent & Clark, 2018).
When adding curriculum it is important to ensure that the teaching methodologies are efficient and effective (Kent & Clark, 2018). One university in Indiana found that the STAR Legacy Cycle was practical. The STAR Legacy cycle include basic principles that consist of five steps: a challenge, initial thoughts, perspectives and resources, wrap-up, and assessment. Therefore, before a lecture, the students were given a ten-question pretest. Students were also given out-of-class assignments concerning children’s oral health and a posttest. In the class, students practiced screenings and fluoride varnish application (Kent & Clark, 2018).
Furthermore, there is a growing amount of evidence that supports interprofessional education (Nash et al., 2018). A university in Colorado has implemented an interprofessional approach to expand the HEENT (head, eyes, ears, nose, and throat) assessment to HEENOT (head, ears, eyes, nose, oral, and throat) (Estes et al., 2018). Nurse practitioner students were taught how to conduct oral exams, apply fluoride varnish, and recognize oral health pathology by dental faculty. The nursing students then completed a survey concerning their comfort towards oral health and their opinions about the activities completed (Estes et al., 2018).
This interprofessional activity was completed during four different semesters (Estes et al., 2018). All of the nursing students reported that they felt more comfortable administering oral health exams after the activity in each of the four semesters. The senior-level students agreed with an interprofessional approach more than any other semester’s students. Also, senior students had a better report for organization and timing as well. This highlights an improvement in teaching methods and an increase in nursing students concerning oral health (Estes et al., 2018).
During a dissertation study by Opacich (2014), students participated in a pre-and post-test concerning oral health. The students had a pretest average of 59% and a posttest average of 82%. In the pretest, 21 students reported that they have not performed a comprehensive oral examination during a child’s welfare visit.
During the posttest, only five students reported they did not perform comprehensive oral examinations. Twenty-eight students (97%) also reported that they had not performed fluoride varnish on the pretest. During the posttest, only eight students reported not having performed fluoride varnish (Opacich, 2014).
During the pretest, 21% of the students felt as if they did not have enough knowledge to perform a comprehensive oral examination (Opacich, 2014). In the posttest, however all of the students felt as if they had the needed knowledge. When asked about fluoride varnishing in the pretest, 17 students did not feel like they had the proper knowledge, whereas only one student did not feel as if they had the proper knowledge on the posttest. This study emphasizes the positive effect that an oral health education program has on students (Opacich, 2014).
Therefore understanding the deficits to dental health in Arkansans and across the delta, Arkansas State University began integrating heavy content areas of dental health within their existing family nurse practitioner curriculum and having students complete the Smiles for Life oral health curriculum. Educating future providers in the first step addressing growing dental health concerns across the delta region and curtailing future health issues that arise from poor dental health.
Estes, K. R., Callanan, D., Rai, N., Plunkett, K., Brunson, D., & Tiwari, T. (2018). Evaluation of an interprofessional oral health assessment activity in advanced practice nursing education. Journal of Dental Education, 82(10), 1084.
Kent, K., & Clark, C. A. (2018). Open wide and say A-Ha: Adding oral health content to the nurse practitioner curriculum. Nursing Education Perspectives (Wolters Kluwer Health), 39(4), 253–254.
Lee, J. S., & Somerman, M. J. (2018). The importance of oral health in comprehensive health care. JAMA, 320(4), 339–340.
Müller, F., Shimazaki, Y., Kahabuka, F., Schimmel, M., & Müller, F. (2017). Oral health for an ageing population: the importance of a natural dentition in older adults. International Dental Journal, 67, 7–13.
Nash, W. A., Hall, L. A., Lee Ridner, S., Hayden, D., Mayfield, T., Firriolo, J., … Crawford, T. N. (2018). Evaluation of an interprofessional education program for advanced practice nursing and dental students: The oral-systemic health connection. Nurse Education Today, 66, 25–32.
Opacich, E. (2014). Improving oral health for underserved populations: Graduate nursing student education. Dissertation Abstracts International: Section B: The Sciences and Engineering. ProQuest Information & Learning.
Riley, E. (2018). The importance of oral health in palliative care patients. Journal of Community Nursing, 32(3), 57-61.