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Oral Health Program: Teaching Caregivers on Oral Health Part 1 March 19, 2018 Michele Andrus, Leslie Coleman, Marisa Martin, Haleigh Turley

NEEDS ASSESSMENT

A. General Data

1. Description of Site

Pelican Bay was opened in January 2013 and is located at 2501 South Major Drive in Beaumont, Texas. (3)"Pelican Bay is a senior living community designed to make a positive difference in the lives of our residents. Our team of professionals recognize and appreciate each person's God-given potential and want each one of our residents to maintain as much of their independence as possible." (2) It is a highly recommended facility in the Southeast Texas area. The facility consists of two sides: Memory Care and Assisted Living. The Assisted Living portion of the center focuses on patients who need help with daily care but cannot function safely on their own. The Memory care portion of the center is designated for Alzheimer’s and Dementia patients. The entire facility is equipped with alarms and cameras are specifically targeted to the Memory Care section to monitor patients regularly. (4) The residents receive daily care based on their needs from onsite caregivers. The facility accepts mainly private pay and some military benefits. They do not accept Medicare payments currently.

2. Description of Target Group

The residences living in Pelican Bay Assisted Living Facility are our target population. There are approximately 70 total residents from Memory Care and Assisted Living. The criterion for residency is based on the activities of daily living; eating, bathing, dressing, toileting, transferring or walking, and continence or bladder control. (2) Our focus of education will be directed towards the caregivers so that a direct impact can be made on their residents' oral health. The skills taught to the caregivers will positively influence the lives of our target population.

3. Description of Staff Population

The staff population consists of a Registered Nurse, two LVNs, nine Caregivers, and two med aides. The RN is the overseer of the Memory Care and Assisted Living centers. There is one LVN in charge of the Assisted Living side and one LVN Memory Care side. Jennifer Rinker, CNA, RDH, BS started her career as a dental hygienist but later went back to school for her CNA because she saw the need for health care providers with oral health knowledge in long-term care facilities. (8) The caregivers are divided into three people per shift and the site has three shifts per day.

The caregivers are the backbone of the facility and are the most interactive with the residents. This part of the staff does laundry, cleans residents living area, assist with activities of daily living, and provide a sense of comfort to senior residents. There is also a Med-aide on two shifts throughout the day who are responsible for providing proper medications to the residents. The entire staff is responsible for planning holiday parties and special events. (1)

4. Description of Services Provided

Cindy Dorsey is the Life Enrichment Director for the residents of Pelican Bay. The residents have a variety of activities planned throughout the month that they can attend. There are set activities planned for each day of the week, which can be found on their monthly calendar. Examples of these activities include: board games, prize bingo, outings to Wal-Mart, exercise sessions, and social hour. The daily schedule is as follows: (1)

6:00- Wake up 7:30- Breakfast 9:00- Let's Walk or Sit and Fit 10:30- Various games depending on the day 11:30- Lunch 1:00- 3:00 Various activities and games; nap optional 5:00- Dinner 5:30- Social hour or movie/popcorn

In the future, the activities coordinator could implement our oral health program into their set daily routine. The staff will be able to use the skills learned during this time to implement oral cancer screenings and teach proper denture care to the residents. These plans will promote a better quality of life for the residents and an above average standard of care at Pelican Bay.

5. Other Pertinent Data

The water fluoridation of the Pelican Bay facility is 0.7ppm. (1)

B. Information Related to Dental Health

Pelican Bay is a private pay facility. They do not provide any type of preventive oral hygiene aids to their residence. Pelican Bay will provide transportation to dental offices if needed. They also offer fluoridated water provided by the city. The family is the sole provider of preventative care for the residents. (1) The previous oral health program was directed

toward the residents, contributing limited benefits due to lack of compliance. (1) There was also a mental health barrier because most of the residents could not recall what was taught at the oral health sessions. Due to lack of compliance from the staff, we were unable to assess the knowledge and awareness of dental health that the staff is using daily. A pre-test will be given at the first education session to gather initial information and assure compliance from the staff.

C. Dental Health Status:

Describe the prevalence of dental disease & dental care for these groups and their dental needs relative to other needs. Relate this to their SES and ethnic/cultural group membership.

1. Dental Caries Prevalence

1. 93% of seniors 65 and older have had dental caries on permanent teeth.

1. White seniors, higher income families, and individuals with higher education portray more decay.

Characteristic

 

Percent with decay, missing, or filled permanent teeth

Age

65

to 74 years

93.25

75

years or more

92.70

Sex

Male

 

93.64

Female

 

92.49

Race and Ethnicity

 

White, non-Hispanic

 

94.86

 

Black, non-Hispanic

 

80.20

Mexican American

 

83.82

Poverty Status (Income compared to Federal Poverty Level)

 

Less than 100%

 

83.47

100% to 199%

 

90.92

Greater than 200%

 

95.53

 

Education

 

Less than High School

83.73

High School

 

94.27

More than High School

97.04

Smoking History

 

Current Smoker

 

89.28

Former Smoker

93.48

Never Smoked

93.01

Overall

93.00

(10)

Unmet Needs

 

1.

18% of seniors 65 and older have untreated decay.

2.

Black seniors, Hispanic seniors, lower income individuals, and less educated individuals have more untreated decay.

Age

   

65

to 74 years

   

17.07

75

years or more

   

19.52

 

Sex

   

Male

   

20.42

Female

   

16.43

Race and Ethnicity

   

White, non-Hispanic

   

15.92

Black, non-Hispanic

   

36.78

 

Mexican American

   

41.19

 

Poverty Status (Income compared to Federal Poverty Level)

 

Less than 100%

   

33.22

 

100% to 199%

   

23.82

Greater than 200%

   

14.22

Education

   

Less than High School

   

26.16

 

High School

   

17.68

More than High School

   

14.30

Smoking History

   

Current Smoker

   

27.28

Former Smoker

   

18.74

Never Smoked

   

16.58

Overall

   

18.18

(10)

 

Severity

 

1. Seniors 65+ have an average of 9.24 decayed or missing permanent teeth as well as 43.02 decayed and missing permanent surfaces.

2. Hispanic subgroups and those with lower incomes present with more severe decay on permanent teeth.

Characteristi Decayed Missing Filled c permanen permanent permanent t teeth teeth (MT) teeth (FT) (DT)
Characteristi
Decayed
Missing
Filled
c
permanen
permanent
permanent
t teeth
teeth (MT)
teeth (FT)
(DT)
Total decayed,
missing, or
filled
permanent
teeth (DMFT)
Age
65
to 74
0.39
8.32
8.96
17.68
years
75
years or
0.47
9.41
8.42
18.30
more
Sex
Male
0.53
8.67
8.37
17.57
Female
0.35
8.96
8.99
18.30
Race and
Ethnicity
White, non-
0.36
8.30
9.57
18.23
Hispanic
Black, non-
1.04
12.61
3.25
16.90
Hispanic
Mexican
1.10
9.74
4.26
15.11
American
Poverty
Status
(Income
compared to
Federal
Poverty
Level)
Less than
1.01
12.19
4.10
17.30
100%
100% to
0.58
10.79
6.84
18.21
199%
Greater than
0.29
7.61
10.24
18.15
200%
Education
Less than
0.77
11.99
4.92
17.68
High School
High School
0.38
9.58
8.39
18.35
More than
0.28
6.71
10.91
17.90
High School
Smoking

History

       

Current

0.82

12.45

5.68

18.95

Smoker

Former

0.42

9.58

8.41

18.40

Smoker

Never

0.39

7.76

9.31

17.46

Smoked

Overall

0.43

8.81

8.71

17.96

(10)

2.Periodontal Disease

1. 10.20-11.03% of seniors age 65 and over have periodontal disease. Of this group, 10.58% are categorized as having moderate to severe periodontal disease.

2. Older seniors, Black/Hispanic seniors, current smokers, those from

a lower income, and less educated individuals are more likely to have periodontal disease. This group is also more likely to have moderate/severe periodontal disease.

Characteristic Percent with periodontal disease* Percentage with moderate or severe periodontal disease* Age 65
Characteristic
Percent with
periodontal
disease*
Percentage with
moderate or severe
periodontal disease*
Age
65
to 74 years
10.20
14.26
75
years and over
11.03
20.75
Sex
Male
12.97
20.61
Female
8.56
14.40
Race and Ethnicity
White, non-Hispanic
8.99
15.47
Black, non-Hispanic
23.92
24.47
Mexican American
17.23
24.20
Poverty Status
(Income compared
to Federal Poverty
Level)
Less than 100%
17.49
31.96
100% to 199%
11.59
18.75
Greater than 200%
8.62
13.91
Education
Less than High
16.56
28.24

School

     

High School

8.30

15.51

More than High School

8.90

12.38

Smoking History

   

Current Smoker

13.80

32.01

Former Smoker

9.20

19.25

Never Smoked

11.12

14.08

Overall

10.58

17.20

(10)

3.Oral Hygiene Perceived Condition of Teeth and Mouth

1. 24% of Seniors 65+ report the condition of their teeth/mouth as very good or excellent.

2. 16% of all Seniors 65+ report the condition of their teeth/mouth as poor.

3. Black/Hispanic Seniors, those with lower incomes, and individuals with less education report the condition of their teeth/mouth as poor.

1. Seniors with higher incomes and higher education have a greater likelihood of reporting the condition of their teeth/mouth as very good or excellent.

This information comes from the perceived (self-reported) condition of teeth and mouth among Seniors Age 65 and older.

(10)

4.Oral Cancer

Oral Cancer Prevalence

1. Oral cancer is more prevalent in older age groups, with males at a higher percentage than females.

Age

Sex

Oral Cancer

 

Cases

60-69

Male

 

40,095

 

60-69

Female

18,110

70+

Male

 

60,638

70+

Female

39,446

Oral Cancer Incidence

1. 10.5 adults per 100,000 will develop oral cancer.

1. Oral cancer rates are higher for males than females.

2. Oral cancer rates increase with age. This increase becomes more rapid after age 50 and peaks between the ages of 60 and 70.

Age

Sex

Race

Oral Cancer

 

Incidence

50-59

Male

All

51.9

50-59

Female

 

All

17.9

60-69

Male

 

All

 

58.9

 

60-69

Female

 

All

 

26.0

 

70-79

Male

 

All

 

59.4

 

70-79

Female

 

All

 

29.4

 

80+

Male and

All

40.0

Female

 

1. Oral cancer rates are higher in Hispanic and Black males.

Age

Sex

Race

Oral Cancer

 

Incidence

60-69

Male

 

Black

 

61.0

 

60-69

Female

Black

16.2

60-69

Male

 

Hispanic

 

32.9

 

60-69

Female

Hispanic

 

9.2

60-69

Male

Caucasian

52.7

60-69

Female

Caucasian

18.4

60-69

Male

Asian

34.4

60-69

Female

Asian

14.2

70-79

Male

 

Black

 

61.6

 

70-79

Female

Black

20.5

70-79

Male

 

Hispanic

 

38.7

 

70-79

Female

Hispanic

 

15.6

70-79

Male

Caucasian

60.7

70-79

Female

Caucasian

27.0

70-79

Male

Asian

36.0

70-79

Female

Asian

17.2

80+

Male

Black

43.4

80+

Female

Black

19.5

80+

Male

Hispanic

 

39.7

80+

Female

Hispanic

20.9

80+

Male

Caucasian

62.0

80+

Female

Caucasian

30.0

80+

Male

Asian

35.6

80+

Female

Asian

28.2

Notes About Oral Cancer Incidence Statistics:

1. Statistics were generated from malignant cases only.

1. Rates are expressed as cases per 100,000.

2. Statistics are provided by the SEER Program for research purposes only

3. Due to the impact of Hurricane Katrina on Louisiana's population for the July - December 2005 time period, Louisiana cases diagnosed for that six-month time period have been excluded from these statistics.

(10)

5. Utilization of Dental services

Time Since Last Dental Visit

1. 23% of Seniors 65 and older have not been to the dentist in the last 5 years.

2. About half of all Seniors 65 and older have been to the dentist within the past year.

3. More Black and Hispanic Seniors and those with lower incomes and less education have not been to the dentist in the past 5 years.

4. Seniors with higher incomes and more education are much more likely to have seen a dentist within the past year.

Charact

Never

1 Year

1 to 2 Years

2 to 3 Years

3 to 5 Years

More

eristic

or Less

than 5

     

Years

Age

           

65

to 74

*

56.90

8.78

6.04

6.67

21.23

years

75

or

*

51.64

9.28

6.01

7.37

25.52

more

years

Sex

           

Male

*

56.15

8.40

5.71

6.37

23.04

Female

*

53.56

9.33

6.21

7.41

23.24

Race and Ethnicit y White, * 57.96 8.35 5.63 6.10 21.85 non- Hispani c Black,
Race
and
Ethnicit
y
White,
*
57.96
8.35
5.63
6.10
21.85
non-
Hispani
c
Black,
*
37.99
13.45
5.59
11.28
30.59
non-
Hispani
c
Mexica
4.12
38.31
9.92
9.25
9.32
29.08
n
Americ
an
Poverty
Status
(Incom
e
compar
ed to
Federal
Poverty
Level)
Less
*
30.23
9.39
7.48
13.14
38.82
than
100%
FPL*
100% to
*
42.19
9.56
6.88
7.59
33.51
199%
FPL
More
*
67.08
8.86
4.49
4.85
14.22
than
100%
FPL
Educati
on
Less
*
35.28
10.61
6.90
9.99
36.43
than
High
School
High
*
53.63
7.79
6.44
7.25
24.82
School
More
*
71.47
8.68
4.96
4.07
10.77
than
High

School

             

Smokin

           

g

Status

Current

*

33.91

8.86

4.17

13.15

39.00

Smoker

Former

*

54.91

8.46

6.81

6.20

23.42

Smoker

Never

*

57.75

9.70

5.72

6.56

19.97

Smoke

d

Overall

*

54.52

9.01

6.03

6.99

23.18

(10)

6. Additional Information Tooth Loss Number of Teeth Remaining

1. Seniors over age 65 have an average of 18.90 remaining teeth.

2. Black seniors, current smokers, and those with lower incomes and less education have fewer remaining teeth.

Characteristic Mean Number of Permanent Teeth Age 65 to 74 years 19.34 75 years or
Characteristic
Mean Number of Permanent
Teeth
Age
65
to 74 years
19.34
75
years or more
18.36
Sex
Male
19.03
Female
18.77
Race and Ethnicity
White, non-Hispanic
19.39
Black, non-Hispanic
15.19
Mexican American
18.15
Poverty Status (Income
compared to Federal
Poverty Level)
Less than 100%
15.58
100% to 199%
16.99
Greater than 200%
20.08
Education
Less than High School
15.86

High School

18.10

More than High School

20.96

Smoking History

 

Current Smoker

 

15.39

Former Smoker

18.16

Never Smoked

19.91

Overall

18.90

(10)

Number of Adults with Total Tooth Loss

1. 27.27% of seniors over age 65 have no remaining teeth

2. Older seniors, women, Black seniors, current smokers, and those with lower incomes and less education are more likely to have no

remaining teeth.

Characteristic Percentage with no Remaining Teeth Age 65 to 74 years 23.93 75 years or
Characteristic
Percentage with no Remaining
Teeth
Age
65
to 74 years
23.93
75
years or more
31.30
Sex
Male
24.42
Female
29.30
Race and Ethnicity
White, non-Hispanic
26.12
Black, non-Hispanic
32.81
Mexican American
23.90
Poverty Status (Income
compared to Federal
Poverty Level)
Less than 100%
44.19
100% to 199%
36.61
Greater than 200%
17.25
Education
Less than High School
43.32
High School
28.28
More than High School
13.65
Smoking History

Current Smoker

49.69

Former Smoker

28.69

Never Smoked

21.72

Overall

27.27

(10)

Goal and Objectives

Goal: The primary goal for this program is to increase the staff's knowledge of oral health care by 20% to prevent and control oral diseases in the care facility.

Objectives: Directed towards the staff of Pelican Bay

1. Teach common oral conditions found in elderly and denture patients

1. Demonstrate the proper method for an oral cancer screening

2. Teach proper denture care

3. Teach proper oral hygiene care methods

4. Increase the oral health knowledge of the staff at Pelican Bay by

10%.

Rationale for Program

Beyond dentistry, there is a significant lack of oral health care knowledge among health care providers. This lack of knowledge includes caregivers that work at long-term care facilities such as Pelican Bay. (9) Daily oral hygiene is an activity that many of these residents have difficulty with. Educating those who help with this task is vital in maintaining the resident's oral health. The World Health Organization (WHO) has recognized the need to incorporate oral health services into existing health care systems. (9) The older adult population has the highest percentage of dentures due to the prevalence of tooth loss in this age group. (10) Although dentures decrease masticatory function by up to 1/7 of natural teeth, they improve the quality of life for the edentulous population. (7) Dentures are also costly, creating a barrier to care for this age group due to lack of dental coverage through medicare. (6) Health care providers with very little knowledge of oral health create a problem in long-term care facilities. In this type of facility, it is the caregiver's responsibility to assist residents with their daily oral hygiene care. (1) This includes brushing, flossing, rinsing, cleaning dentures/partials, and assuring that these things are done properly

without damage or loss of oral care aids and dentures.

The 65+ population has the highest amount of oral cancer cases compared to all other population groups. (10) Healthcare personnel, specifically at long-term care facilities for 65+, have little knowledge on how to perform an oral cancer screening. (12) Oral cancer screenings can be easily done by looking in one's mouth with some form of light source. (11) If done correctly, oral cancer screening can help detect cancerous lesions at the earliest stages and increase chances of survival. (11)

Educating the caregivers at Pelican Bay on oral cancer screenings, denture care, and overall oral health will have a positive impact on their facility and improve the quality of life for their residents.

Program Design

A. Activities

1. Session One (February 6 th , 2018)

a. Life Enrichment Director and LVN for Assisted Living Side Present oral health care program to caregivers to improve oral health of residents Discuss the need to teach caregivers to clean and care for dentures and

do oral cancer screenings Discuss the best time to work with caregivers Pre-test Give flyer with oral health program times and dates This session will take 30 minutes and we will need the Life Enrichment Director and the Resident Care Director.

2. Session Two (March 27 th , 2018)

a. Caregivers

Presentation of general oral health conditions and how to implement oral

cancer screening.

i. Use brochures on Oral Cancer screening to explain the procedure for an oral cancer screening and to provide examples of irregular tissue.

ii. Demonstrate how to evaluate a patient's oral cavity using a light

source (pen light, or loupes), tongue depressor and gauze. This session will take an hour and we will need the caregivers to attend.

3. Session Three (April 3 rd , 2018)

a. Caregivers

Presentation of proper denture cleaning and why it is important for healthy oral tissues. Relation of improper denture cleaning and candidiasis infection.

i.

Demonstrate how to clean a denture with a denture brush, while explaining the procedure and reasoning for overnight soaking.

ii. Define candidiasis and use flip book to show pictures that provide a visual aid of oral tissues and tissues affected by candidiasis.

iii. Acknowledge the staff's concern about the high incidence of dentures that are thrown away in the trash or lost by residents by giving donated cases with chains.

This session will take an hour and we will need the caregivers to attend.

4. Session Four (April 10 th , 2018)

a. Caregivers

Assessment of the oral health program. Caregivers will give a

demonstration and relay what they have learned to other providers in the Pelican Bay facility.

i. Evaluate the caregivers' ability to implement the program.

ii. Post-test

iii. Have caregivers demonstrate how to clean dentures and evaluate their ability to recall the reasoning for the soaking technique and leaving dentures out overnight.

iv. Have caregivers identify pictures of normal and abnormal tissue

using visual aids from a flip book.

v. Address the staff's concern about residents losing dentures and evaluate how donated cases are helping. This session will take an hour and we will need the caregivers to attend.

B. Constraints and Alternative Strategies

1.

Caregivers may have a lack of interest in the program

a.

Use visual aids

b.

Ask open ended questions

c.

Involve caregivers in the presentation

2.

There may only be partial attendance

a.

Free t-shirt for attending program presentations

b.

Whitening strips door prize at last session

3.

Not able to get pre-test completed/returned

a.

Give pre-test at beginning of 2 nd session

C. Resources The following are the resources required to implement the Oral Health Program

1.

Personnel

a.

Life Enrichment Director and Resident Care Director (first and last sessions only)

b.

Caregivers (Sessions 2-4)

c.

As many of the staff as possible (session 4)

2.

Visual Aids

a.

Flipbook with pictures of different pre-cancerous lesions (Made by Clinicians)

b.

Flipbook with pictures of common denture lesions (Made by clinicians)

c.

Typodont with toothbrush (Provided by clinicians)

d.

Denture model (Provided by LIT)

e.

Brochures; The Oral Cancer Exam, Older Adults and Oral Health, Daily oral care guide for caregivers, Dry Mouth

3.

Supplies

a.

Denture Cleaner, Denture toothbrush, Polident tabs, gauze, tongue depressors, mouth mirrors (donated by LIT)

b.

Gloves, masks, loupes (supplied by clinician)

4.

Evaluation Material

a.

Pre-test

b.

Post-test: same as pre-test

c.

Administrator Evaluation

5.

Supplements

a.

Cases for dentures/partials (donated by Dr. Williams D.D.S)

b.

Chains for cases (donated by clinicians)

c.

Outline of the program plan (supplied by clinicians)

d.

Incentive T-Shirts (donated by clinicians)

e.

Incentive Whitening Stripes (donated by clinicians)

f.

Flyer to put near time clock for staff to be aware of program dates and time (created by clinicians)

g.

List of dental providers for low cost in the area (made by clinicians)

D. Budget

The estimated cost of the oral health program is as follows:

Denture brushes (donated by LIT Dental Hygiene for use) Denture cleaner (donated by LIT Dental Hygiene for use) Polident tablets (donated by LIT Dental Hygiene for use) Partial cases (donated by Dr. Williams D.D.S for use) Chains for partial cases (donated by clinicians) Oral Cancer screening brochures (supplied by NIH) Gloves (supplied by clinician) Mask (supplied by clinician) Gauze (donated by LIT Dental Hygiene for use) Tongue Depressors (donated by LIT Dental Hygiene for use) Loupes (supplied by clinician) T-Shirts (donated by clinicians) Whitening Strips (donated by clinicians)

E. Timetable

There will be a total of four sessions between February and April. The schedule is as follows:

Session 1: February 6, 2018

Session 2: March 27, 2018 Session 3: April 3, 2018 Session 4: April 10, 2018

Evaluation

A. Formative

1. Weekly review of oral cancer screening, have caregivers demonstrate

2. Weekly review of denture care, caregivers demonstrate

3. Weekly meeting with Resident Care Director and/or Memory Care

Director to evaluate the program

4. Weekly review of all general health care knowledge to help the knowledge to be remembered

B. Summative

1. A pre-test and posttest will be given to the caregivers and then compared to assess the growth in their oral healthcare knowledge.

2. An ending questionnaire will be given to the Life Enrichment Director, Resident Care Director, and the Memory Care Director to assess the effectiveness and what accomplishments came from the oral health program.

3. A written instruction manual will be provided by the clinicians to Pelican Bay to have as a reference to train future caregivers and employees.

4. An annual check with the administrators will bring in long term data on the successful utilization of the oral cancer screenings and care of dentures for the residents

References

1. Cindy Dorsey and Tameka Wycoff, LVN. Personal Interview February 7, 2018. 409-860-1672

2. http://www.pelicanbayassistedliving.org/ Retrieved February 13, 2018

5. Investapedia.com/terms/a/adl

6. Gnjato, S. (2016). Impact of Dentures on Oral Health-Related Quality of Life. Medicinski Pregled / Medical Review, 69(7/8), 203-211. doi:10.2298/MPNS1608203G

7. Kaur Shergill, D. (2017). A Question to Denture Wearers- Does it Improve the Quality of Life? International Journal of Community Health & Medical Research, 3(1), 55-58.

doi:10.21276/ijchmr.2017.3.1.12

8. Rinker, J. (2015). Denture Care and Nursing Home Residents. Rdh, 35(6), 26-30. http://www.rdhmag.com/articles/print/volume-

Retrieved March 8, 2018.

9. World Health Organization (WHO)

11. Gomes, M. S., Bonan, P. F., Ferreira, V. N., de Lucena Pereira, L.,

Correia, R. C., da Silva Teixeira, H. B., &

Development of a mobile application for oral cancer screening.

Technology & Health Care, 25(2), 187-195. doi:10.3233/THC-

Bonan, P. (2017).

161259

12. Baumann, E., Koller, M., Wiltfang, J., Wenz, H., Möller, B., & Hertrampf, K. (2016). Challenges of early detection of oral cancer:

Raising awareness as a first step to successful campaigning. Health Education Research, 31(2), 136-145.

doi:10.1093/her/cyv099

Appendix+

1. Pretest/posttest

2. List of low cost dental care providers in the area

3. Brochures from NIH:

1. The Oral Cancer Exam

2. Older Adults and Oral Health

1. Daily oral care guide for caregivers

2. Dry Mouth

1. Assisted Living & Memory Care Rates 2018

2. Pelican Bay Assisted Living Community February 2018 Newsletter

3. Program evaluation