ORAL CARE PLAN: AGING GRACEFULLY INITIATIVE (AGI)

Roshney Ali, Trinh Luu, Carolina Sifuentes

Needs Assessment

A. General Data:
1. Description of the site:

Aging Gracefully Initiative (AGI), located at 8626 Tara Ln, Port Arthur, Texas, is
an organization created for senior citizens. The AGI center is a nonprofit
organization that has been established since 2018. Aging Gracefully Initiative
(AGI), has been funded by individual donations, or offerings given by members
of the church. The goal of this center is to provide seniors with a path to gather for
education, fitness, socialization, and support. (1) The activities delivered at the
senior center will help the elderly to remain integrated and be involved in the
community. (2) The senior center will strive to create new and innovative ways to
ensure that members will get care filled with dignity, compassion, and inspiration
regardless if the needs or numbers of the elderly grow. (1)

2. Description of target group:

Our target population are senior citizens. The target population consists of forty
elderly individuals aged 65 years and above. Based on the staff's questionnaire
assessment, the seniors only brush once a day, have never flossed before, and
have some degree of hypersensitivity. The seniors could possibly have additional
oral conditions that may be underdiagnosed. One of the goals of the organization
is for the staff to provide the seniors a pathway to support them in various aspects
of self-care. If an elderly is having difficulties in any aspect of life, the
organization will take action for the challenges present in order to improve the
individual’s quality of life. (1)

3. Description of Staff Population

The staff population consists of two coordinators, one assistant coordinator, and a
group of assistants. There are a total of seven staff members. All staff members
provide seniors with an avenue to gather for support, socialization, general
education, and fitness. The activities at the AGI center will help older adults
remain integrated and be a vital part of the community and focus on the “mind,
body, and soul”. (2) The coordinators with a master’s or an associate’s degree in
business coordinate the daily events and activities, plans and supports programs,
guides team members and seniors. The assistant coordinator with an associate
 degree in education helps the coordinators with events, carrying out activities, and
substitutes if any coordinator(s) are not available. The group of assistants with
GED certificates help with carrying out the planned activities, supporting the
coordinators, and assisting the seniors. (1)

4. Description of services provided

There are two coordinators of the organization who are responsible for the
creation of the activities and designate the duties of the five other staff. The
coordinators and the staff gather every Monday from 4pm to 6pm to carry out the
events. The team intends to continue creating innovative events that will benefit
the senior citizens. They hold special events once a month to travel as a group to
various cities such as Houston, or Galveston. Furthermore, they attend exhibitions
for learning activities, collaborate with other seniors from different cities, visit
parks, and do arts & crafts to gain experiences. The daily routine of the seniors
include doing fun activities such as yoga, playing games together, using social
media, taking citizenship classes, physical and mental exercises, and learning how
to use different types of technology. (1)

5. Other pertinent Data

The average water fluoridation for Jefferson county in the Port Arthur area is 0.70
mg/L. (3)

B. Information Related to Dental Health

Although, Aging Gracefully Initiative (AGI) center has activities and resources for
mental and medically related health, there is nothing established related to dental care.
The center lacks preventive measures and supplies that are essential for dental health. The
center is highly interested in a dental program to be conducted for the seniors. Only some
staff have knowledge and are aware of the importance of dental health. Overall, all staff
and the elderly desire for dental sessions so that more knowledge is gained. As a result, it
will help motivate everyone to seek dental help. By conducting a dental program,
everyone can support one another in terms of taking preventive measures. (1)
C. Dental Health Status

1. Dental caries

​ The table displays that 96% of seniors have had decay in their teeth in 2011–2016,
a 3 percentage point increase from 1999–2004. (4)
- Older adults have more root caries than any other age group. Approximately 50%
of persons aged older than 75 years of age have root caries affecting at least one
tooth. Also, a significant risk factor for root caries is exposed root surfaces caused
by periodontal diseases and its negative consequences such as attachment loss. (5)

- Xerostomia
Patients with xerostomia have been shown to have significantly more carious
lesions than those without xerostomia, with 70% of those who reported dry mouth
having at least one carious lesion compared with only 56% in those who did not
report dry mouth. (5)

Older adults might experience xerostomia from their medications. It affects 30%
of patients older than 65 years and up to 40% of patients older than 80 years. (5)
2. Periodontal Disease

According to the bar graph, 44% of 55–74 year olds had moderate or severe
periodontitis, and this increased to 61% of over 75 year olds. (6)
 3. Health Status to Dental Health
(Disability/Mobility)

Based on the bar labeled "Difficulty with mobility," the elderly aged 65 and older
experience the greatest challenge with mobility. The bar has a higher percentage
than any other listed problems related to old age. Since dental care at home and
mobility are connected, the elderly would have a higher chance of not being able
to carry out a proper oral care routine. (7)

4. Oral Cancer

Gender Occurrence of Oral Cancer

Female x

Male 2x

Head and neck cancers are more than twice as common among men as women.
(8)

Being a Smoker or Nonsmoker Risk for Oral Cancer

Nonsmoker x

Smoker 10x

Smokers are at 10 times higher risk for oral cancer compared to non-smokers.
(9)
 5. Edentulous

Age Range Percentage of tooth loss in

older adults

75 years & older 32.2%

65-74 years 26.5%

Adults aged 75 years and older have more tooth loss compared to adults aged 65-74
years. According to the table, the prevalence of edentulism increased in those with
advanced age. (16)

6. Dental Checkups

In 2017, approximately two-thirds of adults aged 65 and over had a dental visit in the past
12 months. Older adults who were poor (42.7%) or near poor (42.8%) were less likely to
have had a dental visit compared with not-poor (74.4%) older adults. (11)
GOAL:

Promoting oral health education and awareness, preventing and managing the conditions,
maintaining functional dentition, and increasing access to care.

OBJECTIVES:

● Seniors will create an oral care routine to carry out at home and learn the
importance of dental care by the end of the program.
● Seniors will learn about the positive values of the connection between oral and
general health and wellness at each session.
● At the end of each session, seniors will practice oral hygiene techniques and steps
at home.
● Seniors will be able to access the resources of the healthcare system by the end of
first session
● Seniors will increase their dental knowledge by 10% by the end of third session
● Demonstrate or modify oral hygiene techniques by the end of third session

RATIONALE:

Oral health is a crucial aspect of overall health and well-being. Poor oral health can lead
to a range of serious health problems, including heart disease, stroke, and diabetes, among others
(12). Additionally, oral health problems can have a negative impact on the quality of life,
including pain, difficulty eating, and social isolation (12). There is a growing body of literature
that supports the need for oral health programs for geriatric patients.
A review of the literature reveals a number of programs that have been successful in
promoting oral health among seniors. For example, in an article titled “Oral care for older people
in residential areas. Nursing & Residential Care”, Beth Burns offers insights into implementing a
fundamental evaluation tool and a daily care regimen to ensure proper oral hygiene (12). She
found that older patients commonly reported issues related to their dentures as a chief complaint.
Wearing dentures can lead to the development of ulceration known as keratoses, caused by
constant rubbing, and a condition called denture-induced stomatitis (12). Ill-fitting dentures,
coupled with poor denture hygiene, are significant factors that increase the risk of oral candidal
infection (12). It is essential to provide the seniors with education and resources on oral health
care as it can help them understand the importance of maintaining good oral health and how to
prevent and treat oral health conditions.. Similarly, a program for older adults in rural
communities in Australia published in Australian Journal of Rural Health found that there was a
need for targeted oral health promotion programs for the elderly population in rural areas (13).
The study also highlighted the importance of oral health knowledge, attitudes, and behaviors
among the elderly population (13). The objectives of the program are based on best practices and
evidence-based approaches to promoting oral health among seniors. By focusing on creating an
oral care routine, educating seniors about the connection between oral and general health, and
increasing access to care, the program aims to improve seniors’ oral health knowledge and
behavior. The ADA's guidelines for dental care for older adults emphasize the importance of
providing comprehensive dental care for older adults, including preventive services, restorative
services, and education and counseling on oral health (14). It aims to promote the importance of
assessing the quality of oral healthcare in older adults and to propose a framework for measuring
quality that considers patient-centered outcomes, evidence-based care, and patient safety (14).
The guidelines also highlight the need for dental care providers to be aware of age-related
changes and medical conditions that may impact oral health in older adults (14). It supports the
rationale for an oral health program for geriatric patients by emphasizing the importance of
providing comprehensive dental care services and education and counseling to prevent and
manage oral diseases in older adults. The WHO's global strategy on oral health highlights the
need for oral health programs that address the specific needs of older adults, such as improving
access to dental care and providing education on oral health (10). The document also emphasizes
the link between oral health and overall health outcomes in older adults (10), which supports the
rationale for an oral health program for geriatric patients that addresses the impact of oral health
on overall health and well-being. A study shows that poor oral health was associated with an
increased risk of developing several chronic conditions in older adults, such as cardiovascular
disease, diabetes, and pneumonia (15). The study also found that improving oral health in older
adults can lead to improved overall health outcomes (15). This study supports the rationale for an
oral health program for geriatric patients that focuses on preventing and managing oral diseases
to improve overall health outcomes. Promoting good oral health habits and educating older
adults about the importance of oral health can have long-lasting benefits. By providing education
and counseling, geriatric patients can learn how to maintain good oral health habits and prevent
future oral health problems, which can lead to better health outcomes and a higher quality of life.

PROGRAM DESIGN:

A. Activities
The purpose of our oral health program is to promote oral health and awareness of
the elderly population. By raising awareness, the seniors will be able to take
necessary actions to maintain good oral health. The elderly will gain an
opportunity through this program to improve their oral hygiene care and build
support from one another. The discussions will include educating the seniors
about proper oral self care, providing basic knowledge about oral diseases and
basic oral screenings, and dental prostheses care. Three educational sessions will
be presented, with each session taking place once a week. These sessions will be
conducted in the following:

1. Session 1 (week 1)
a. Seniors
- Provide an overview of a dental health plan
regarding senior citizens' oral health. Topics will
include the correlation between oral health and
overall health, the importance of maintaining oral
health, plaque control, and dental prostheses
cleaning.
1. Present our goals by distributing visual aids/flyers
2. Distribute quiz handouts to assess the dental
knowledge of the seniors
3. Discuss the oral risks/conditions that the elderly fall
under
4. Discuss the importance of regular dental visits and
for maintaining a good oral hygiene
5. Present what plaque is and how to control it
6. Demonstrate the Bass Method Technique on a
typodont
7. Provide recommendations what equipments and
type of toothpaste can be used to carry out the
brushing technique
8. Discuss importance of maintaining a clean dental
prosthesis
9. Demonstrate denture cleaning using a denture brush
and denture cleaner.
10. Provide toothbrushes and toothpastes to seniors
11. Brief review over what was learned and then give a
preview for the next session

This session will require an hour and will require team members
and coordinators of the organization for assistance.

2. Session 2 (week 2)
a. Seniors
- Presentation of gum diseases and preventive methods. This
session will involve collaboration with the group to assess
 their dental knowledge and techniques learned to help with
oral hygiene.
1. Present new topic with open-ended questions about
periodontal disease
2. Discuss how periodontal disease initiates and negative
consequences involved
3. Educate seniors of signs of periodontal disease
4. Display their risk factors involved with their age and
periodontal disease
5. Introduce and demonstrate flossing technique to the group
with the use of video and typodont
6. Distribute to show what types of flosses are available to use
for oral care
7. Brief review over what is learned and give preview for the
following session

This session will require an hour and will require team members
and coordinators of the organization for assistance.

3. Session 3 (week 3)
a. Seniors
- Presentation will be focused on assisting seniors to identify signs
of concerns with their oral cavity. The session will look into
strategies that can be used at home for self assessment. Topics will
include caries development, and oral cancer screening.
1. Open a discussion to hear feedback from previous sessions and
collaborate as a group to review what the seniors have learned
2. Present new topic about caries development with open-ended
questions
3. Play a game to introduce cariogenic and non cariogenic food items
4. Present what is fluoride and its benefits
5. Transition to oral cancer topic by differentiating what is a cavity
and suspicious areas
6. Demonstrate home techniques to evaluate the condition of oral
cavity
7. Ensure the seniors understanding by displaying oral cancer signs of
the oral cavity vs cavities or decays on powerpoint slide
8. Express the importance of regular dental visits and getting an
assessment of the oral cavity
 9. Brief review of the topic and answer questions
10. Motivate all seniors and congratulate them for their completion of
the program

This session will require an hour and a half.

B. Constraints and Alternative Strategies

1. Constraint: Residents might have difficulty demonstrating the

skills due to mobility issues.

Alternatives: 1. Use assistive technologies, such as specialized

toothbrushes, flossing aids, or water flossers, to help patients with
mobility issues maintain proper oral hygiene at home. 2. Education
and training will be provided to patients, family members,
caregivers, and home health aides to ensure proper use and
maintenance of the devices.

2. Constraint: There may be a lack of interest from the seniors due to

lack of knowledge or different beliefs.

Alternatives: 1. Make the presentation interactive by asking

questions to the seniors. 2. Engage the seniors with other activities
such as visual aids or demonstrations to help them understand
through different ways.

3. Constraint: There may be difficulties of keeping up with regular

dental visits and various dental needs due to transportation
difficulties.

Alternatives: 1. Utilize mobile dental clinics that can travel to

different locations. 2. Offer affordable or free transportation to
dental appointments. 3. Provide seniors with telehealth options.
C. Resources
The following resources will be required for implementation of the program:

1. Personnel: The coordinators and team members from the center (for all
sessions). The seniors and their family members or caregivers (for all
sessions). The dental hygiene students from LIT (for all sessions).
2. Supplies:
a. Toothbrushes (soft bristles), Sensodyne toothpaste, floss picks,
interdental brushes, floss (40 kits). Non-alcohol mini mouthrinses
(40). Denture brushes and denture cleaner (6 kits).
b. Gloves, paper napkins, three sample dentures, eight teeth models,
two sample water flosser devices, tongue depressor, gauze -
provided by LIT Dental Hygiene Clinic
3. Visual Aids:
a. Powerpoint that includes information about each session (plaque,
healthy vs unhealthy oral cavity, periodontal disease, oral cancer
signs, caries/tooth decay, proper care for dentures or prosthetic
devices), a video about using water flosser
b. Flip chart for demonstration purposes for proper brushing, flossing,
and denture cleaning, oral cavity home assessment)
c. Colored Handouts of cariogenic and non cariogenic foods

4. Evaluation Material:
a. Pretest - one form
b. Post-test - same form
5. Supplements:
a. List of locations that provide discounts or payment plans for dental
care needs
b. An outline of program plan-provided by the clinicians
D. Budget:
The estimated cost for the dental health program is as follows:

Toothbrush kits (provided by LIT Dental

Hygiene Clinic for use)

Gloves (provided by LIT Dental

Hygiene Clinic for use)

Denture Cleaner (provided by LIT Dental

Hygiene Clinic for use)

Denture brushes (provided by LIT Dental

Hygiene Clinic for use)

Water flosser (provided by LIT Dental

Hygiene Clinic for use)

Teeth models (provided by LIT Dental

Hygiene Clinic for use)

Gauze, tongue depressors, (provided by LIT Dental

napkins Hygiene Clinic for use)

Denture models (provided by LIT Dental

Hygiene Clinic for use)

Mouth rinses (provided by LIT Dental

Hygiene Clinic for use)

E. Time Table:
Before each session, all necessary resources will be obtained. There will be three
sessions over the course of three weeks. The schedule is as follows:
Session 1: Wednesday, April 5
Session 2: Wednesday, April 12
Session 3: Wednesday, April 19

F. Evaluation:
A. Process evaluation (formative):
1. A weekly meeting with the coordinators and team members to
evaluate the progress of the oral health program.
 2. A weekly questionnaire delivered to seniors to assess the dental
knowledge obtained per topic.
3. A weekly observation of oral health techniques to ensure the skills
are understood by seniors. Oral health techniques will include Bass
Method technique, flossing technique, and denture cleaning
technique.
4. A weekly review of self oral cancer screening to verify if seniors
are able to identify signs of disease.

B. Product Evaluation (summative):

1. Pre-test and post-test will be provided to the seniors to determine
and compare their level of knowledge before and after the program
is held.
2. A survey will be given to the seniors to evaluate their experience
and success of the oral health program
3. A periodical check with the coordinators will be conducted to
determine if seniors are carrying out a beneficial oral care routine
at home.
4. Provide a typed instructional brochure to the seniors about the oral
health program and targeted topics.
5. A biannual check with coordinators and team members will take
place to verify the promotion of dental health topics and to ensure
the implementation of any oral hygiene-related activities.

References:
1. Dholasaniya, Asmita. ( February 7, 2023). Personal Interview.

2. The.Ismaili. (2023, February 15). Aging Gracefully: An Initiative of the Aga Khan
Council for the United States. May 5, 2021; Aging Texas Well: Texas Health and Human
Services Commission. Retrieved from:
 https://www.hhs.texas.gov/sites/default/files/documents/about-hhs/communic
ations-events/meetings-events/atwac/april-2021-atwac-agenda-item-3.pdf

3. Water Fluoridation Data. Retrieved from:

https://nccd.cdc.gov/DOH_MWF/Default/WaterSystemDetails.aspx

4. Dental Caries Data. Retrieved from:

https://www.nidcr.nih.gov/research/data-statistics/dental-caries/seniors#table
1

5. Aging and Dental Health (Xerostomia). Retrieved from:

https://www.ada.org/resources/research/science-and-research-institute/oral-h
ealth-topics/aging-and-dental-health#:~:text=Older%20adults%20are%20at
%20increased,affecting%20at%20least%20one%20tooth.

6. Prevalence of periodontal disease in older individuals. Retrieved from:

https://onlinelibrary.wiley.com/doi/full/10.1111/adj.12280

7. Health Status to Dental Health (Disability/Mobility). Retrieved from:

https://acl.gov/sites/default/files/aging%20and%20Disability%20In%20Ame
rica/2020Profileolderamericans.final_.pdf

8. Oral cancer in individuals. Retrieved from:

https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet#:~:text=n
ot%20go%20away.-,How%20common%20are%20head%20and%20neck%
20cancers%3F,are%20among%20women%20(31).

9. Oral cancer in smokers vs nonsmokers. Retrieved from:

https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/leg
islation/tobacco-product-labelling/smoking-oral-cancer.html

10. World Health Organization. (2013). Oral health: Action plan for promotion and integrated
disease prevention. World Health Organization. Retrieved from:
https://apps.who.int/iris/handle/10665/21909

11. Percentage of dental check ups. Retrieved from:

https://www.cdc.gov/nchs/products/databriefs/db337.htm#:~:text=In%20201
7%2C%20among%20adults%20aged%2065%20and%20over%2C%2065.6
%25,those%20aged%2085%20and%20over.
12. Burns, B. C. (2012). Oral care for older people in residential. Nursing & Residential
Care, 14(1), 26–31.

https://eds-p-ebscohost-com.libproxy.lamar.edu/eds/pdfviewer/pdfviewer?vid
=29&sid=565cb293-bcfe-49d5-801e-2cfef2b49d94%40redis

13. Crocombe, L. A., Stewart, J. F., Brennan, D. S., Slade, G. D., & Spencer, A. J. (2013). Is
clinical oral health poorer in regional areas compared with major city areas? Australian
Journal of Rural Health, 21(3), 150–157.
https://doi-org.libproxy.lamar.edu/10.1111/ajr.12034

14. American Dental Association. (2015). Measuring Oral Healthcare Quality in Older
Adults: Executive Summary of Recommendations. Retrieved from
https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/reso
urces/research/dqa/educational-resources/measuring_oral_healthcare_qualit
y_in_older_adults_report.pdf?rev=b51863421ce2448cb3f89c8ede080f72&has
h=3B2ADB28008ADD45817F8670A40EA161

15. Chalmers JM, Carter KD, & Spencer AJ. (2004). Oral health of Adelaide nursing home
residents: longitudinal study. Australasian Journal on Ageing, 23(2), 63–70.
https://doi-org.libproxy.lamar.edu/10.1111/j.1741-6612.2004.00019.x

16. Slade, G. D., Akinkugbe, A. A., & Sanders, A. E. (2014). Projections of U.S. Edentulism
prevalence following 5 decades of decline. Journal of dental research, 93(10), 959–965.
https://doi.org/10.1177/0022034514546165
Appendix

● Pre test and post test

● Lesson plans (session 1 to session 3)
● Sheet with dental care available in Beaumont
● Brochure in Gujarati for dental awareness
● Colored handouts on cariogenic and non cariogenic food items
● Handout on Plaque
● Handout on Periodontal disease
● Handout on Oral Cancer Self Assessment
● Handout on Bass Method Technique
● Handout on Flossing Technique
● Handout on denture cleaning
● Program evaluation survey
NAME:

PRE-TEST

1. When should you visit a dentist?

a. Never
b. Only when you have pain
c. Regularly
d. Once a year
e. I do not know
2. What is not a benefit of dental health?
a. Fresh breath
b. Cavity prevention
c. Healthy gums
d. Loss of teeth
e. I do not know
3. How often should you brush your teeth?
a. Once a day
b. Twice a day
c. Thrice a day
d. Every time you eat or snack
e. I do not know
4. What is plaque?
a. Bacteria on the face
b. Bacteria in the mouth
c. Bacteria on the foot
d. Bacteria on the hand
e. I do not know
5. If you have dentures, how often should you clean them?
a. Once a day
b. Twice a day
c. Thrice a day
d. Every time you eat or snack
e. I do not know
6. How often should you floss?
a. Not necessary
b. I do not know what that is.
c. Once a day
d. Once a month
e. I do not know
7. Oral cancer only happens if you chew tobacco or smoke.
a. True
b. False
NAME:

POST-TEST

1.When should you visit a dentist?

a. Never
b. Only when you have pain
c. Regularly
d. Once a year
e. I do not know
2. What is not a benefit of dental health?
a. Fresh breath
b. Cavity prevention
c. Healthy gums
d. Loss of teeth
e. I do not know
3. How often should you brush your teeth?
a. Once a day
b. Twice a day
c. Thrice a day
d. Every time you eat or snack
e. I do not know
4. What is plaque?
a. Bacteria on the face
b. Bacteria in the mouth
c. Bacteria on the foot
d. Bacteria on the hand
e. I do not know
5. If you have dentures, how often should you clean them?
a. Once a day
b. Twice a day
c. Thrice a day
d. Every time you eat or snack
e. I do not know
6. How often should you floss?
a. Not necessary
b. I do not know what that is.
c. Once a day
d. Once a month
e. I do not know
7. Oral cancer only happens if you chew tobacco or smoke.
a. True
b. False