The OHNEP Interprofessional
Oral Health Faculty Toolkit
Adult-Gerontology Acute Care Nurse
Practitioner Program
CURRICULUM INTEGRATION OF INTERPROFESSIONAL
ORAL HEALTH CORE COMPETENCIES:
Advanced Physical Assessment Across the Lifespan
• Principles of Adult Gerontology Acute Care I- II
• Principles of Adult Gerontology Acute Care III
• Resources
•
© Oral Health Nursing Education and Practice (OHNEP)
INTRODUCTION
S
The Oral Health Nursing Education and Practice (OHNEP) program has developed an Interprofessional Oral Health Faculty Tool Kit to
provide you with user friendly curriculum templates and teaching-learning resources to use when integrating oral health and its links
to overall health in your Acute Care Adult-Gerontology Nurse Practitioner program.
Oral health and its relation to overall health has been identified as an important population health issue. Healthy People 2020 (2011),
the IOM Reports, Advancing Oral Health in America (2011) and Building Workforce Capacity in Oral Health (2011), as well as the IPEC
Competencies (2011), challenged HRSA to develop interprofessional oral health core competencies for nondental providers.
Collectively, these documents reflect those interprofessional oral health competencies that can be used by Acute Care AdultGerontology Nurse Practitioners for faculty development, curriculum integration and establishment of “best practices” in critical
care, acute and ambulatory settings.
The HRSA interprofessional oral health core competencies, the IPEC competencies and the NONPF core competencies provide a
framework for the acute care curriculum templates and resources. Exciting teaching-learning strategies that take students from
Exposure to Immersion to Competence can begin in the classroom, link to simulated or live clinical experiences and involve critical
acute & ambulatory care clinical experiences, as well as advocacy and policy initiatives as venues you can readily use to integrate
oral health into your existing acute care curriculum. The Acute Care Adult- Gerontology Nurse Practitioner curriculum template
illustrates how oral health can be integrated into acute care health assessment and clinical management courses.
The Smiles for Life interprofessional oral health curriculum provides a robust web-based resource for you to use that articulates with
the oral health curriculum template for each course. A good place to begin oral health integration is by transitioning the HEENT
component of the history and physical exam to the HEENOT approach. In that way, you and your students will NOT forget about
including oral health in patients encounters.
Research evidence continues to reveal an integral relationship between oral and systemic health. It is important for nurse
practitioners on the frontline of acute care to have the oral health competencies necessary to recognize both normal and abnormal
oral conditions and provide acute care patients with education, prevention, diagnosis, treatment and referral as needed.
We encourage you and your students to explore the resources in the templates as you “weave” oral health and its links to overall
health into your Acute Care Adult-Gerontology Nurse Practitioner program. If you need additional technical assistance, please feel
free to contact us at [email protected]
AG-ACNPCurriculumIntegrationofInterprofessionalOralHealthCompetenciesinAdvancedPhysicalAssessment
IPEC Competencies:
Values and Ethics,
Roles and
Responsibilities
Interprofessional
Communication,
Teams &Teamwork
HRSA Oral Health
Competencies:
Oral Health Risk
Assessment, Oral Health
Evaluation,
Oral Health Preventive
Intervention,
Communication and
Education
NONPF Competencies:
Assesses the complex
acute, critical, and
chronically-ill patient
for urgent and
emergent conditions,
using both
physiologically and
technologically derived
data, to evaluate for
physiologic instability
and risk for potential
life-threatening
conditions
KNOWLEDGE: ORAL EXAM
Goal: Understand the oral exam
E
N
T
R
Y
L
E
V
E
L
A
S
S
E
S
S
M
E
N
T
• Complete Smiles for Life Module #7
• Submit SFL Certificate of Completion
• Complete SFL Quiz for Module #7
(Appendix 1)
• Read Putting the Mouth Back in the
Head: HEENT to HEENOT (Haber et al,
2015)
KNOWLEDGE: ORAL CARE OF ADULT
Goal: Understand oral care issues of adults in
acute care
2) IMMERSION: DEVELOPMENT
SKILL/BEHAVIOR
Goal: Describe best practices in dental caries
management across the lifespan
•
Review Adult Caries Risk Assessment
Tool CAMBRA for patients over age 6
(Appendix 5)
Download SFL Adult Oral Health
Pocket Card (Appendix 6)
•
SKILL/BEHAVIOR
Goal: :Identify oral pathologies
•
•
•
Complete Smiles for Life modules #1 & 3
Complete quizzes (Appendix 2, 3) and
submit SFL certificates of completion
Read Oral Health Patient Facts : Overview,
Diabetes, HPV
•
KNOWLEDGE: ORAL CARE OF OLDER
ADULT
Goal: Understand oral care of older adults in
acute care
•
•
Complete Smiles for Life Module #8,
submit certificate o f completion, &
complete quiz (Appendix 4)
Read Oral Health Patient Facts : Older
Adult
CONSTRUCTS
© Oral Health Nursing EducationandPractice (OHNEP)
Identify oral pathologies in :
• Adult photographs (Appendix 7, 8)
• Adult oral health manikin
• Discuss diagnoses- related risk factors and
management strategies
SKILL/BEHAVIOR
Goal :Documentation of oral Health
•
Develop an electronic health record
entry for an older adult with an
acute care health condition (e.g.,
diabetes, pneumonia, congestive
heart failure, dementia), which
includes oral health history, risk
assessment, exam and
management plan (HEENOT)
3) COMPETENCE: ENTRY-TO-PRACTICE
SKILL/BEHAVIOR
Goal: Demonstrate integration of HEENOT
• Using SP in simulation experience, demonstrate
competency in oral health history (including
frequency of sugar/tobacco/alcohol intake), risk
assessment and physical exam of adult in acute
setting, identifying any oral abnormalities
• Each student will compare acute care oral health
assessment skills with classmate using the
S • Evaluation of Interrater Reliability Assessing Oral
U
Health in Acute Care Settings (Konradsen et al.,
M
2014)
M
A
T
I
V
E
SKILL/BEHAVIOR
Goal: Describe oral health practices of
different cultures
• Read: Is the Value of Oral Health
Related to Culture and Environment or
Function and Aesthetics? (Nassani et
al, 2015)
• Each student will choose one culture
and report on oral health practices of
that culture
A
S
S
E
S
S
M
E
N
T
SKILL/BEHAVIOR
Goal: Understand Issues related to oral health
of older adults in acute care settings
•
•
Read: Xerostomia Among Older Adults
with Low Income: Nuisance or Warning?
(Lee et al., 2016)
Post and explain causes of xerostomia in
older adults and management strategies
on discussion board
INTER-PROFESSIONAL PARTNERSHIP & COLLABORATIVE PRACTICE FOR
OPTIMIZATION OF CIENT/PATIENT HEALTH OUTCOMES
1) EXPOSURE: INTRODUCTION
ADVANCED
PHYSICAL
ASSESSMENT
ACROSS THE
LIFESPAN
APPENDIX 1
Advanced Physical Assessment Across the Lifespan
Smiles for Life Module 7 Quiz: Oral Examination
1. What constitutes a tooth’s outer layer?
A. Enamel
B. Dentin
C. Pulp
2. What is a full complement of adult teeth?
A. 26
B. 28
C. 30
D. 32
3. Oral cancer is most common in
which area of the mouth?
A. Hard palate
B. Surface of tongue
C. Inside of cheek
D. Posterolateral tongue
4. Which of the following is NOT needed
by a clinician to conduct a thorough
oral exam?
A. An exam light to illuminate key
features in the mouth
B. Tongue depressors to lift the
lip and retract the cheek
C. A mouth mirror to view lingual surfaces
of teeth
D. Dental explorer
E. Gauze pads to grasp the tongue
6. A complete oral examination includes
each of the following EXCEPT:
A. Temporomandibular joint (TMJ) exam
B. Cervical node exam
C. Palpation of the floor of the mouth
D. Sinus exam
E. Exam of the skin around the mouth
5. You are performing an oral exam on
your 21 year old patient who has been
using smokeless tobacco for 4 years.
What part of this patient’s oral cavity is
especially important for you to
examine?
A. The sun-exposed areas of the patient’s
cheeks
B. The inner aspect of the patient’s lips and
cheeks
C. Any discoloration or pitting of the
patient’s teeth
D. Any plaque build-up along the patient’s
gum line
E. The patient’s posterior pharynx
(Clark et al, 2010)
APPENDIX 2
Advanced Physical Assessment Across the Lifespan
Smiles for Life Module 1 Quiz: The Relationship of Oral to SystemicHealth
1. What is a consequence of
untreated dental caries?
A, Osteonecrosis of alveolar bone
B, Gingival hyperplasia
C, Oral mucositis
D, Tooth fractures
2. Which condition is
associated with periodontal
disease?
A. Asthma
B. Preterm labor
C. Sinusitis
D. Hypothyroidism
3. Which of the following
medications is
linked to gingival hyperplasia?
A. Phenytoin
B. Amoxicillin
C. Digoxin
D. Coumadin
4. What can a clinician do to promote
oral health?
A. Collaborate with dental and other
health professionals
B. Apply dental sealants
C. Prescribe oral fluoride supplements
to every patient
D. Apply fluoride varnish to the teeth
of all adults
5. Which of these classes of
medications is NOT generally
associated with decreased salivary
flow?
A. Antihistamines
B. Antibiotics
C. Corticosteroids
D. Anticholinergics
E. Diuretics
6. A patient undergoing chemotherapy for
cancer is at risk for which of these oral
complications due to the effects of
chemotherapy?
A. Osteonecrosis of alveolar bone
B. Gingival hyperplasia
C. Oral mucositis
D. Tooth fractures
7. Which of the following infections is NOT
potentially caused by direct extension from
a dental source?
A. Otitis media
B. Sinusitis
C. Brain abscess
D. Facial cellulitis
8. What is the suggested common pathway
linking chronic periodontitis and
conditions such as diabetes, coronary
artery disease and adverse pregnancy
outcomes?
A. Direct bacterial extension
B. Poor nutrition
C. Circulating antibodies
D. Inflammation
9. Which of the following is NOT a
mechanism for inter-relationships between
oral and systemic disease?
A. Behavioral
B. Iatrogenic
C. Neurologic
D. Inflammatory
(Clark et al, 2010)
APPENDIX 3
Advanced Physical Assessment Across the Lifespan
Smiles for Life Module 3 Quiz: Adult Oral Health
1.Which dental procedure does NOT require
prophylaxis for individuals at high risk
of bacterial endocarditis?
A. Dental extractions
B. Periodontal procedures
C. Post-operative suture removal
D. Prophylactic cleaning of teeth if
bleeding is anticipated
E. Re-implantation of avulsed teeth
2.Periodontal disease can be clinically
distinguished from gingivitis in which of
the following ways?
A. Inflammation of the gums
B. White discoloration of the permanent teeth
C. Enlarged pockets at the gum base
D. Gingival hypertrophy
3.Which of the following is NOT a common
site for oral cancers?
A. Tongue
B. Floor of mouth
C. Hard palate
D. Lower lip
4.Which of the following is most likely to lead
to poorer oral health in the elderly?
A. Alzheimer’s dementia
B. Coronary artery disease
C. Hypothyroidism
D. All of the above
5. Risk factors for adult caries may include all
the following except:
A. Low socioeconomic status
B. Existing tooth restoration
C. Decreased salivary flow
D. A vegetarian diet
E. Physical disabilities
6. Which of the following patients requires
bacterial endocarditis antibiotic prophylaxis?
A. A 26 year old woman with mitral valve prolapse
undergoing routine teeth cleaning with no
anticipated bleeding.
B. A 64 year old man with a prosthetic mitral valve
who is undergoing a tooth extraction.
C. A 16 year old boy with a ventricular septal defect
completely repaired in infancy who requires
extraction of an impacted wisdom tooth.
D. A 32 year old man who had bacterial
endocarditis 5 years ago who isundergoing
orthodontic appliance adjustment.
7.Which of the following is not a normal
age-related tooth change?
A. Gingival recession
B. Root caries
C. Yellowing of teeth
D. Wearing away of teeth with exposed dentin
8. Whichof the following statements,
concerning xerostomia or dry mouth, is
not true?
A. Xerostomia is caused by a decrease in
the production of saliva
B. Xerostomia can cause a burning sensation,
change in taste, and difficulty swallowing
C. Medications can contribute to xerostomia
D. Xerostomia can increase the development of
caries
E. Xerostomia is rarely a problem for patients
wearing complete dentures
9.Which of the following has been implicated
in the development of recurrent aphthous
ulcers?
A. Trauma
B. Vitamin C deficiency
C. Sickle Cell Anemia
D. Herpes simplex virus infection
10. Which of the following factors is
NOT involved in the development of
“Meth Mouth”:
A. Poor oral hygiene
B. Increased carbohydrate consumption
C. Nighttime mouth breathing
D. Teeth grinding
E. Xerostomia
(Clark et al, 2010)
APPENDIX 4
Advanced Physical Assessment Across the Lifespan
Smiles for Life Module 8 Quiz: Geriatric Oral Health (part I)
1. What is the most common site for
caries in the elderly?
A. Site of a previous restoration (filling)
B. On a root that is exposed due to
gingival recession
C. On coronal surface of tooth
D. On the buccal surface of molars
4. Which statement is true regarding
dental prostheses?
A. Implants are commonly placed in a
jaw to replace teeth lost due to severe
osteoporosis
B. Dentures should be removed and
cleaned daily
C. Bridges should be removed daily to
facilitate cleaning of teeth
2. Which of the following is an
D. A partial denture is permanently fixed
absolute contraindication for
to adjacent teeth and therefore does
placing dental implants?
not need to be removed to perform a
A. Diabetes mellitus that is controlled
complete oral assessment
B. Root caries in the teeth that are to
be replaced
5. HPV influenced oral cancers have
C. Use of IV bisphosphonates
which of the following characteristics?
D. Use of medication known to cause
A. Account for the rise in oral cancers in
xerostomia
younger individuals , age 40-64
B. Are usually seen in the anterior portion
of the mouth, especially the buccal
3. What is the adverse intraoral
mucosa or the lip
effect with which calcium channel
C.
Epidemiologically related to exposure
blockers are most associated
to HPV 18
with?
D.
Less likely to be associated with oral
A. Stomatitis
cancer than other sexually transmitted
B. Thrush
infections such as syphilis and
C. Gingival hyperplasia
gonorrhea
D. Osteonecrosis of mandible
6. What is the most significant reason why complete tooth loss
has declined in the US from 50% to 18% in the last 60 years?
A. Increased use of dental insurance in the elderly
B. Increased use of bottled and filtered water products among adults
C. Addition of fluoride to most community water systems
D. Increased use of multiple prescription medications in the elderly
7. While performing an oral exam on a 72 year old patient, you
observe the finding in the photograph. How should you manage
this finding?
A. Refer the patient to an oral surgeon for immediate biopsy of
probable oral cancer
B. Schedule the patient to return in 2 weeks to reassess the lesion. If
the lesion is still present, you should then refer the patient for
biopsy
C. Treat the patient with an antifungal solution and reassess in 2
weeks
D. Document this finding as sublingual varicosities that are normal in
this age group and require no further evaluation
(Clark et al, 2010)
APPENDIX 4
Advanced Physical Assessment Across the Lifespan
Smiles for Life Module 8 Quiz: Geriatric Oral Health (part II)
8. Which of the following statements is true
regarding the oral health of elderly patients with
dementia?
A. Aging alone is the major contributor to poor oral
health of older individuals with dementia
B. Medications used to treat hypertension,
depression and behavioral disturbances seen in
this population have little effect on their oral
health
C. Since this population struggles with Activities of
Daily Living (ADLs), they are at high risk for poor
oral health unless caregivers assist with oral care
D. Reminding these individuals to brush their teeth
each day is adequate to achieve and maintain
good oral health
10. Elderly with poor oral hygiene, missing teeth
and dental pain are at risk for worsening oral
health due to which of the following nutritional
factors?
A. Lack of foods rich in vitamins such as vitamin C
and beta carotene
B. Compensating for taste alteration due to
prescribed medication with soft, sugared foods
such as ice cream, pudding and white bread
which can lead to caries in remaining teeth
C. Use of mints or sweetened beverages to relieve
dry mouth
D. All of the above
11. Which of the following is an
appropriate use of fluoride in older
adults?
A. Topical fluoride treatments for
exposed roots
B. Oral fluoride supplementation for
patients with multiple carious lesions
C. Oral fluoride supplementation for
patients with multiple carious lesions
D. Topical fluoride for gingival
hyperplasia caused by phenytoin
therapy
E. Topical fluoride as a routine
preventive measure in patients with
excellent oral care (no caries or
periodontal disease)
9. After a hip fracture, a 76 year old woman is
admitted to a long-term care facility for
rehabilitation. While examining her mouth shortly
thereafter, you see the condition in the
photograph. What is the most likely cause of
what you see?
A. The patient developed cellulitis of her palate
during her recent hospital stay
B. The patient’s palate was damaged during
intubation for anesthesia
C. The patient’s dentures were improperly cleaned
while she was in the hospital
D. The patient probably has an oral cancer
(Clark et al, 2010)
APPENDIX 1-4 Advanced Physical Assessment Across the Lifespan
Smiles for Life Answer Key
Module 1:
1. A
2. B
3. A
4. A
5. B
6. C
7. A
8. D
9. C
Module 3:
1. C
2. C
3. C
4. A
5. D
6. B
7. B
8. E
9. A
10. C
Module 7:
1. A
2. D
3. D
4. D
5. B
6. D
Module 8:
1. A
2. C
3. C
4. B
5. A
6. C
7. D
8. C
9. C
10. D
11. A
(Clark et al, 2010)
APPENDIX 5
Advanced Physical Assessment Across the Lifespan
American Dental Association Caries Risk Assessment Form (Ages >6)
www.ada.org/~/media/ADA/Public Programs/Files/topics_caries_educational_over6.ashx
APPENDIX 6
Advanced Physical Assessment Across the Lifespan
Smiles for Life Adult Oral Health Pocket Card Side 1
Other Oral Disease Risk Factors
Tobacco and alcohol use (cancers)
Family history of oral cancers
Lack of mouth guard use for sports
Methamphetamine use (erosions)
Bulimia (erosions)
Significant GERD (erosions)
Screening Oral Exam
Observation
Remove all dentures and appliances
Teeth and oral hygiene
Palate and gums
Buccal mucosa
Floor of mouth & tongue
(lateral borders & undersurface)
Posterior pharynx
Palpation
Floor of mouth
Neck
Record
Signs of caries
- White spots, brown spots, pits
Signs of periodontal disease
- Poor oral hygiene (presence of plaque)
- Erythematous or receded gums
- Loose teeth
Signs of other oral disease
- Soft tissues lesions
- Tooth erosion
Refer to dentist:
All adults for 6 month check ups
All adults with signs of caries, periodontal
disease or suspicious oral lesions.
ANTIBIOTIC PROPHYLAXIS GUIDELINES FOR
ORAL PROCEDURES**
At Risk Medical Conditions
Highest Risk
Acquired valvular dysfunction
Prosthetic cardiac valves
Previous bacterial endocarditis
Congenital heart disease (CHD)
- Unrepaired cyanotic CHD
- Completely repaired congenital heart defect
during the first 6 months after the procedure
- Repaired CHD with residual defects
Cardiac transplantation recipients who develop
cardiac valvulopathy
Lower Risk - No longer prophylaxed
Acquired valvular dysfunction
Hypertrophic cardiomyopathy
Mitral valve prolapse with audible regurgitation
Isolated secundum atrial septal defect
Previous coronary artery bypass grafting
Physiologic, functional, or innocent murmurs
Previous Kawasaki disease w/o valve dysfunction
Cardiac pacemaker or implanted defibrillator
Prophylaxis also recommended for patients with the
following implanted medical devices:
Total joint replacement
- In place less than 2 years
- Immunocompromised patient
- Previous prosthetic joint infection
Vascular grafts in place less than 6 months
Arteriovenous shunt for hemodialysis
Neurosurgical shunts
Indwelling catheters
Planned Procedure
Prophylaxis recommended for highest risk patients for:
All dental procedures that involve manipulation of
gingival tissue or the periapical region of teeth or
perforation of the oral mucosa
Prophylaxis NOT recommended for:
Local anesthetic injections through non-infected tissue
Removable appliance placement
Oral radiographs
Orthodontic appliance adjustment
Shedding of primary teeth
Bleeding from trauma to the lips and oral mucosa
Antibiotic choices
Standard prophylaxis (give 1 dose only orally 30 – 60
minutes before procedure):
Amoxicillin: Adults: 2.0 g; children: 50 mg/kg
Unable to take oral medication (give 1 dose only 30 – 60
minutes before procedure):
Ampicillin: Adults: 2.0 g; children 50 mg/kg; IM or IV
Cefazolin or Ceftriaxone: Adults: 1.0 g; children 50
mg/kg; IM or IV
Allergic to penicillin (give orally 1 dose only 30 – 60
minutes before procedure):
Clindamycin: Adults: 600 mg; children: 20 mg/kg
Cephalexin: Adults: 2.0 g; children; 50 mg/kg
(caution if hypersensitivity to penicillin)
Azithromycin or clarithromycin: Adults: 500 mg;
children: 15 mg/kg
**IMPORTANT NOTICE:
The “Antibiotic Prophylaxis Guidelines” above are based on the latest recommendations by the American
Heart Association (updated 2007). It is advised to
consult the American Heart Association website for
more details and for any updates: www.heart.org
(Silk, Douglass & Douglass, 2011)
APPENDIX 6
Advanced Physical Assessment Across the Lifespan
Smiles for Life Adult Oral Health Pocket Card Side 2
ANTICOAGULATION GUIDELINES FOR ORAL
PROCEDURES
Cessation of anticoagulation or anti-platelet agents
carries a risk of thromboembolic event
Cleanings, fillings, and simple extractions can be
performed without interrupting anticoagulation
Bleeding can be controlled with local agents, e.g.
surgical (oxidized cellulose polymer), tranexamic acid
or epsilon amino caproic acid mouthwash (discuss
with dentist/oral surgeon)
Patients that are at high risk for thromboembolic
events that need to undergo oral procedures that are
high risk for bleeding can be managed with “bridge therapy” using enoxaparin (Lovenox) and/or heparin days before the procedure
Communication with dentist/oral surgeon is vital
GERIATRIC ORAL HEALTH
Xerostomia
Signs
Need to sip water or suck candies to talk
Needs fluids to form food bolus when eating
Oral burning/soreness and altered taste
No pooling of saliva in floor of mouth
Tongue fissured
Etiology
Primary disease (Sjogrens/RA/salivary tumor)
Medications – anticholinergics, antidepressants,
antipsychotics, diuretics, antihypertensives, sedatives,
antihistamines, inhalers
Management
Discontinue meds or move to morning dosing
Avoid sugar containing foods and drinks
Xylitol mints, sugar-free gum
Rx brush on topical fluoride gel
Rx saliva substitutes
Regular dental visits – higher risk for caries
ADULT ORAL HEALTH POCKET CARD
Hugh Silk MD, Alan Douglass MD, Joanna Douglass BDS
Smiles for Life Oral Health Curriculum
www.smilesforlifeoralhealth.org
October 2011
Creation of this product was funded by:
National Interprofessional Initiative on Oral Health
Denture Care and Problems
Care
Soak in water or denture cleaner overnight
Rinse with water after every meal
Brush daily with soft brush and denture cleaner
Problems
Problems with chewing, cheek biting, speech,
cracked corners of mouth = poorly fitting dentures
Erythematous candidiasis under dentures
- Nystatin rinse 3x daily, ointment under denture
- Soak denture in chlorhexidine or nystatin
PERMANENT TOOTH CHART:
The information contained in this card should not substitute for
consultation with an oral health expert.
PRIMARY CARE
Prevention of Caries & Periodontal Disease
Eliminate sweet snacks/drinks between meals
Brush twice daily with fluoridated toothpaste
Floss daily
Regular dental visits every 6 months
Regular oral exam at annual medical exam
Caries Risk Factors
Presence of cavities or multiple fillings
Gingival recession
Xerostomia (medications, disease)
Poor oral hygiene
Poor access to dental care
Low socio-economic and/or education status
Inadequate fluoride
High frequency foods/drinks/medications with sugar
Special health care needs (oral health often overlooked)
Presence of partial dentures or other appliances
Periodontal Disease Risk Factors
Poor oral hygiene including lack of flossing
Tobacco use
Diabetes and/or Osteoporosis
Family history of periodontal disease
Medications (anticonvulsants, methotrexate, Ca++
channel blockers may cause gingival hyperplasia)
(Silk, Douglass & Douglass, 2011)
APPENDIX 7
Advanced Physical Assessment Across the Lifespan
Adult Oral Health Checklist
Please check as you identify each item:
x
x
Strep throat (A)
Periodontal disease (B)
Black hairy tongue (C)
Herpetic lesion (D)
Gingival recession (E)
Canker sore (F)
Angular cheilitis (G)
Tori madibularis (H)
Images from:
CDC public health images library
Gujral, D. M., Bhattacharyya, S., Hargreaves, P., & Middleton, G. W. (2008). Periodontal disease in a patient receiving Bevacizumab: a case report. Journal of medical case reports, 2(1), 47.
Jain, A., & Kabi, D. (2013). Severe periodontitis associated with chronic kidney disease. Journal of Indian Society of Periodontology, 17(1), 128.
Jeong, J. S., Lee, J. Y., Kim, M. K., & Yoon, T. Y. (2011). Black hairy tongue associated with erlotinib treatment in a patient with advanced lung cancer. Annals of dermatology, 23(4), 526-528.
Khuller, N. (2009). Coverage of gingival recession using tunnel connective tissue graft technique. Journal of Indian Society of Periodontology, 13(2), 101.
Kwon, K. H., Lee, D. G., Koo, S. H., Jo, M. S., Shin, H., & Seul, J. H. (2012). Usefulness of vy advancement flap for defects after skin tumor excision. Archives of plastic surgery, 39(6), 619-625.
Lee, K. H., Lee, J. H., & Lee, H. J. (2013). Concurrence of Torus Mandibularis with Multiple Buccal Exostoses. Archives of plastic surgery, 40(4), 466-468. tori madibularis
APPENDIX 7
Advanced Physical Assessment Across the Lifespan
Adult Oral Health Answer Key
Answers
x
x
A
Strep throat (A)
Periodontal disease (B)
Black hairy tongue (C)
Herpetic lesion (D)
Gingival recession (E)
Canker sore (F)
Angular cheiltis (G)
Tori madibularis (H)
B
F
E
D
C
C
F
H
G
APPENDIX 8
Advanced Physical Assessment Across the Lifespan
Adult Oral Health Answer Key
Please check as you identify each item:
Melanoma (A)
Candidiasis (B)
Denture sores (C)
Denture Stomatitis (D)
APPENDIX 8
Advanced Physical Assessment Across the Lifespan
Geriatric Oral Health Answer Key
Answers
A
Melanoma (A)
B
Candidiasis (B)
Denture sores (C)
Denture Stomatitis (D)
D
D
Images from:
CDC Public Health Images Library
Clark M.B., Douglass A.B., Maier R., Deutchman M., Douglass J.M., Gonsalves W., Silk H., Tysinger J.W., Wrightson A.S., & Quinonez R. (2010). Smiles for life: a national oral health curriculum.
3rd Edition. Society of Teachers of Family Medicine. Retrieved from smilesforlifeoralhealth.com
AG-ACNPCurriculum IntegrationofInterprofessionalOralHealthCompetenciesinPrinciplesofAdultGerontologyAcuteCareI- II
PRINCIPLES OF
ADULT
GERONTOLOGY
ACUTE CARE I- II
HRSA Oral Health
Competencies:
Oral Health Risk
Assessment, Oral Health
Evaluation,
Oral Health Preventive
Intervention,
Communication and
Education
NONPF Competencies::
Provides for the
promotion of health and
protection from disease
by assessing for risks
associated with care of
complex acute, critical,
and chronically-ill
patients
E
N
T
R
Y
L
E
V
E
L
A
S
S
E
S
S
M
E
N
T
2) IMMERSION: DEVELOPMENT
3) COMPETENCE: ENTRY-TO-PRACTICE
SKILL/BEHAVIOR
SKILL/BEHAVIOR
KNOWLEDGE: ORAL HEALTH EDUCATION
Goal: Understand importance of maintaining oral Goal: Provide comprehensive health maintenance Goal: Advocate for smoking cessation programs in your
services to patients in acute care
health throughout hospitalization
acute care setting
Read :
Watch video: Oral Health in Older Adults in
Read:
Acute Care Settings (NICHE 2014)
• Who Needs Oral Care? (Konradsenet al., 2014)
• High Intensity Interventions Promote Smoking
Read:
• Evaluating and Managing Dental Complaints in
Cessation Among Hospitalized Adults (Ostroff,
• The Impact of Hospitalization on Oral Health
Primary and Urgent Care (Idzik and Krauss, 2013)
2013)
(Terezakis et al., 2011)
• Develop management plan for patients in acute
• Nursing Interventions for Smoking Cessation
• Oral Care of Hospitalized Older Patients in the
care and include HEENOT in history, risk
(Rice et al., 2013)
Acute Medical Setting (Salamone et al., 2013)
assessment, exam and management plan
S • Develop an evidence-based plan for smoking
• Oral Status and the Need for Oral Health Care
• Research & present different types of suction
U
Among Patients Hospitalized with Acute
cessation in older adults with COPD, diabetes,
toothbrushes for hospitalized adults
M
Medical Conditions (Hanne et al., 2012)
CAD or CVD
M
A
KNOWLEDGE: ORAL HEALTH MAINTENANCE SKILL/BEHAVIOR
SKILL/BEHAVIOR
T
Goal: Understand relationship of oral care and Goal: Provide comprehensive health
Goal: Collaborate interprofessionally to provide
I
VAP
V
maintenance services to reduce risk of VAP
comprehensive oral healthcare services to
E
• View Oral Health and Mechanically Ventilated
mechanically ventilated patients
Critically Ill Adults (Jones et al., 2014)
• Develop an evidence-based oral care
A
• Read :
S
protocol for mechanically ventilated
• Present an Interprofessional panel (e.g.,
S
o Ventilator-Associated Pneumonia Bundle:
patients, include HEENOT in history, risk
AGCNP, MD, DDS, nutritionist, respiratory
E
Reconstruction for Best Care (Munro et al.,
assessment, exam and management plan
therapist) on oral health issues n hospitalized
S
2014)
S
patients, Include dentures, nutrition, smoking,
o Guidelines for the Management of Adults with
M
VAP, stroke, surgery
E
Hospital-Acquired, Ventilator-Associated, and
N
Healthcare-Associated Pneumonia (ATS, 2005)
T
KNOWLEDGE: ORAL-SYSTEMIC CONNECTION
Goal: Understand importance of oral health
care in palliative care settings
SKILL/BEHAVIOR
Goal: Understand importance of oral
health in palliative care settings
•
•
•
Watch video Oral Health at the End of Life
(Wholihan, 2014)
Watch Oral Health in Long-Term and
Palliative Care Settings (NICHE, HIGN &
OHNEP, 2015)
CONSTRUCTS
© Oral Health Nursing EducationandPractice (OHNEP)
Develop an evidence-based oral care
protocol for patients in palliative care,
include HEENOT in history, risk
assessment, exam and management
plan
SKILL/BEHAVIOR
Goal: Collaborate interprofessionally to provide
comprehensive oral healthcare services to
adults in palliative care
•
•
Develop an evidence-based oral care
protocol for for patient in palliative care
Present an Interprofessional panel (e.g.,
AGCNP, MD, DDS, speech & language
pathologist) on oral health and symptom
management in palliative care patients
INTER-PROFESSIONAL PARTNERSHIP & COLLABORATIVE PRACTICE FOR
OPTIMIZATION OF CIENT/PATIENT HEALTH OUTCOMES
IPEC Competencies:
Values and Ethics,
Roles and
Responsibilities
Interprofessional
Communication,
Teams &Teamwork
1) EXPOSURE: INTRODUCTION
AG-ACNPCurriculumIntegrationofInterprofessionalOralHealthCompetenciesinPrinciplesofAdultGerontologyAcuteCareIII
1) EXPOSURE: INTRODUCTION
2) IMMERSION: DEVELOPMENT
SKILL/BEHAVIOR
Goal: Identify oral manifestations of chronic
disease in hospitalized adults
KNOWLEDGE: HOSPITALIZED ADULT WITH
CHRONIC DISEASE
Goal: Recognize oral health care needs of
hospitalized patients with chronic diseases
•
IPEC Competencies:
Values and Ethics,
Roles and
Responsibilities
Interprofessional
Communication,
Teams &Teamwork
Students read about one chronic disease
(Appendix 1) and present findings to class:
• Kidney Disease
• Liver Disease
E • Diabetes
N
T • Cancer
R • HIV
Y
HRSA Oral Health
Competencies:
Oral Health Risk
Assessment, Oral Health
Evaluation,
Oral Health Preventive
Intervention,
Communication and
Education
NONPF Competencies::
Assesses individuals with
complex health issues
and co-morbidities,
including the interaction
with aging and acute and
chronic physical and
mental health problems;
Works collaborativ el y
with a variety of health
professionals to achieve
patient care goals,
promote stabilization and
restoration of health in
complex acute, critical,
and chronic illness.
CONSTRUCTS
L
E
V
E
L
A
S
S
E
S
S
M
E
N
T
Each student will develop comprehensive
oral care plan for patient with chronic
disease and oral health needs , include
HEENOT in history, risk assessment, exam
and management plan
Collaborate on case study (Appendix 2) of
adult hospitalized for diabetic ketoacidosis
KNOWLEDGE: HOSPITALIZED ADULT IN ICU SKILL/BEHAVIOR
Goal: Identify oral health care needs of patients
Goal: Recognize oral health care needs of
in ICU
hospitalized patients in ICU
•
Read:
• Oral Health and Care in the ICU (Munro et
al., 2004)
• Periodontal Disease as a Risk Factor for
•
Ischemic Stroke (Grau et al., 2004)
KNOWLEDGE: HOSPITALIZED OLDER ADULTS
WITH NEUROLOGICAL DISORDERS
Goal: Recognize oral health needs of hospitalized
older adults with neurologic problems
• Review slides: Parkinson's Disease & Oral
Health (Jeter et al., 2015)
• Read:
• Reducing care-resistant behaviors during
oral hygiene in persons with dementia
(Jablonski et al, 2011)
• Ensuring Oral Health for Older Individuals
with Intellectual and Development
Disabilities (Waldman & Perlman, 2012)
• Oral Hygiene Care for Functionally
Dependant and Cognitively Impaired
Older Adults (Johnson et al., 2011)
© Oral Health Nursing EducationandPractice (OHNEP)
3) COMPETENCE: ENTRY-TO-PRACTICE
Student will develop comprehensive oral
health care plan for adults in ICU, include
HEENOT in history, risk assessment, exam
and management plan
Collaborate on case study of older adult
with oral health needs, hospitalized
for severe stroke
SKILL/BEHAVIOR
Goal: Develop comprehensive oral health plan
for hospitalized older adults with neurologic
problems
•
•
Student will develop comprehensive oral
health care plan for hospitalized older
adults with neurological disorders ,
include HEENOT in history, risk
assessment, exam and management plan
Collaborate on case study of older adult
with oral health needs hospitalized for
pneumonia
COLLABORATIVE PANEL
Goal: Collaborate interprofessionally to provide
comprehensive oral healthcare services to adult in
acute care with chronic disease and oral health
care needs
S
U
M
M
A
T
I
V
E
A
S
S
E
S
S
M
E
N
T
Students will create interprofessional panel to
collaborate on developing a management plan for
hospitalized patients with chronic disease and oral
health care needs, including appropriate referral
structures
COLLABORATIVE PANEL
Goal: Collaborate interprofessionally to provide
comprehensive oral healthcare services to
hospitalized adult in ICU
•
Students will create interprofessional panel
(e.g., AGCNP, MD, DDS, respiratory
therapists) to collaborate together on
developing a management plan for patients
in ICU
COLLABORATIVE PANEL
Goal: Collaborate interprofessionally on case
study of older adult with cognitive decline and
oral health needs
• Read: Opportunities for Nursing-Dental
Collaboration: Addressing Oral Health Needs
Among the Elderly (Coleman, 2005)
• AG- ACNP and dental students to collaborate
on developing a comprehensive oral health
management plan for case studies of older adults
with cognitive decline and oral health needs
INTER-PROFESSIONAL PARTNERSHIP & COLLABORATIVE PRACTICE FOR
OPTIMIZATION OF CIENT/PATIENT HEALTH OUTCOMES
PRINCIPLES OF
ADULT
GERONTOLOGY
ACUTE CARE III
APPENDIX 1
Principles of Adult Gerontology Acute Care III
Oral Health Needs of Hospitalized Adults with Chronic Diseases
Kidney Disease
Patterns of Oral Disease In Adults with Chronic Kidney Disease Treated with Hemodialysis
(Palmer et al., 2015)
Liver Disease
Oral Diseases and Liver Pre and Post- Transplantation Disorders (Kusterer, 2011)
HIV
Impact of Periodontal Intervention on Local Inflammation, Periodontitis, and HIV Outcomes
(Valentine et al, 2016)
Diabetes
Oral Health, an Untapped Resource in Managing Glycemic Control in Diabetes, and Promoting
Oral Health (Darling-Fisher et al., 2015)
Cancer
Mucositis Prevention by Improved Dental Care in Acute Care Leukemia Patients (Djuric et al.,
2006)
APPENDIX 1
Principles of Adult Gerontology Acute Care III
DiabetesCaseStudy
Presentation: A 48-year- old Hispanic woman with a long history of obesity, diabetes, dyslipidemia, and reactive airway disease
presented to the hospital emergency department with a 5-day history of weakness, fever, productive cough, nausea, and vomiting.
Patient report and chart review confirmed that 2 years before this presentation, her diabetes had been managed with diet alone. In
the past year, glipizide (Glucotrol), metformin (Glucophage), and ultralenteinsulin were added because of poor glycemic control.
On examination, her temperature was 99.1° F, blood pressure was 98/64 mmHg, pulse was 136,and respirations were 36. There
was a strong smell of ketones in the exam room. The patient was drowsy but cogent. Her head and neck exam revealed poor
dentition and symptoms of periodontal disease. Her lung sounds were clear without wheezes or rhonchi. Her heart sounds were
normal. The abdominal exam revealed mild epigastric tenderness to deep palpation but no rebound tenderness or guarding.
Extremities were well perfused with symmetric pulses.
Laboratory results were remarkable for a room air arterial blood gas with pH of 7.12, pCO 2 of 17mmHg, and bicarbonate of 5.6
mEq/l. Urinalysis revealed 4+ glucose and 3+ ketones. Chemistry panel revealed a glucose of 420 mg/dl, BUN of 16 mg/dl,
creatinine of 1.3 mg/dl, sodium of 139mEq/l, chloride of 112 mEq/l, CO 2 of 11.2 mmol/l, and potassium of 5.0 mEq/l. Chest X-ray
revealed no infiltrate.
Questions
1. Is this patient experiencing diabetic ketoacidosis (DKA)?
2. What type of diabetes does this patient have?
3. What kind of oral care would be important to provide to the patient?
4. What is the relationship between diabetes and periodontal disease?
5. Who is on your interprofessional team and what are the roles of each team member?
6. What is included in your plan for inpatient treatment?
7. What are the expectations for out patient treatment?
Adapted from Clinical Diabetes
http://journal.diabetes.org/clinicaldiabetes/v18n22000/pg88.htm
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www.IPECollaborative.org
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www.IPE.UToronto.ca
University of Toronto’s Centre for
Interprofessional Education
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