Oral Health Flags Tool

The Oral Health Flags tool was developed for case management and nursing staff to use with clients. The tool builds upon our work with other service providers to identify “red flags” for specific chronic conditions in order to help clients determine when they should access dental services. The Oral Health Flags tool is now included with our other case management educational and informational materials and can be used across the continuum of care, including hospital settings, clinic settings, and home visits.

Submitted by: Mary Patricia O’Leary RN, BSN, Chronic Care Program Manager and Maria Langlais, Planner Aging and Disability Services (ADS Seattle/King County)

Project Goal(s) and Objective(s)
The goal was to create a simple visual tool for staff to use with clients as they discuss the importance of oral health and when to seek care. After reviewing the Oral Health Flags content, case management staff can more effectively:

  1. Explain the importance of daily oral health care.
  2. Help clients Identify oral health issues early and problem solve.
  3. Commit to using the flags with clients receiving Care Transition coaching.

Please describe the need(s) or challenge(s) being addressed.
The Oral Health Flags tool addressed:

  • The need for a concise quick reference guide for case managers to use when discussing the importance of oral health during assessment visits with clients.
  • The need to provide clients and caregivers with basic information they can reference easily after the case manager leaves.
  • The need for ongoing messaging on the importance of oral health as it relates to chronic disease, and integration of this messaging into service delivery.

The development of the Oral Health Flags tool addressed these key needs and is a key part of our ongoing oral health messaging efforts to integrate oral health education into service delivery.

ADS had previously designed flags for other health issues and decided to add Oral Health Flags so that case managers could better educate clients regarding oral health. In addition to developing the Oral Health Flags, ADS added an oral health section to the client/patient Personal Health Record, which is located on the reverse side of the Oral Health Flags tool.

Successes and Challenges
Because we had such a positive staff response to other Flags tools—they love the quick reference guide that they can give to clients as a “leave behind”—we anticipate staff will also appreciate and utilize the Oral Health Flags tool.

Lessons Learned
During the launch of the English-only Oral Health Flags tool, it quickly became apparent to staff that they also needed a tool for the large population of clients whose primary language is not English and for those with very low literacy skills. ADS incorporated the feedback and developed a low literacy Oral Health Flags tool and versions in other languages as well.

Oral Health Flags handouts:

Aging and Disability Services is committed to healthy aging, and we recognize that oral health is an important part of the aging process. The development of the Oral Health Flags is part of our effort to integrate oral health awareness and education into the continuum of care and to promote the importance of oral health for both our staff and clients.

The Oral Health Flags efforts will be sustained in the following ways:

  • Employee orientation/training will provide oral health education including a review of the Oral Health Flags and an overview of how to use the tool when working with clients.
  • Case managers will assess for oral health issues when completing client assessments and provide the Oral Health Flags and other educational materials to clients and caregivers.

Photos, Videos, and Testimonials/Quotes
Comments from case managers:

  • I would use the Oral Health Flags during my assessments. I would use them as a “teaching tool” with clients who haven’t seen a dentist for 12 months, and with those who report any oral problems.  I would probably use them as a “leave behind” reference/reminder for clients who appear to follow good oral health practices.
  • Case managers could use periodic reminders/refreshers about the importance of a short oral health conversation with clients at time of assessment. I routinely ask about brushing and flossing, and ask about any oral pain or redness.  I believe case managers could benefit from coaching, particularly as it relates to having a conversation with a client who reports having fewer than half their natural teeth. The clients’ report that dental care is less important because they have fewer of their natural teeth.
  • Case managers would benefit by having specific recommendations for clients who have full dentures, and especially those who have poorly fitting dentures, or those who rarely wear their dentures. 
  • The Oral Health Flags could also be sent along with routine mailings to clients.
  • I recently saw an older client with TBI/dementia who has trouble getting adequate nutrition because his dentures don’t fit properly so he doesn’t wear them. His daughter had questions about low- and no-cost resources for denture replacement and also about the appropriate foods to serve her dad until he can/does get replacement dentures.