Oral Health Training for Case Managers

Overview
Aging and Disability Services hosted a special training program for all case management and other professional staff on oral health that included a PowerPoint presentation and an in-person presentation by a local practicing dentist. The presentation was a professional development opportunity for staff to more directly address issues for aging clients; including general oral health, oral health connection to chronic diseases, dental caries, and dry mouth.

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

Project Goals
There were three primary goals for the training. After completing the training, staff would:

  1. Understand the importance of oral health, particularly for Aging and Disability Services clients
  2. Name three categories of drugs that can cause dry mouth
  3. Commit to doing three things that could be implemented in their work to address oral health

To accomplish the goals, the training provided a comprehensive introduction to the importance of oral health that would be of benefit to case management staff as they conduct various types of assessments with clients. Based on one-on-one conversations and questions asked during the training, it is clear that many staff members were unaware of the seriousness of dry mouth as well as the other oral health issues related to aging. We wanted the training to not only provide basic information, but to also enhance current staff skills, particularly nursing staff, related to oral health and chronic disease management.

Please Describe the Need(s) or Challenge(s) Being Addressed
This training was designed to address the need for case management program staff to understand the importance of oral health as it relates to chronic disease management. The high hospitalization and re-hospitalization rates in King County, along with information in the client assessments, indicated that many of the medically complex clients have oral health issues.

Approach
Our approach was to design a training that all staff, including nurses, social workers, social service aides, family caregiver support specialists, and planning and contracts staff could participate. By having together, we were able to deliver a cohesive and comprehensive message about the importance of oral health, both for our staff and for the clients they serve.

Our PowerPoint presentation included basic information about oral health and its importance to overall health, as well as detailed information about the impact of oral health on specific chronic conditions. The presentation included oral health related screenshots and questions from the different assessment tools used by staff in ADS programs, including CARE, TCARE, and KITS, the assessment tool for King County Care Partners. We included elements from the assessments that specifically address oral health (e.g., mouth pain, chewing/swallowing, last dental visit), as well as other elements that staff may not have previously considered oral health related (nutrition, tobacco use, chronic disease diagnoses and medications).

Following the PowerPoint presentation, we invited the local dentist to provide a first-hand account of his knowledge and experiences. He shared several compelling human interest stories of how unattended oral health problems can lead to serious and costly client outcomes, and he provided helpful information on how we can help our clients access dental care.

Successes and Challenges
We had a very positive response to the presentation. Staff appeared engaged, evident by the number of questions and comments, and seemed eager to put what they learned into practice. Following the training, staff shared positive feedback and reported it was a great learning session. In particular, they learned a lot about dry mouth and indicated they will ask more open-ended questions when completing assessments now that they understand the importance of the oral health.

A challenge for the presenters was fielding questions posed by staff related to the limited availability of dental services for our client population. An additional challenge was addressing the topic of oral health in clients who no longer had their own teeth since staff was unaware of the importance of bringing up the topic of oral health when the patient/client no longer had any dentition.

Lessons Learned
Through this training, our presenters learned that you cannot assume that all social workers and nursing staff are comfortable and/or confident in asking clients/patients open-ended questions about oral health. And staff learned that it is important to move beyond asking yes/no questions when completing oral health screens in patient/client assessments.Additionally, staff was unaware of the importance of bringing up the topic of oral health when the patient/client no longer had any dentition.

Our advice to other organizations considering this process is to start with the basics. As stated above, it’s important to not make assumptions about what staff know about oral health. Additionally, having a dentist participate in the training is very important. Subject experts are a great addition to any presentation, and we were fortunate to have someone who spoke so passionately and knowledgably about oral health. The information he provided was directly applicable to our work, and the client stories he shared resonated with our staff.

Materials
PowerPoint presentation
The Role of Oral Health in Successful Care Transitions: How AAAs Can Address Oral Health Issues to Improve Health Outcomes

Sustainability
This presentation was just the start in what we hope will be an ongoing focus on oral health for our staff and clients. Aging and Disability Services is committed to healthy aging, and oral health is an important part of the aging process.

As a result of this training, we have a number of sustainable activities that we can now put into place:

  • We anticipate that new employee orientation/training will include an oral health component.
  • We would like to see an annual refresher on the importance of oral health, perhaps around the idea of “Oral Health” month.
  • Staff will assess for oral health issues when completing client assessments.
  • We will include nursing staff when providing education and support to clients, family members, caregivers, and informal supports (non-paid caregivers).
  • We hope to distribute supplies, including toothpaste, toothbrushes, floss, and fluoride rinses at least annually.

Funding may be needed to continue the oral health activities; however, we would also anticipate trying to keep the activities going without funding.

Photos, Videos, and Testimonials/Quotes
Below are testimonials from staff who attended the training:

“The oral health training was invaluable in demonstrating and teaching the significance of dental care and oral health as related to general health and well-being for our clients.  This training reiterated the importance of assessing dental needs of our clients, how those needs may affect their overall health, and the need for improved access to dental care for our clients.“
Long Term Care Case Manager

“I was astounded by the devastating effects that poor oral hygiene can have on one’s overall health.  The example given of how an infection from a tooth spread to a patient’s heart, etc., causing irreparable damage and costing the systems hundreds of thousands of dollars, was a good reminder that this is a vital component of a comprehensive assessment and care plan.”
King County Care Partners Case Manager

“The Oral Health training provided information that I can bring up during the assessment. Understanding the importance of oral health in disease prevention and learning about the relationship between oral health and general health was informative and much-needed. “What happens in the mouth is often a reflection of what happens in the body” is what I often tell my clients as I bring up this issue. Many of my clients have dry mouth due to medication and we have a discussion about how this can often lead to more complex medical conditions if left untreated. Many are surprised to find out how much of an important role their mouth plays in their overall health.”
Russian Bilingual Case Manager

“As a social worker/case manager this training was a reminder of how important Oral Health is in disease prevention. The training also highlighted the important role I play in educating clients and caregivers on why maintaining good oral hygiene is essential in ensuring good overall health.  I use the examples provided in the training to show how it can lead to oral and facial pain, problems with their heart and other major organs and digestion problems.  I have found client’s and family members receptive to this information.”
Punjabi Bilingual Case Manager