1. Oral Health Status of Low-Income Seniors Living in Sedgwick County
Judy Johnston1, Milan Bimali1,2, Susan Parsons3,
1: Department of Preventive Medicine and Public Health, KUSM-W
2: Office of Research, KUSM-W
3: School of Nursing, Wichita State University

2. What we will discuss: Project history and pilot data
2017 project description & data
Discussion

3. Project History
Pilot project funded in 2015 by Frontiers: The Heartland Institute for Clinical and Translational Research (NIH funds) and Kansas Bioscience Authority
Exploring mechanisms for improved oral health outcomes among older adults living in assisted living communities
Low-cost intervention in assisted living communities coordinated with WSU Nursing, Physician Assistant, and Dental Hygiene Departments
Study approved by University of Kansas School of Medicine – Wichita and Via Christi Health Systems Institutional Review Boards

4. Project History
Inclusion criteria: > 60 yrs. of age; living in assisted living community in Wichita area; with some or all natural teeth; currently using manual toothbrush
Designed with 3 cohorts of seniors
Control
Brushing reminder & manual toothbrush
Brushing reminder & power toothbrush

5. 2015-2016 Data: Access & Oral Hygiene
18-months of recruitment yielded one cohort of 25 participants
Median age: 84.4 yrs. (71-91)
Education:
20% completed high school or less
75% experience in college or technical school

6. Dental Insurance Status

7. Oral Health Status
Mouth Pain

8. Oral Health Status

9. Oral Health Status Other Indicators Tooth Mobility – None
Urgent Care Needs – None
Early Care Needs – 4 people
Untreated decay (2)
Broken tooth (1)
Broken filling (1)
Periodontal Disease (1)

10. Oral Health Habits

11. Oral Health Quality of Life

12. Oral Health Quality of Life

13. Oral Health Quality of Life

14. Oral Health Quality of Life

15. Oral Health Quality of Life

16. Oral Health Quality of Life

17. 2017 Healthy Smiles Project Description
Study approved by University of Kansas School of Medicine – Wichita Institutional Review Board
Observational study of:
oral health access,
oral health self-care practices,
oral health status, and
oral health quality of life

18. 2017 Healthy Smiles Project Description
Inclusion criteria: Live in HUD-subsidized senior housing community in or around Wichita.
Three data collection tools:
Oral health access, OH self-care practices, and demographic information
Oral Health Assessment for Seniors Oral Health Impact Profile 14 (QOL assessment)

19. Low-Income Housing Criteria
HUD-subsidized Housing
SG County Median Income - $66,400
Income Limit Category
Very Low (50%) Income Limits
Extremely Low Income Limits
Person(s) In Family 1
$23,250
$13,930 2
$26,600
$15,920 3
$29,900
$17,910 4
$33,200
$19,900 5
$35,900
$21,492
HUD-subsidized Senior Housing is for those aged 55 years and older

20. Specific Aims
Assess oral health status of low-income seniors living in or near Sedgwick County, KS
Assess oral health quality of life of low-income seniors living in Sedgwick County, KS
Assess oral health self-care behaviors of low-income seniors living in Sedgwick County, KS
Explore correlations of oral health status and/or behaviors and health outcomes and/or quality of life outcomes

21. Participants Participants
Ten HUD-subsidized senior residences in Wichita, Derby & El Dorado
Recruiting presentations by PI
174 signed consent forms
Required a minimum of 10 participants to schedule data collection on-site from 6-9 PM on scheduled weekday evenings
Participants
163 participants kept appointments and completed assessments (93%)
Incentives (~ $10 in oral self-care supplies) were provided

22. Data Collection Data collected March 9 - April 24, 2017
ECP Hygienists – Oral Health Assessment
Doreen Eyler, GraceMed
Davette McCoy, E.C. Tyree health and Dental Clinic
Kathy Trilli, WSU Dental Hygiene Program
WSU accelerated nursing students were taught to administer:
Oral health access survey questions
OH self-care practices, and demographic information survey questions,
Oral Health Impact Profile 14 (QOL assessment)
All tools were read to all participants and oral responses recorded by nursing students
Either Ms. Johnston or Dr. Parsons supervised students at each data collection event

23. Oral health access, oral health self-care practices, and demographic information

28. Oral Health Assessment Tool for Seniors
Indicators from Basic Screening Surveys: An Approach to Monitoring Community Oral Health of Older Adults, Association of State and Territorial Dental Directors (ASTDD), October 2010, with the addition of specific quantitative measures of gingival health and tooth mobility

29. ASTDD Recommended Indicators
Seven recommended and five optional oral health status indicators for older adults
Recommended Indicators
Dentures and denture use
Number of natural teeth
Untreated decay
Root fragments
Need for periodontal care - Loe and Silness Gingival Index
0 = Normal gingival
1 = Mild inflammation – slight change in color, slight edema
2 = Moderate inflammation – redness, edema, and glazing.
3 = Severe inflammation – marked redness and edema, ulceration, tendency to spontaneous bleeding
Suspicious soft tissue lesions
Urgency of need for dental care

30. ASTDD Recommended Indicators
Optional Indicators
Functional posterior occlusal contacts
Substantial oral debris
Severe gingival inflammation
Obvious tooth mobility (Miller Classification of Tooth Mobility)
0 = Normal (physiologic) movement when force is applied
1= Mobility greater than physiologic
2= Tooth can be moved up to 1mm or more in a lateral direction (buccolingual or mesiodistal); Inability to depress the tooth in a vertical direction (apicocoronal)
3= Tooth can be moved 1mm or more in a lateral direction (buccolingual or mesiodistal; Ability to depress the tooth in a vertical direction (apicocoronal)
Severe dry mouth

31. Oral Health Assessment Data
Removable lower denture: 38%
Removable upper denture: 47%
Wear lower denture to eat: 33%
Wear upper denture to eat: 44%
Substantial oral debris: 8%
Untreated decay: 39%
Untreated root decay: 25%
Root fragments: 22%
Dry cracked lips: 35%
Dry cracked tongue: 37%
Lack of saliva: 41%

33. Oral Health Impact Profile 14: Oral Health Quality of Life Assessment

34. Oral Health Impact Profile 14
Never Occasionally Often
Top to bottom: Self-conscious, Eating, Aching, Taste, Words

35. Oral Health Impact Profile 14
Never Occasionally Often
Top to bottom: Embarrassed, Relaxation, Interrupted Meal, Diet, Tense

36. Oral Health Impact Profile 14
Never Occasionally Often
Top to bottom: Functionality, Life Satisfaction, Usual Activity, Irritable

37. Correlations

38. Eating Discomfort correlated with untreated root decay, root fragments & mouth pain; Feeling of embarrassment correlated with denture use

39. Additional Findings
Risk of pneumonia among participants with “Normal” Miller Mobility is 7% lower than “Mobile” Miller mobility
Risk of “dry mouth (lack of saliva)” is 4% higher among participants with untreated root decay compared to those without untreated root decay

40. Questions for Discussion
Should we try to replicate this study in other areas of KS?
Why or why not?
What additional research questions about oral health among seniors are of interest?
What ideas for low-cost interventions might you have?