This document summarizes an evaluation of Saskatchewan's "Better Oral Health in Long Term Care" program. The program provides oral health training to staff and implements oral health assessments, care plans, and treatment referrals for long-term care home residents. An evaluation of two homes found that after 6 months of implementation, residents showed significant improvements in oral cleanliness, gum health, tongue health, lip health, denture health, and dry mouth. It recommends expanding the program province-wide and continuing data collection to assess long-term impacts.

1. Maryam Jafari, MPH
Evaluation of the Oral Health Status of Saskatchewan
LTC Home Residents Following the Implementation
of Better Oral Health in Long Term Care Program

2. Overview
• Background
Aging Population, Oral Health and Overall Health
• BOH in LTC Program Background
History, Overview, Impact
• Evaluation of BOH in LTC Program
Materials and Methods, Results, Recommendations

3. Overview
1- Background
Aging Population, Oral Health and Overall Health
BOH in LTC Program Background
History, Overview, Impact
Evaluation of BOH in LTC Program
Materials and Methods, Results, Recommendations

5. LTC Homes
SK, 2015-2016: The total number of residential-based continuing care
homes: 155 , with 12,718 residents (90% ≥ 65y. and 55% ≥85 y)
Poor Oral Health Status
• Pre-existing medical conditions
• Limited access to oral health professionals
• Dependence on caregivers for performing daily oral care.

6. Poor Oral Health Status
• Tooth decay
• Gingivitis
• Periodontitis
• Denture stomatitis
• Not named dentures
• Xerostomia=dry mouth
Denture Stomatitis

7. Importance of Oral Health
• An important part of overall health
A healthy body cannot be achieved without a healthy mouth
• A determinant of quality of life
• Links between oral disease and systemic conditions

8. Cardiovascular Disease Diabetes
Aspiration Pneumonia
10% Morbidity/Mortality
Net benefit US $300 million

9. Overview
Background
Aging Population, Oral Health and Overall Health
2- Better Oral Health in Long Term Care: Best Practice
Standards for Saskatchewan Program
History, Overview, Impact
Evaluation of BOH in LTC Program
Materials and Methods, Results, Recommendations

10. History:
• Since 2011, SOHC and SOHP have collaborated to develop a model for
oral heath care in LTC homes. “BOH in LTC” has been adapted from the
Australian Better Oral Health in Residential Care.
• In 2014, the Program was focus tested at Parkridge Centre in SHR.
• In 2015, SHR hired a dental assistant into the LTC Oral Health Coordinator
(LTC-OHC) position to implement and maintain the program in LTC
homes.
• LTC-OHC audited and refreshed staff at the Parkridge Centre.
• In 2016, LTC-OHC has fully implemented the Program at two LTC homes
(Sherbrooke Community Centre and Sunny Side Adventist Centre) in SHR.

11. Educator's Portfolio
For Education/Training
Professional Portfolio
For Nurses
Staff Portfolio
For Care Aides
Overview:

12. 4 Key
Processes
Description
1. Oral Health
Assessment
Performed by a Licensed Oral Health
Professional
2. Oral Health
Care Plan
Developed by Oral Health Care Team and
residents
3. Daily Oral
Hygiene
Maintained by Care Aides
4. Oral Health
Treatment
Referrals made for a comprehensive
examination/treatment

13. Impact:
The majority of Saskatchewan health
regions have expressed interest in or
implemented BOH in LTC program.

14. Overview
Background
Aging Population, Oral Health and Overall Health
BOH in LTC Program Background
History, Overview, Impact
3- Evaluation of BOH in LTC Program
Materials and Methods, Results, Recommendations

15. Materials and Methods:
1-Staff Training
• Mangers,
• Registered Nurses (RNs),
• Continuing Care Aides (CCAs)
 Pre test
 A 3-hour learning module
 A 3-hour hands-on session
 Post test
Sherbrooke Community Centre
Sunny Side Adventist Centre

16. 2-Initial Oral Health Assessment:
LTC-OHC or Trained RN
Healthy
Changes
Unhealthy
Exterior of face
Lips
Tongue
Gum and tissues
Oral cleanliness
Teeth
Denture(s)
Saliva
Dental pain
Oral Health Assessment Tool (OHAT)

17. 3- Oral Health Care Plan:
LTC-OHC, RN, CCAs

18. 4- Oral Health Care Delivery: CCAs
Basic Oral Health Supplies
For Edentulous Residents
For Dentate Residents
Not Requiring Assistance
For Dentate Residents
Requiring Assistance /w.
Swallowing Difficulties
Perivex
RNs followed up with checking the daily oral care that the CCAs provided

19. 5-Follow-up Oral Health Assessment (after 6 months)
LTC-OHC or Trained RN
Healthy
Changes
Unhealthy
Exterior of face
Lips
Tongue
Gum and tissues
Oral cleanliness
Teeth
Denture(s)
Saliva
Dental pain

20. 6- Oral Health Treatment
•LTC-OHC/ RNs completed consents for referrals to a dentist.
•Fee-for-service dentistry was provided either on-site or the residents’
private practice dentist.

21. 7- Statistical Analysis
• Wilcoxon Signed Rank Test
• P-value <0.05 was significant

22. Results:
Training
LTC Home Number of Staff Trained
Sherbrooke
Community Centre
39
•1 Leadership Manager of Learning and Growth/
Training and development
•7 Neighbourhood Team Mangers
•9 Registered Nurses
•22 Continuing Care Aides
Sunny Side
Adventist
Centre
10
•1 Director of care
•1 Leadership Director of Education and Safety
•1 Resident Care Coordinator
•2 Registered Nurses
•5 Continuing Care Aides
Total 49

23. Demographics and Oral Heath Status
•177 residents (initially 252)
•Females (52%) and Males (48%)
•76.24±17.65 years
•111 Dentate (62.72%),
66 Edentulous (37.28%)
≥65 y. 75.15%

24. In total: (83 out of 177) 47% had partial/complete dentures
80.3%

25. OHAT Scores:
The scores of 6 aspects significantly changed after 6 months.
Lips
Tongue
Gum and tissues
Oral cleanliness
Denture(s)
Saliva

26. • Following 6 months: 29.72%
more residents had healthy lips

27. • Following 6 months: 27.45%
more residents had healthy
tongue.

28. • Following 6 months: 28.76%
more residents had healthy
gum(s).
• Following 6 months: 68.40 %
fewer residents had unhealthy
gum(s)

29. • Following 6 months: 9.81% more
residents had healthy saliva

30. • Following 6 months: 40.62%
more residents had clean mouth
• Following 6 months: 72.27 %
fewer residents had food
particles, tartar and plaque in
their mouth.

31. • Following 6 months: 18.64%
more residents had healthy
dentures

32. OHAT Scores:
The scores of 3 aspects did not significantly change after 6 months.
Face
Teeth : 30% of dentate did not consent for referrals
Dental Pain

33. Referrals Required Referrals Made Referrals
84 (47.45%)
71 dentate,
13 edentulous
55 (31.07%)
48 dentate,
7 edentulous
55 of those (65.5%) completed
consent and were seen by a dental
team for comprehensive
exam/treatment.
23 (30%) were
not seen by
dental team

34. Conclusion:
• Within the limitations of this study, residents
who received care under BOH in LTC
Program showed an improvement in their
oral health status.
• The results also signifies the multidisciplinary
approach and role of LTC-OHC, who works
collaboratively with the LTC team, in
improving the oral health care.

35. Recommendations:
• To emphasize the 10 recommendations that was previously
developed/endorsed by SOHC and SOHP for consideration and action
by the SK Ministry of Health
• a LTC-OHC should be employed in each health region to facilitate the
delivery of initial oral assessments, dental examinations and treatment,
daily oral hygiene for residents and oral health education.
• That SOHC and SOHP continue data collection (quantitatively and
qualitatively) with longer follow up periods.

36. • To establish an effective data collection and information systems, and
provincial oral health surveillance system.
• To establish a provincial legislation for an oral screening and care
plans for LTC residents.
• To implement the Program across the province.

37. 51st
Canadian Association of Public Health Dentistry Conference
(Toronto: Sep 22-23, 2017)

39. • Leslie Topola
Manager, Population and Public Health,
SHR
• Kerrie Krieg
Long Term Care Oral Health Coordinator, SHR
• Vanessa Ripley
Manager, Seniors’ Health and Continuing Care, SHR
• Dr. Raju Bhargava (Varsity Dental Group)
Dentist, SHR
• Sherbrooke and Sunnyside staff
• Saskatoon Health Region
• Saskatchewan Oral Health Coalition
• Saskatchewan Oral Health Professions

40. maryam.jafari@usask.ca
Maryam Jafari