Oral health education for non-dental health care providers in a Massachusetts Program of All-inclusive Care for the Elderly (PACE) program

Abstract

Objectives: Older adults (age 65+) are the fastest growing age group within the United States. In 2022, only 64% of older Americans visited the dentist for a dental exam or cleaning compared to 95% having a doctor visit. Non-dental healthcare providers can play a role in assessing oral health (OH) concerns among older adults. This exploratory study examined whether non-dental providers who received OH education training would have increased knowledge and higher confidence to perform oral assessments in their older adult patients. Methods: Physicians and nurse practitioners (N=21) of a Program for All-inclusive Care for the Elderly (PACE) center in Massachusetts were recruited. Providers completed a 13-item pre-test, then attended a virtual education session (1 hour) covering OH knowledge and skills including training to perform a basic oral exam, identify xerostomia, conduct an oral cancer screening, and assess denture hygiene and associated lesions. The education session was followed by a 10-item post-test and brief discussion. Two-months later, providers were given a 14-item questionnaire followed by a 30-minute-long discussion session. The questionnaires items on knowledge, attitudes, and practices (KAP) and confidence in assessing OH among older adults as well as demographic questions. Results: Nineteen out of 21 providers participated in the OH education. Sixteen participated in the pre-test; 19 in the post-test; and 15 in the 2-month follow-up. Before the education session, 56% did not have prior OH training in their health profession education, while 31% did have training. Prior to the education, 81% of providers reported sometimes conducting an OH screening; 13% did not conduct screenings. At the 2-month follow-up, 87% of providers reported conducting an OH screening in some appointments. Providers acknowledged the importance of additional training (e.g., skill-building) for assessing OH among older patients. In the brief discussions, providers explored that overall, they felt that their oral health knowledge was increased after the OH education session. They also discussed how the OH training/skill building increased their confidence in assessing OH among their older adult patients. Conclusions: Half of the PACE providers did not receive oral health education in their health profession training. They suggested additional lectures with tips and skill-building exercises.