An oral health baseline of need at a predominantly African American Program of All-Inclusive Care for the Elderly (PACE): Opportunities for dental-nursing collaboration.

This descriptive study sought to establish an oral health baseline of need for enrollees at a Program of All-Inclusive Care for the Elderly (PACE) and identify opportunities for nursing interventions. The Oral Health Assessment Tool (OHAT) was applied to a random sample of 120 enrollees, 64 of whom met inclusion criteria, agreed to participate to assess their oral health status, and were included in the analysis. The mean OHAT score was 4.4 (SD = 2.6; range 0-12). Higher scores indicate poorer oral health. The oral conditions found needing the most attention were gums, saliva, natural teeth, dentures, and oral cleanliness. Oral cleanliness scored the worst on the OHAT, highlighting opportunities for nursing interventions and the necessity for oral hygiene routines. This study also identifies the need for nurses to address enrollees' oral health and relay information back to the PACE interdisciplinary team (IDT) to initiate referrals to the dentist as needed.

Penntorship: The value of mentoring during a pandemic.

COVID-19 presented learning and social challenges for dental and high-school students alike due to isolating environments with fewer interpersonal interactions. After recognizing these challenges, two pre-doctoral dental students developed Penntorship, a program at University of Pennsylvania, School of Dental Medicine, where dental students' mentor students at West Philadelphia High School (WPHS) utilizing online technology. PURPOSE: This survey study explored the benefits of a newly developed mentoring program, Penntorship, for mentors and mentees. METHODS: Seventy dental students volunteered to mentor WPHS students throughout the 2020-2021 school year. After receiving training by Mentor Independence Region, mentors coordinated weekly meetings with mentees on Zoom to assist with homework assignments, discuss interests, and assess mentee's career goals. Over six months, 185 mentor meetings were held by 56 dental students with 28 different high-school students participating in the program. Surveys were distributed and analyzed to determine outcomes of the program. RESULTS: Survey results revealed that both dental students and high-school students gained new friendships, improved communication skills, and developed a positive perspective during the pandemic. CONCLUSION: With online learning formats and social distancing during the pandemic, dental students expressed a need for more social interaction. Penntorship served to support dental students during this challenging year and filled a social need for young individuals in the community. Both mentors and mentees benefited from the program and will continue to work together in the coming academic year. *IRB approval obtained 8/30/2021.

Delivery and financing of oral health care in long-term services and supports: A scoping review.

BACKGROUND: The oral health of older adults requiring long-term services and supports is reported to be poor as there is no national standard of care for the provision of oral health care. The purpose of this scoping review was to understand the breadth of models of delivery and financing of oral health care in the full spectrum of long-term services and supports. TYPES OF STUDIES REVIEWED: A literature search was performed in 4 electronic databases: MEDLINE via PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Included articles were those that were regarding a nursing home population or dependent older adults living in the community, included a delivery or financing model for oral health care, and included an outcome measurement. RESULTS: Sixteen articles were included in the review. Delivery mechanisms included onsite mobile oral health care at nursing homes and adult day health care centers for those living in the community or home visits for those who were homebound. Other mechanisms included teledentistry or using alternative workforce models such as certified public health dental hygienists. Numerous studies reported positive oral health outcomes when comprehensive care was provided in a variety of settings. Other reported outcomes included oral health stability, caries indexes, cost, and oral health-related quality of life. CONCLUSIONS AND PRACTICAL IMPLICATIONS: If providing onsite oral health care is not possible at facilities, programs can consider home visits, teledentistry, and alternative workforce models.

Dental Care in Programs of All-Inclusive Care for the Elderly: Organizational Structures and Protocols.

OBJECTIVES: This study uses a national model of community-based long-term services and supports, the Program of All-inclusive Care for the Elderly (PACE), to identify organizational structures and protocols that can facilitate the delivery of dental examinations. DESIGN: We developed an online survey instrument and conceptual model for this study representing 10 domains believed to characterize a quality PACE dental program. SETTING AND PARTICIPANTS: The Qualtrics survey was distributed nationally to all 124 PACE programs in the 31 states PACE was available. Respondents in this study represented 35 programs (program response rate = 28.2%) in 23 states (state response rate = 74.2%). METHODS: Selected independent variables from each of the 10 domains were tested against the reported delivery of dental examinations variable using the Kendall τ and χ2. Twenty-nine programs were included in the final analysis. RESULTS: Most programs mandated a dental examination within 31-60 days of enrollment (63.6%). Few programs had a dental manual (15.6%) or any quality assurance for dental care (32.3%). A majority of programs (58.8%) stated that they had a protocol for enrollees to receive a cleaning every 6-12 months. Having a system for quality assurance for dental care, protocol for a cleaning every 6-12 months, mandating a comprehensive dental examination and providing preventive dental services onsite with built-in equipment, were all statistically associated with a higher reported delivery of dental examinations. CONCLUSION AND IMPLICATIONS: Organizations providing long-term services and supports, including PACE, can use these identified domains to develop minimal standards to ensure dental care is part of innovative models of community-based long-term services and supports. Implementing these domains can facilitate effective delivery of dental examinations that have the potential to support positive oral health and general health outcomes.

Setting the PACE for frail older adults in the community: An underused opportunity for furthering medical-dental integration.

BACKGROUND: The integration of dentistry into comprehensive and long-term care has occurred infrequently and with limited success. The authors aim to describe how the Program of All-Inclusive Care for the Elderly (PACE) has the potential for such incorporation for the growing population of nursing home-appropriate older adults preferring to age in place. METHODS: The authors used a 56-item online survey to explore aspects of oral health care within PACE, including organizational structure, availability and provision of care, preventive protocols, and provider reimbursement. The survey was distributed to all 124 programs nationally. Data analyses included descriptive statistics for each of the variables of interest. RESULTS: Thirty-five programs completed the survey (28%) in 23 states (74%) where PACE is available. Most programs covered comprehensive dental services and predominantly provided care off-site. Most programs reimbursed dentists at Medicaid fee-for-service rates and some at commercial rates. Dentistry was most frequently ranked the second-highest specialty focus behind mental health. CONCLUSIONS: PACE is a comprehensive interdisciplinary model of care and an underused opportunity for furthering medical-dental integration. It uses local dental resources in order to accommodate the oral health care needs of the growing population of older adults preferring to age in place. PRACTICAL IMPLICATIONS: PACE is an opportunity for the dental profession to further medical-dental integration and ensure that newer models of long-term care include comprehensive and coordinated oral health care programs. It is also an opportunity to promote an integrated model of care with policy makers to support integrated oral health care for the nursing home-eligible population.

An Assessment of Global Oral Health Education in U.S. Dental Schools.

Dental schools need to produce graduates who are adequately prepared to respond to the complex needs and challenges of the increasingly diverse and interconnected world in which they will practice dentistry. To enhance discussions about the coverage of global oral health competencies in dental education, the aims of this study were to assess how global health education is currently incorporated into predoctoral dental training in the U.S. and which global oral health competencies are being covered. Surveys were emailed to all 64 accredited U.S. dental schools during the 2015-16 academic year. Respondents from 52 schools completed the survey (response rate 81%). The results showed that social determinants of oral diseases and conditions, how to identify barriers to use of oral health services, and how to work with patients who have limited dental health literacy were covered in the greatest number of responding schools' curricula. Key areas of global health curricula that were covered rarely included global dental infrastructure, data collection design, and horizontal and vertical programming approaches to health improvement. Despite current dialogue on the addition of global oral health competencies to dental curricula, only 41% of the responding schools were currently planning to expand their global oral health education. Based on these results, the authors conclude that it may be most feasible for dental schools to add recommended global oral health competencies to their curricula by incorporating didactic content into already established courses.