Theses and Dissertations at Montana State University (MSU)
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Item Integrating pediatric oral health into a rural, public-health setting(Montana State University - Bozeman, College of Nursing, 2020) Bowden, Janelle Marie; Chairperson, Graduate Committee: Laura LarssonRural, low-income families in Montana experience individual and environmental barriers to oral healthcare access. In addition to knowledge deficits regarding pediatric milestones in oral health care, families in rural areas also have few, if any, pediatric dentists who accept Medicaid clients. The Centers for Disease Control and Prevention reported 2- to 5-year-olds are the only age group where the incidence of tooth decay is on the rise. This evidence-based demonstration research documents the baseline oral-health status of Park County Women, Infants, and Children (WIC) participants as well as the longitudinal efficacy of a bundled intervention to improve oral-health status in this high-priority population. Anticipatory guidance, caries risk assessment, repeated fluoride varnish application, and referrals for establishing a dental home and completing referrals for untreated decay are the bundled interventions under investigation in this project. Each level of intervention was documented in terms of state and national goals for the prevention of early childhood caries. The rate of signed forms consenting to treatment was used as a proxy measure that educating pregnant moms, parents, and caregivers about caring for baby teeth was effective. The long-term goal is to improve oral-health status in the Park County WIC population. The results of this research illustrated that performing oral-health assessments in a public-health setting provides an opportunity for nurses to promote sound oral-health practices, educate families on oral hygiene, and provide interventions aimed at preventing early childhood caries. Integrating oral health into public health as well as primary-care settings is a feasible and imperative practice in order to decrease the rates of ECC. A collaborative and integrative effort will ensure more children are screened for and educated on ECC. Introducing the intervention bundle at the WIC office in Park County proved to be a successful way of performing oral-health screenings, applying preventative FV, educating families on oral hygiene practices, and referring children to a dental home.Item Integrating oral health into a doctor of nursing practice curriculum(Montana State University - Bozeman, College of Nursing, 2017) Hausauer, Janice Donaldson; Chairperson, Graduate Committee: Elizabeth S. KinionCurrently, the United States oral health care delivery system does not reach the populations with the highest need for oral health services, resulting in continued oral health disparities in underserved populations. Incorporating oral health education in the formal education of primary care providers is a strategy to achieve the overall goals of primary health care by improving care for individuals and populations and lowering overall health care costs. The role of nurse practitioners in improving oral health outcomes and expanding access to care is dependent upon the improvement of oral health education in graduate nursing curricula. The purpose of this DNP professional project was to incorporate oral health content into one course in the DNP curriculum and to explore the potential opportunities for expanding oral health education throughout the DNP curriculum. The PDSA Model of Improvement (Institute for Healthcare Improvement, 2017) was utilized to pilot the integration of oral health content into a graduate health assessment course and to review ten DNP courses for oral health content. Graduate students enrolled in the class were surveyed regarding oral health perceptions and experiences. The majority of participants indicated that patients in their agencies had unmet dental needs. Participants reported knowledge of the oral-systemic health connection. Participants indicated that oral health should be included in the overall health assessment of patients and that oral health education should be included in non-dental curricula such as nursing. Student responses were consistent with the literature indicating the most common barriers to implementing oral health in practice were time, lack of oral health education, and lack of referral mechanisms. Although oral health content was noted in nine of the ten DNP courses reviewed, the content was highly variable throughout the courses. Oral health was not a thread throughout the curriculum. There is a need for integration of oral health content in graduate nursing curricula. The first step for developing a nursing workforce with core competencies in oral health promotion is to prepare nurse practitioner students with oral health knowledge, skills, and abilities.Item Addressing preventive oral health for pregnant women, childbearing age females & children age zero to six in primary care(Montana State University - Bozeman, College of Nursing, 2017) Johnson, Abrianna Lee; Chairperson, Graduate Committee: Elizabeth S. KinionMost oral health disease is preventable despite the availability of effective prevention and treatment (Nathe, 2016). Oral health conditions are becoming a silent epidemic and during pregnancy the risk increases for oral disease (Qualis Health, 2015; Vamos, Walsh, Thompson, Daley, Detman, & DeBate, 2015). About 40% of pregnant women have a varying form of periodontal disease (Lieff et al., 2004). The social impact on school-age children substantially affects their academics, as more than 51 million school hours are lost each year due to dental related illnesses (U.S. Department of Health and Human Services, 2003). The purpose of this project was to educate providers, nurses, and patients in a primary care clinic on the importance of oral health care and to create simple referral process for at risk patients. The author gave a pretest on oral health best practice to seven primary care nurses. After the pretest, the author gave an oral health education seminar. The nurses took a posttest based on content from the educational seminar. Patients who met the inclusion criteria were given oral health surveys to determine oral health status and need for referral to a dentist. Six of the seven nurses completed the seminar and testing showing a higher post-seminar test score. The V-statistic of 21 showed a p-value of 0.0178 suggesting strong evidence the nurses' scores tended to be higher after the seminar. Of the nineteen adults surveyed regarding their oral health status, 62% showed good oral health behaviors. Of the eleven pediatric patients surveyed regarding their oral health status, 75% answered positive oral health behaviors. The literature supported the value of oral health education in primary care. Awareness was created in the clinic with the use of posters and educational packets given to all participating patients. There is a great need for preventive oral health education to primary care providers, pregnant women, childbearing age females, and parents of children. Current research on the value of preventive oral health education and dental care is needed in primary care.Item Translating prenatal oral health guidelines into obstetric practice, a practice change project(Montana State University - Bozeman, College of Nursing, 2017) Martin, Terryn Lynn; Chairperson, Graduate Committee: Elizabeth S. KinionEarly childhood caries (ECC) is prevalent and burdensome to a child's quality of life and development, albeit preventable. ECC prevention strategies implemented in the prenatal period are well supported by evidence to reduce ECC incidence and dictated in numerous prenatal oral health guidelines. However, obstetric (OB) providers do not often practice this evidence. The purpose of this project was to assess, plan, implement, and evaluate the introduction of prenatal oral health practices, that coincide with current prenatal oral health guidelines, to OB providers at one OB clinic. To do so, current prenatal oral health guidelines were evaluated and coalesced to form of a prenatal oral health protocol (POHP). Two OB provider and medical assistant (MA) pairs implemented the POHP over a 90-day implementation period in one OB clinic. Lewin's Change Theory guided the practice change process. To determine if, by implementing the POHP, the prenatal oral health practices of participating OB providers were significantly improved, before and after patient's charts were reviewed and data measuring provision of oral health practices were compared using a permutation test. It was also planned to measure dental attendance. A written survey was given to participating OB providers and MAs at the end of the project to gain their perspective on the practice change process and likelihood of sustainability. The results show that significantly more patients had documentation of prenatal oral health education (p<.0002, 95% CI 0.476-0.857), oral screening questions (p<.0002, 95% CI 0.857-1), and an oral screening exam (p<.0002, 95% CI 0.619-0.952) after the POHP was implemented than before. A dental referral was not made, thus it is unknown how many patients, in receiving a dental referral, would have attended the dentist at some point during pregnancy. Four out of 17 patients, correctly screened, should have received a dental referral based on the POHP, but did not. The survey showed favorable views of the practice change process and likelihood of sustainability. In conclusion, prenatal oral health practices can be incorporated into the practice of OB providers using a POHP, an appropriate implementation period, and a practice change process guided by Lewin's Change Theory.Item Plaque control as a method for improving dental health instruction(Montana State University - Bozeman, 1973) Morris, Robert BradleyItem Implementing an oral health tool and motivation interviewing tool to improve oral health care among type II diabetics on a northern plains reservation(Montana State University - Bozeman, College of Nursing, 2016) Show, Jennifer Aurice; Chairperson, Graduate Committee: Elizabeth S. KinionType II diabetes and periodontal disease are two common chronic diseases that have been shown to have a physiologically bi-directional relationship. In recent years, type II diabetes and periodontal disease have reached epidemic proportions throughout the United States; disproportionately affecting racial and ethnic minorities such as American Indians. American Indians often have diabetes rates that are two times the general U.S. population and periodontal disease rates that are equally as high. Adding to the oral health disparity in American Indian populations, accessing dental care is often limited making oral health preventive behaviors especially important. This project chose to examine oral health in a group of American Indian adults with type II diabetes focusing on 1) the identification of oral health status using the Oral Health Assessment Tool 2) the facilitation of oral health care to the local Indian Health Service agency and 3) supporting and improving preventive oral health behaviors through motivational interviewing. Participants took part in bi-weekly face-to-face motivational interviewing sessions with their oral health status being evaluated using the Oral Health Assessment Tool concurrently. Participants were referred to the local Indian Health Service agency for dental care based on Oral Health Assessment scores. Scores could range from 0 (good oral health) to 16 (poor oral health). The overall analysis of data found a slight improvement in average Oral Health Assessment Tool scores from 2.75 at baseline to 2.25 at three months. Content analysis of the motivational interviewing sessions found an increased interest among participants to improve oral health behaviors such as brushing for longer periods of time or a desire to quit smoking. The findings of this study are encouraging. While the Oral Health Assessment Tool scores did not improve by leaps and bounds, it does show promise for the use of motivational interviewing to improve preventive oral health behaviors in the American Indian population while also showing the ease of integrating the Oral Health Assessment Tool into general diabetes care.Item Oral health outreach and education in a non-dental, American Indian setting(Montana State University - Bozeman, College of Nursing, 2016) Taubert, Kate Lisco; Chairperson, Graduate Committee: Laura LarssonTooth decay is the single most common chronic childhood disease (Centers for Disease Control and Prevention, 2014) and children with minority and low socioeconomic status are at an increased risk for early childhood caries (ECC) development. The number of children who routinely visit primary care providers is much higher than those who have seen a dental provider (American Academy of Pediatrics, 2008). Thus, pediatric primary care providers are in an opportune position to provide oral health screenings, interventions, and referrals. The purpose of this quality improvement project was to identify, implement, and evaluate a Doctor of Nursing Practice (DNP) pediatric oral health outreach and education quality improvement project in an American Indian, pediatric primary care setting. The intervention contained three parts including a caries risk assessment, caregiver education, and a same-day dental home referral. All caregiver/child dyads age birth - 5 years presenting to the pediatric clinic for a well-child visit were eligible and consented to the intervention (n = 47). The results determined that 86.84% of the sample population was at high risk for caries development and that 52.78% of children with first tooth eruption had previously seen a dentist. Of those children, 78.95% had caries. For children with first tooth eruption that had not seen a dental provider in the past three months, a successful completed referral rate of 72.41% was obtained. The average intervention duration was 4.73 minutes. The intervention was successful in integrating well-child and well-dental visiting into a combined visit that was feasible to sustain. All caregiver/child dyads consented to the intervention and received age appropriate oral health education. This interprofessional collaboration and was effective in addressing three aspects of oral health prevention and outreach. Oral health is part of total health, and thus should be incorporated into routine well-child visits.Item School nurse collaboration to provide evidence based flouride varnish for high caries risk students and referral for restorative dental care(Montana State University - Bozeman, College of Nursing, 2016) Trost, Michelle Louise; Chairperson, Graduate Committee: Laura LarssonDespite improvements in public health dentistry, low-income children continue to experience dental caries at higher rates than their counterparts. Commonly cited factors that impede low-income families from obtaining dental care include difficulty getting time off from work, lack of transportation or childcare, and lack of knowledge regarding the importance of oral health care. Community-based approaches to reduce caries rates, such as school-based dental sealant programs, are gaining popularity. School nurses can have an instrumental role in improving oral health access within their schools by collaborating with personnel from these programs to perform assessments, case-finding, and fluoride varnish application with increased frequency. Utilizing dental sealant program screening data from a low-income elementary school, school nurses identified students at highest risk for dental caries (N = 98) and offered a repeat application of fluoride varnish six months following the initial screening and application. In addition, school nurses utilized the screening data to identify students with untreated decay (N = 49). Those students who had not obtained professional dental care following the initial screening were offered referral to an onsite mobile dental van for professional restorative care. The results of this project indicated that school nurses can successfully enhance fluoride protection and improve access to preventive and professional oral health care for children attending low-income schools.Item The effect of contracted reinforcers on targeted nutrition-related dental behaviors in six Bozeman pediatric subjects(Montana State University - Bozeman, College of Education, Health & Human Development, 1980) Lilly, Karen Pal