ODH Pilot Project Delivering Care to Nursing Home Residents: An Update


by THE MISSOURI OFFICE OF DENTAL HEALTH S


eptember 1, 2022, the Missouri Office of Dental Health (ODH) was awarded a grant by the Health Resources and Services Administration to execute a pilot project extending ‘disease control’ interventional oral healthcare to ‘older adult’


residents of long-term care facilities (LTCF). The reasons for this pilot project are:


• There are currently approximately 65,000 residents living in LTCF in Missouri.


• ODH surveillance prior to the COVID-19 pandemic indicated that only six to 10 percent of LTCF residents have access to oral healthcare services.


• According to surveillance, more than 50 percent of LTCF resi- dents have overt decay and more than 70 percent have periodon- tal disease. Post-pandemic surveillance in other states indicates oral disease incidence in this population has increased.


• Several research articles published in peer reviewed journals con- cluded there is evidence that periodontal infections and other oral infections may adversely affect systemic comorbid condi- tions such as diabetes, rheumatoid inflammatory disease and atherosclerotic heart disease, and may be a primary etiological cause of inhalation pneumonia.


• Nursing Home Acquired Pneumonia (NHAP) is the second most common cause of infection among nursing home residents, and it is associated with the highest mortality rate. Approximately one in three nursing home residents will experience pneumonia each year, and it is the most frequent cause of hospitalization in this cohort.


• Two studies providing interventional periodontal care to nurs- ing home residents resulted in a significantly reduced rate of pneumonia in the treated residents compared to a control group without oral healthcare.


• Two primary barriers to oral healthcare for this population have been a long-standing shortage of dentists in Missouri and low Medicaid remuneration rates. The latter has been addressed with a substantial remuneration rate increase in the 2022 legislative session.


The pilot project design is as follows:


• Extend oral healthcare teams (OHT) of a dental hygienist and an expanded function dental assistant into LTCF using telehealth mediated supervision (computers, internet, live-feed camera, intraoral scanner, telephone) by a supervising dentist (SD).


• OHT’s collect consents, medical and dental histories, and diag- nostic data (dental charting, x-rays, photos, scans).


• The SD reviews histories and uses the American Society of 24 focus | FALL 2023 | ISSUE 3


ODH has identified three dental contractors to provide care in LTCFs. We have held two contractor training sessions. We are in the process of screening prospective patients. We anticipate treating 300 to 400 patients during the grant period. Interim reports will be made twice a year.


For questions about this project, contact Dr. Guy Deyton at guydeyton@gmail.com or Dr. Jackie Miller at jacqueline.miller@health.mo.gov.


Anesthesiologist’s Physical Status Classification System and a frailty assessment instrument to decide which patients can safely be treated in the LTCF using telehealth mediated supervision.


• The SD screens for emergent care and makes appropriate refer- rals if necessary. The SD writes a disease control treatment plan consisting of necessary non-surgical periodontal care and decay arresting fluoride treatment.


• The OHT delivers disease control treatment to patients in the LTCF under telehealth mediated supervision. The supervising dentist must be available for synchronous consultation if neces- sary.


The Office of Dental Health will report on the following outcomes:


• Number of residents screened and number of residents deemed eligible by SDs for treatment in LTCFs;


• Updated surveillance of oral disease in LTCF residents; • Number of treatments delivered by procedure code; • Outcomes of treatment evaluated at maintenance visits; • Ancillary effects of oral disease control treatment on metrics for comorbid medical conditions (diabetes, rheumatoid inflamma- tory disease, pneumonia);


• Evaluations of the oral healthcare program by patient/family, LTCF staff and dental contractors delivering care; and, • Summary reports of any adverse incidents.


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