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Jablonski-blueJablonski RA, Therrien B, Mahoney EK, Kolanowski A, Gabello M, Brock A.

An intervention to reduce care-resistant behavior in persons with dementia during oral hygiene: a pilot study.

Spec Care Dentist. 2011 May-Jun;31(3):77-87. doi: 10.1111/j.1754-4505.2011.00190.x.

Oral health, while not emphasized in nursing, is directly related to systemic health. Poor oral hygiene has been linked to ventilator-associated pneumonia, pregnancy complications, diabetes, coronary artery disease, increased mortality and lower quality of life. Oral hygiene care is provided most often either by nurses or by non-professional employees supervised by nurses. Dr. Rita Jablonski has published a review article entitled, “Oral Health and Hygiene Content in Nursing Fundamentals Textbooks” in the 2012 volume of Nursing Research and Practice. The article, which is in direct response to a 2009 Institute of Medicine panel on oral health, addresses the quality and quantity of information on oral health in nursing textbooks aimed at pre-licensure students.

Dr. Jablonski performed an extensive literature search for nursing textbooks published in English from 2006 to 2010 using the search terms “nursing”, “fundamentals”, and “textbook”. Seven textbooks were identified and examined for quantity (number of pages and percentage of pages) and quality (congruence with best care practices) of information. As predicted, information about oral health and hygiene was sparse. The number of pages ranged from less than 1.0 to 3.3 and the percentage of content ranged from 0.27% to 1.1%. Information quality was highly variable and was likely hindered by a lack of evidence-based guidelines for oral care. Nurses are encouraged to collaborate with dental professionals and to incorporate current clinical guidelines.

Given its importance to overall health, oral hygiene is particularly important for nursing home residents. There is a worrisome trend towards worsening oral health in nursing home residents, probably due to an increased frequency of full or partial dentition. Most nursing home residents require assistance with oral care. Many, particularly those with more severe dementia, are prone to care resistant behaviors (CRBs). Dr. Jablonski and her colleagues (2011) published the results of a pilot study, “Reducing Care-resistant Behaviors during Oral Hygiene in Persons with Dementia”, exploring the feasibility of an intervention to reduce CRBs in patients with moderate to severe dementia in BMC Oral Health. A secondary aim was to examine the intervention’s effect on oral health.

Seven subjects (mean age=82.29) received a baseline assessment using the Oral Health Assessment Tool (OHAT). The Intervention, Managing Oral Hygiene Using Threat Reduction (MOUTh) was then administered. MOUTh is based on the theory that CRBs are a fear-based response to unintentionally threatening behaviors during oral care and utilizes behavioral techniques to reduce threat perception. Specific strategies included avoidance of elderspeak, cueing, gesturing, bridging and pantomiming. Singing was very helpful with one subject but was upsetting to others, demonstrating the importance of individualization. Best oral hygiene practices for older adults were incorporated. After 14 days, the mean CRB rate declined but did not reach significance. OHAT scores, however, were significantly improved by day 7 and remained improved at Day 14. This study provides evidence to support a larger trial which is now being conducted.


Jablonski, R. A. (2012). Oral Health and Hygiene Content in Nursing Fundamentals Textbooks. Nursing Research and Practice. Volume 2012.

Oral health is directly related to systemic health. Poor oral health results in plaque buildup and inflammation of the gingiva. Poor oral health linked to ventilator-associated pneumonia, adverse outcomes in pregnancy, diabetes, coronary artery disease, lower quality of life and higher mortality. Not adequate oral health content in nursing school curriculum.

In 2009 IOM convened an oral health panel. The panel wanted to know about oral health in nursing school curricula as nurses are responsible for providing or delegating this care. Jablonski did a search of nursing fundamentals textbooks. The purpose of this paper is to describe the quantity and quality of oral hygiene content in before licensure nursing fundamentals textbooks.

Did google search on textbooks published in English from 2006-2010 intended for pre-licensure nursing. All books were obtained Page count and percentage devoted to oral health. Quality was operationalized as congruency with best care practices.

Seven textbooks met the search criteria. Percentage of oral health content ranged from 0.27% to 1.1%,



For more information, contact Dr. Jablonski at rajablon@uab.edu
Article summary by Jennifer Frank, PhD (jfranf@uab.edu)


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