The purpose of this paper is to describe the quantity and quality of oral hygiene content in a representative sample of before-licensure nursing fundamentals textbooks. Seven textbooks were examined. Quantity was operationalized as the actual page count and percentage of content devoted to oral health and hygiene. Quality of content was operationalized as congruency with best mouth care practices. Best mouth care practices included evidence-based and consensus-based practices as published primarily by the American Dental Association and supported by both published nursing research and review articles specific to mouth care and published dental research and review articles specific to mouth care. Content devoted to oral health and hygiene averaged 0.6%. Although the quality of the content was highly variable, nearly every textbook contained some erroneous or outdated information. The most common areas for inaccuracy included the use of foam sponges for mouth care in dentate persons instead of soft toothbrushes and improper denture removal. 1. Introduction Oral hygiene is vitally important because oral health is directly related to systemic health [1–3]. Poor oral health results in plaque buildup and inflammation of the gingiva. Plaque harbors pathogens associated with pneumonia [4]. In fact, poor oral hygiene has been linked to ventilator-associated pneumonia across the lifespan [5, 6]. Inflammation of the gingival tissues, either with or without periodontal disease, has been related to adverse outcomes in pregnancy, such as premature-birth and low-birth-weight infants [7]. Other systemic diseases associated with inadequate oral hygiene and resulting poor oral health include diabetes [8–10] and coronary artery disease [11]. Inadequate oral health negatively impacts quality of life and mortality, as well [12]. In 1986, Jones et al. surveyed nursing schools in the New England region to determine the quantity of oral health in both undergraduate and graduate curricula [13]. At the undergraduate level, Jones et al. reported an hour or less of overall oral health content in the entire curricula for 50% of the surveyed schools [13]. Fourteen percent of the undergraduate programs included 2 to 3 hours of oral health content specific to older adults; the remaining schools reported zero to 1 hour [13]. More recent reports of oral health content in undergraduate/predoctoral nursing, medical, and pharmacy schools show little, if any, improvement. Nearly 60 percent of educators in nursing, medicine, and pharmacology in English-speaking universities around the world
References
[1]
M. P. Cullinan, P. J. Ford, and G. J. Seymour, “Periodontal disease and systemic health: current status,” Australian Dental Journal, vol. 54, supplement 1, pp. S62–S69, 2009.
[2]
P. J. Ford, S. L. Raphael, M. P. Cullinan, A. J. Jenkins, M. J. West, and G. J. Seymour, “Why should a doctor be interested in oral disease?” Expert Review of Cardiovascular Therapy, vol. 8, no. 10, pp. 1483–1493, 2010.
[3]
J. R. Gurenlian, “Inflammation: the relationship between oral health and systemic disease,” Dental Assistant, vol. 78, no. 2, pp. 8–43, 2009.
[4]
A. Azarpazhooh and J. L. Leake, “Systematic review of the association between respiratory diseases and oral health,” Journal of Periodontology, vol. 77, no. 9, pp. 1465–1482, 2006.
[5]
K. Hutchins, G. Karras, J. Erwin, and K. L. Sullivan, “Ventilator-associated pneumonia and oral care: a successful quality improvement project,” American Journal of Infection Control, vol. 37, no. 7, pp. 590–597, 2009.
[6]
L. Johnstone, D. Spence, and J. Koziol-McClain, “Oral hygiene care in the pediatric intensive care unit: practice recommendations,” Pediatric Nursing, vol. 36, no. 2, pp. 85–97, 2010.
[7]
Y. W. Han, “Oral health and adverse pregnancy outcomes—what's next?” Journal of Dental Research, vol. 90, no. 3, pp. 289–293, 2011.
[8]
S. Bakhshandeh, H. Murtomaa, R. Mofid, M. M. Vehkalahti, and K. Suomalainen, “Periodontal treatment needs of diabetic adults,” Journal of Clinical Periodontology, vol. 34, no. 1, pp. 53–57, 2007.
[9]
L. N. Borrell and S. P. Joseph, “Periodontal treatment may control glycemic status among diabetic patients,” Journal of Evidence-Based Dental Practice, vol. 11, no. 2, pp. 92–94, 2011.
[10]
W. J. Teeuw, V. E. A. Gerdes, and B. G. Loos, “Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis,” Diabetes Care, vol. 33, no. 2, pp. 421–427, 2010.
[11]
N. Kurihara, Y. Inoue, T. Iwai et al., “Oral bacteria are a possible risk factor for valvular incompetence in primary varicose veins,” European Journal of Vascular and Endovascular Surgery, vol. 34, no. 1, pp. 102–106, 2007.
[12]
D. M. P. Padilha, J. B. Hilgert, F. N. Hugo, A. J. Bos, and L. Ferrucci, “Number of teeth and mortality risk in the Baltimore Longitudinal Study of Aging,” Journals of Gerontology, vol. 63, no. 7, pp. 739–744, 2008.
[13]
J. A. Jones, T. Fulmer, and T. Wetle, “Oral health content in nursing school curricula,” Gerontology and Geriatrics Education, vol. 8, no. 3-4, pp. 95–101, 1988.
[14]
C. Hein, D. J. Sch？nwetter, and A. M. Iacopino, “Inclusion of oral-systemic health in predoctoral/undergraduate curricula of pharmacy, nursing, and medical schools around the world: a preliminary study,” Journal of Dental Education, vol. 75, no. 9, pp. 1187–1199, 2011.
[15]
Institute of Medicine, Advancing Oral Health in America, The National Academies Press, Washington, DC, USA, 2011.
[16]
A. M. Berry, P. M. Davidson, J. Masters, and K. Rolls, “Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation,” American Journal of Critical Care, vol. 16, no. 6, pp. 552–563, 2007.
[17]
Google Book Project at Penn State, http://www.libraries.psu.edu/psul/googlebooksproject/faq.html.
[18]
Oral health topics: dentures, http://www.ada.org/2648.aspx?currentTab=2.
[19]
Oral Health Topics: Cleaning Your Teeth & Gums, http://www.ada.org/2624.aspx?currentTab=2.
[20]
J. Chalmers and A. Pearson, “Oral hygiene care for residents with dementia: a literature review,” Journal of Advanced Nursing, vol. 52, no. 4, pp. 410–419, 2005.
[21]
J. M. Chalmers and A. Pearson, “A systematic review of oral health assessment by nurses and carers for residents with dementia in residential care facilities,” Special Care in Dentistry, vol. 25, no. 5, pp. 227–233, 2005.
[22]
J. Chalmers, V. Johnson, J. H. Tang, and M. G. Titler, “Evidence-based protocol: oral hygiene care for functionally dependent and cognitively impaired older adults,” Journal of Gerontological Nursing, vol. 30, no. 11, pp. 5–12, 2004.
[23]
J. M. Chalmers, “Behavior management and communication strategies for dental professionals when caring for patients with dementia,” Special Care in Dentistry, vol. 20, no. 4, pp. 147–154, 2000.
[24]
D. A. Clemmens and A. R. Kerr, “Improving oral health in women:nurses' call to action,” The American Journal of Maternal Child Nursing, vol. 33, no. 1, pp. 10–16, 2008.
[25]
J. A. Fitch, C. L. Munro, C. A. Glass, and J. M. Pellegrini, “Oral care in the adult intensive care unit,” American Journal of Critical Care, vol. 8, no. 5, pp. 314–318, 1999.
[26]
J. A. Gil-Montoya, A. L. F. de Mello, C. B. Cardenas, and I. G. Lopez, “Oral health protocol for the dependent institutionalized elderly,” Geriatric Nursing, vol. 27, no. 2, pp. 95–101, 2006.
[27]
M. J. Grap, C. L. Munro, B. Ashtiani, and S. Bryant, “Oral care interventions in critical care: frequency and documentation,” American Journal of Critical Care, vol. 12, no. 2, pp. 113–118, 2003.
[28]
D. J. Jones, C. L. Munro, M. J. Grap, T. Kitten, and M. Edmond, “Oral care and bacteremia risk in mechanically ventilated adults,” Heart and Lung, vol. 39, supplement 6, pp. S57–S65, 2010.
[29]
R. A. Jablonski, “Examining oral health in nursing home residents and overcoming mouth care-resistive behaviors,” Annals of Long-Term Care, vol. 18, no. 1, pp. 21–26, 2010.
[30]
R. A. Jablonski, C. L. Munro, M. J. Grap, C. M. Schubert, M. Ligon, and P. Spigelmyer, “Mouth care in nursing homes: knowledge, beliefs, and practices of nursing assistants,” Geriatric Nursing, vol. 30, no. 2, pp. 99–107, 2009.
[31]
R. A. Jablonski, T. Swecker, C. Munro, M. J. Grap, and M. Ligon, “Measuring the oral health of nursing home elders,” Clinical Nursing Research, vol. 18, no. 3, pp. 200–217, 2009.
[32]
C. L. Munro, M. J. Grap, R. Jablonski, and A. Boyle, “Oral health measurement in nursing research: state of the science,” Biological Research for Nursing, vol. 8, no. 1, pp. 35–42, 2006.
[33]
C. R. Taylor, C. Lillis, P. LeMone, and P. Lynn, Fundamentals of Nursing: The Art and Science of Nursing Care, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 6th edition, 2008.
[34]
J. M. Wilkinson and K. Van Leuven, Fundamentals of Nursing: Theory, Concepts, & Applications, vol. 2, FA Davis, Philadelphia, Pa, USA, 2007.
[35]
R. F. Craven and C. J. Hirnle, Fundamentals of Nursing: Human Health and Function, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 6th edition, 2009.
[36]
S. C. Delaune and P. K. Ladner, Fundamentals of Nursing: Standards and Practice, Thomson Delmar, New York, NY, USA, 3rd edition, 2006.
[37]
P. A. Potter and A. G. Perry, Fundamentals of Nursing, Mosby Elsevier, St. Louis, Mo, USA, 7th edition, 2009.
[38]
P. Lynn, Taylor's Clinical Nursing Skills: A Nursing Process Approach, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 2nd edition, 2008.
[39]
J. M. Wilkinson and K. Van Leuven, Fundamentals of Nursing: Theory, Concepts, & Applications, vol. 1, FA Davis, Philadephia, Pa, USA, 2007.
[40]
R. A. Jablonski, B. Therrien, E. K. Mahoney, A. Kolanowski, M. Gabello, and A. Brock, “An intervention to reduce care-resistant behavior in persons with dementia during oral hygiene: a pilot study,” Special Care in Dentistry, vol. 31, no. 3, pp. 77–87, 2011.
[41]
Institute of Medicine, Retooling for an Aging America: Building the Health Care Workforce, National Academy Press, Washington, DC, USA, 2008.
[42]
D. Felton, L. Cooper, I. Duqum et al., “Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American college of Prosthodontists,” Journal of Prosthodontics, vol. 20, supplement 1, pp. S1–S12, 2011.
[43]
NYUCN Launches Oral Health Nursing Education Program, http://www.nyu.edu/about/news-publications/news/2011/04/26/nyucn-launches-oral-health-nursing-education-and-practice-program.html.
