The OHNEP Interprofessional

Oral Health Faculty Toolkit

Family Nurse Practitioner Program

CURRICULUM INTEGRATION OF INTERPROFESSIONAL

ORAL HEALTH CORE COMPETENCIES:
•  Health Assessment of Families
•  Health Promotion of Families
•  Primary Care of Families
•  Resources

© Oral Health Nursing Education and Practice (OHNEP)

INTRODUCTION

S  
 
  The Oral Health Nursing Education and Practice (OHNEP) program has developed an Interprofessional Oral Health Faculty Tool Kit to provide
  you with user friendly curriculum templates and teaching-learning resources to use when integrating oral health and its links to overall health in your
  Family Nurse Practitioner program.
  Oral health and its relation to overall health has been identified as an important population health issue. Healthy People 2020 (2011), the IOM
Reports, Advancing Oral Health in America (2011) and Building Workforce Capacity in Oral Health (2011), as well as the IPEC Competencies (2011),
challenged HRSA to develop interprofessional oral health core competencies for primary care providers. Publication of the report, Integrating Oral
Health in Primary Care Practice (2014), reflects those interprofessional oral health competencies that can be used by Family Nurse Practitioners for
faculty development, curriculum integration and establishment of “best practices” in clinical settings.

The HRSA interprofessional oral health core competencies, the IPEC competencies and the NONPF core competencies provide the framework for the
curriculum templates and resources. Exciting teaching-learning strategies that take students from Exposure to Immersion to Competence can
begin in the classroom, link to simulated or live clinical experiences and involve community-based service learning, advocacy and policy initiatives as
venues you can readily use to integrate oral health into your existing primary care curriculum. The Family Nurse Practitioner curriculum template
illustrates how oral health can be integrated into health promotion, health assessment and clinical management courses.

The Smiles for Life interprofessional oral health curriculum provides a robust web-based resource for you to use that articulates with the oral health
curriculum template for each course. A good place to begin oral health integration is by transitioning the HEENT component of the history and
physical exam to the HEENOT approach. In that way, you and your students will NOT forget about including oral health in patients encounters.

Research evidence continues to reveal an integral relationship between oral and systemic health. Chronic diseases managed by Family Nurse
Practitioners, such as diabetes, Celiac, HIV and Kawasaki, are but a few of the health problems that have oral manifestations that can be treated or
referred to our dental colleagues. It is important for nurse practitioners on the frontline of primary care to have the oral health competencies
necessary to recognize both normal and abnormal oral conditions and provide patients with education, prevention, diagnosis, treatment and referral
as needed.

We encourage you and your students to explore the resources in the templates as you “weave” oral health and its links to overall health into your
Family Nurse Practitioner program. If you need additional technical assistance, please feel free to contact us at [email protected]
FNP Curriculum Integration of Interprofessional Oral Health Competencies in Health Assessment Across Lifespan

HEALTH 1) EXPOSURE: INTRODUCTION 2) IMMERSION: DEVELOPMENT 3) COMPETENCE: ENTRY-TO-PRACTICE

ASSESSMENT
ACROSS SKILL/BEHAVIOR
KNOWLEDGE: ORAL CARE OF INFANT, SKILL/BEHAVIOR
LIFESPAN Goal: Demonstrate integration of HEENOT in
CHILD AND ADOLESCENT Goal: Identify oral pathologies in infant, child and
oral health history, risk assessment and
adolescent in clinical experience
Goal: Understand oral care of infant, physical exam in infant, child and adolescent
child and adolescent

INTER-PROFESSIONAL PARTNERSHIP & COLLABORATIVE PRACTICE FOR

during simulation lab
IPEC Competencies: •  Read
Values and Ethics,
Roles and •  Complete Smiles for Life Modules #1, •  Read Putting the Mouth Back in the Head: HEENT to
HEENOT (Haber et al, 2015)
Responsibilities 2, 6 Guideline on Caries Risk Assessment
•  Demonstrate integration of HEENOT
Interprofessional •  Submit SFL Certificates of Completion
• 
(AAPD, 2014)
competency in oral health history, risk
Communication,
Teams & Teamwork
E
N
•  Complete SFL Quizzes for Modules #1,
Present one of three pediatric caries risk
assessment tools in class (Appendix 8) U
S assessment and physical exam in newborns,

OPTIMIZATION OF CIENT/PATIENT HEALTH OUTCOMES

T 2, 6 (Appendix 1, 2, 3) •  Identify oral abnormalities in pediatric infants, children and adolescents during
M
R photographs (Appendix 9)
M pediatric clinic
Y A
T
L KNOWLEDGE: ORAL CARE OF ADULT SKILL/BEHAVIOR I SKILL/BEHAVIOR
E Goal: Understand oral care of adults Goal: Demonstrate integration of HEENOT in V Goal: Identify oral pathologies in adult in
HRSA Oral Health V oral health history, risk assessment and E clinical experience
Competencies: E physical exam in adult during simulation lab
Oral Health Risk L •  Complete Smiles for Life Modules A
Assessment, Oral # 3, 5, 7 S •  Demonstrate integration of
Health Evaluation, A •  Submit SFL Certificates of •  Read and discuss Adult Caries Risk S HEENOT competency in oral
Oral Health Preventive S Assessment Tool CAMBRA for patients E
Intervention, Completion health history, risk assessment
S over age 6 (Appendix 10) S and physical exam in adults
Communication E •  Complete SFL Quizzes for S
and Education S •  Identify oral abnormalities in adult M during adult clinic
Modules #3, 5, 7 (Appendix 4, 5, photographs (Appendix 11)
S E
M 6) N
E T
N
T
KNOWLEDGE: ORAL CARE OF OLDER SKILL/BEHAVIOR SKILL/BEHAVIOR
NONPFCompetencies: ADULT Goal: Demonstrate integration of HEENOT in Goal: Identify oral pathologies in older
Delivers evidence-
based practice for Goal: Understand oral care of older adults oral health history, risk assessment and adult in clinical experience
patients throughout physical exam in older adult during
simulation lab
lifespan; Obtains and •  Complete Smiles for Life Module #8 •  Demonstrate integration of
accurately documents
relevant health history •  Submit SFL Certificates of Completion HEENOT competency in oral
for patients of all ages •  Complete SFL Quiz for Module #8 health history, risk assessment
and in all phases of (Appendix 7) •  Read and discuss and physical exam in older
individual and family CAMBRA: Best Practices in Dental adults during adult clinic
lifecycle using collateral Caries Management (Hurlbutt, 2011)
information, as needed •  Identify oral abnormalities in geriatric
photographs (Appendix 12)
CONSTRUCTS

© Oral Health Nursing Education and Practice (OHNEP)

 APPENDIX 1 Health Assessment Across Lifespan

Smiles for Life Module 1 Quiz: The Relationship of Oral to Systemic Health
S   1. What is the most common chronic 5. What can a primary care clinician do to 8. Which of the following infections
disease of childhood? is NOT potentially caused by direct
  A.  Asthma
promote oral health?
A.  Collaborate with dental and other health extension from a dental source?
  B.  Seasonal allergies professionals A.  Otitis media

  C.  Dental caries

D. Cefuroxime
B. Apply dental sealants B.  Sinusitis
C.  Brain abscess
C.  Prescribe oral fluoride supplements to every
  patient D. Facial cellulitis
  2. What is a consequence of untreated D. Apply fluoride varnish to the teeth of all
dental caries? adults 9. What is the suggested common
A.  Osteonecrosis of alveolar bone pathway linking chronic periodontitis
6. Which of these classes of medications and conditions such as diabetes,
B.  Gingival hyperplasia is NOT generally associated with
C.  Oral mucositis coronary artery disease and adverse
decreased salivary flow? pregnancy outcomes?
D. Tooth fractures A.  Antihistamines A.  Direct bacterial extension
B.  Antibiotics B.  Poor nutrition
3.Which condition is associated with C.  Corticosteroids C.  Circulating antibodies
periodontal disease? D. Anticholinergics D. Inflammation
A.  Asthma E.  Diuretics
B.  Preterm labor
10. Which of the following is NOT a
C.  Sinusitis
7. A patient undergoing chemotherapy for mechanism for inter-relationships
D. Hypothyroidism cancer is at risk for which of these oral between oral and systemic disease?
4. Which of the following medications is linked to complications due to the effects of A.  Behavioral
gingival hyperplasia? chemotherapy? B.  Iatrogenic
A.  Phenytoin A.  Osteonecrosis of alveolar bone C.  Neurologic
B.  Amoxicillin B.  Gingival hyperplasia D. Inflamatory
C.  Digoxin C.  Oral mucositis
D. Coumadin D. Tooth fractures
(Clark et al, 2010)
 APPENDIX 2 Health Assessment Across Lifespan

Smiles for Life Module 2 Quiz: Child Oral Health (part I)

S   1.  What are Early Childhood Caries? 5. The mother of your 10 month-old patient asks for a prescription for

  A.  Dental decay in children from 2 – 10 years of age supplemental fluoride. She reports that the family obtains their water
B. An infectious chronic disease from a well. What is your best course of action?
  C.  Deformities in a child’s teeth that are caused by excessive A.  Prescribe a dietary fluoride supplement as well water

  fluoride does not contain fluoride

D. Dental decay caused by a lack of fluoride in a child’s diet B.  Test the well’s fluoride level prior to prescribing a dietary
  2.  Oral bacteria and dietary sugars are two of the
fluoride supplement

  three parts of the “Etiology Triad” of Early Childhood Caries.

C.  Do not prescribe a dietary fluoride supplement as the child
has neither white spots nor caries
What is the third part of the triad?
D. Obtain the fluoride level in wells near the family’s home from the
A.  The enamel and dentine of teeth which is vulnerable to demineralization
local health department before prescribing a dietary fluoride supplement
B.  Bacterial toxins which attach the teeth’s calcium matrix
C.  Saliva which provides a moist environment for the cariogenic oral
6. What does this photograph
bacteria
of a child’s mouth depict?
D. Genetic predisposition to colonization by cariogenic oral bacteria
A.  Fluorosis
3.  What is a risk factor for developing Early Childhood Caries? B.  White spots
A.  High fat diet C. Moderate Early Childhood
B. Patient’s age Caries
C.  Excessive levels of fluoride D. Iron staining
D. Caries in siblings or caretakers 7. To what is the arrow on
4. How can primary care clinicians prevent this photograph of a child’s
Early Childhood Caries? mouth pointing?
A.  Counsel a child’s caregivers about the child’s diet A.  A normal tooth
B.  Apply dental sealants to the teeth of young B.  Fluorosis
patients C.  White spots
C.  Prescribe fluoride to every young patient D. Severe Early Childhood
D. Refer children to a dentist at age 5 Caries

(Clark et al, 2010)

 APPENDIX 2 Health Assessment Across Lifespan

Smiles for Life Module 2 Quiz: Child Oral Health (part II)
S  
  8. What is the first step in performing a knee-to-knee
  oral examination of a child’s mouth?
A.  Have the caregiver hold the child on his or her lap facing the examiner
  B.  Have the caregiver hold the child facing him or her in a straddle position
  C.  The examiner looks in the child’s mouth

  D. Have the caregiver separate the child’s jaws

9. What guidance about teething should a primary

care clinician provide to a toddler’s caregiver?
A.  Teething can cause ear infections and diarrhea
B.  The caregiver should bring the toddler to the office if the child starts to
drool
C.  Teething sometimes causes upper respiratory infections
D. A child who is teething may be fussy

10. The arrow is pointing to a

darkened feature in a child’s mouth.
What is this feature called?
A.  Fluorosis
B.  An avulsed tooth
C.  An eruption hematoma
D. Early childhood caries in an unerupted tooth

(Clark et al, 2010)

 APPENDIX 3 Health Assessment Across Lifespan

Smiles for Life Module 6 Quiz: Caries Risk Assessment, Fluoride Varnish and Counseling (part I)
S   1.  The mother of a 9-month old patient asks what causes 5. While performing an exam on one of
  Early Childhood Caries (ECC). Which is the most accurate reply?
A.  The majority of ECC results from thin or “weak” tooth enamel
your young patients, you observe the
following (see photograph). Describe what
  inherited from the parents you see:

  B.  Bacteria in the child’s mouth break down dietary sugars into
acids which break down tooth enamel
A.  The teeth are normal and have no
white spots or tooth decay
  C.  A lack of protective saliva is the most common cause of ECC B.  The gingiva are pathologically pigmented
D. A calcium deficiency during the time teeth are formed produces
  teeth that lack a sufficiently thick covering of enamel
C.  The tooth’s enamel is thin, so fluoride
varnish must be applied to strengthen the
2. Which of the following factors places a child at the most risk for enamel
developing early childhood caries? D. The color of the tooth indicates that
A.  Having a diagnosis of severe asthma the child is at risk for developing
fluorosis
B.  Living with family members who smoke tobacco or drink
excessive amounts of alcohol 6. What guidance would you provide the mother of your 20 month old
C.  Breast feeding for longer than six months patient who expresses concern about her child developing fluorosis?
D. Having plaque on the teeth The family lives in a town that adds fluoride to the water supply, and
the child has already had 2 cavities:
3.  Which is NOT a mechanism of action for topical fluoride?
A.  Tell the mother to use only a small smear of fluoridated
A.  It inhibits demineralization of the teeth
toothpaste when brushing the child’s teeth
B.  It promotes remineralization of the teeth
B.  Tell the mother to use a non-fluoridated toothpaste
C.  It inhibits bacterial metabolism
C.  Brush the child’s teeth every other day
D. It promotes the release of saliva
D. Only give bottled drinking water to the child
4.  Which of the following is a benefit of fluoride varnish?
A.  Fluoride varnish permanently seals the pits and fissures of teeth 7.  Which children should receive fluoride varnish in the medical office?
B.  Fluoride varnish decreases the need for routine dental care A.  All children at high risk for caries
C.  Fluoride varnish can reverse early decay (i.e., the “white spots”) B.  High risk children without a dental home
and slow enamel destruction C.  Low risk children
D. Fluoride varnish replaces the need to take systemic fluoride supplements D. All children

(Clark et al, 2010)

 APPENDIX 3 Health Assessment Across Lifespan

Smiles for Life Module 6 Quiz: Caries Risk Assessment, Fluoride Varnish and Counseling (part II)
S  
  8. While performing an exam on one of your young patients, you
  observe the teeth indicated by the yellow arrows. Describe the
  tooth’s condition.
A. The teeth are normal and have no visible decay.
  B. The brown areas represent caries where loss of overlying enamel has
exposed 
  underlying dentin.
C. The brown areas indicate that the child has chipped his teeth.
D. The brown color indicates that the child has developed fluorosis.

9. While applying fluoride varnish to an infant what is the gauze

used for?
A. The gauze is the vehicle used to apply the flourish varnish to the
teeth.
B. The gauze is used to hold the tongue out of the way.
C. The gauze is used to dry the child’s teeth and to remove gross
plaque.
D. The gauze is shown to the child to stimulate her to open her mouth.

10. What guidance do you give the grandmother of a child who has
just had fluoride varnish applied to his teeth?
A. The child’s teeth will be discolored for about a week.
B. Do not brush the child’s teeth for at least 48 hours.
C. Brush the child’s teeth in about one hour.
D. Avoid giving the child hot or hard food for 24 hours

(Clark et al, 2010)

 APPENDIX 4 Health Assessment Across Lifespan

Smiles for Life Module 3 Quiz: Adult Oral Health

S   1. Which dental procedure does NOT require
prophylaxis for individuals at high risk
5. Risk factors for adult caries may include all
the following except:
8. Whichof the following statements,
concerning xerostomia or dry mouth, is
  of bacterial endocarditis? A.  Low socioeconomic status not true?
A.  Dental extractions B.  Existing tooth restoration A.  Xerostomia is caused by a decrease in
  B.  Periodontal procedures C.  Decreased salivary flow the production of saliva
  C.  Post-operative suture removal
D. Prophylactic cleaning of teeth if
D. A vegetarian diet
E.  Physical disabilities
B.  Xerostomia can cause a burning sensation,
change in taste, and difficulty swallowing
  bleeding is anticipated C.  Medications can contribute to xerostomia

 
E.  Re-implantation of avulsed teeth 6. Which of the following patients requires D. Xerostomia can increase the development of
bacterial endocarditis antibiotic prophylaxis? caries
2. Periodontal disease can be clinically E.  Xerostomia is rarely a problem for patients
A.  A 26 year old woman with mitral valve
distinguished from gingivitis in which of wearing complete dentures
prolapse undergoing routine teeth cleaning
the following ways?
with no anticipated bleeding.
A.  Inflammation of the gums 9. Which of the following has been
B.  A 64 year old man with a prosthetic mitral
B.  White discoloration of the permanent implicated in the development of recurrent
valve who is undergoing a tooth extraction.
teeth aphthous ulcers?
C. A 16 year old boy with a ventricular septal
C.  Enlarged pockets at the gum base A.  Trauma
defect completely repaired in infancy who
D. Gingival hypertrophy B.  Vitamin C deficiency
requires extraction of an impacted wisdom
tooth. C.  Sickle Cell Anemia
3. Which of the following is NOT a common
site for oral cancers? D. A 32 year old man who had bacterial D. Herpes simplex virus infection
A.  Tongue endocarditis 5 years ago who
B.  Floor of mouth isundergoing orthodontic appliance 10. Which of the following factors is
C.  Hard palate adjustment. NOT involved in the development of
D. Lower lip “Meth Mouth”:
7. Which of the following is not a normal A.  Poor oral hygiene
4. Which of the following is most likely to lead age-related tooth change? B.  Increased carbohydrate
to poorer oral health in the elderly? A.  Gingival recession
A.  Alzheimer’s dementia consumption
B.  Root caries C.  Nighttime mouth breathing
B.  Coronary artery disease C.  Yellowing of teeth
C.  Hypothyroidism D. Teeth grinding
D. Wearing away of teeth with exposed
D. All of the above E.  Xerostomia
dentin
(Clark et al, 2010)
 APPENDIX 5 Health Assessment Across Lifespan

Smiles for Life Module 5 Quiz: Oral Health In Pregnancy

S   1. Which of the following is a C.  Dental treatment should only be done during the 8. If a pregnant woman has an oral
FALSE statement? second trimester for comfort and safety reasons abscess in the first trimester, what
  A.  Gingivitis is very common in pregnancy D. Dental treatment can be done during should she do regarding its
B.  Periodontitis is associated with preterm birth
  C.  Treatment of periodontitis in pregnancy
any trimester treatment?
A.  Take antibiotics and pain medication
  decreases the risk of preterm birth
D. Deep root scaling to improve periodontitis
5. What guidance should you give a pregnant
patient about having dental x-rays during her
only and wait until her second trimester
to see the dentist
  is safe during pregnancy pregnancy?
A.  Dental x-rays should be avoided during B.  Avoid x-rays for further diagnosis
  2. Which of the following is a TRUE statement:
A.  Mothers with caries pass their genetic
pregnancy C.  Have the tooth treated or extracted
under local anesthesia immediately
B.  Dental x-ray should be limited to only one
predisposition for caries on to their babies film per pregnancy D. Delay definitive treatment
B.  Mother with caries pass caries-causing C.  Dental x-rays should be taken as until after delivering her
bacteria to their babies in utero necessary to reach a full diagnosis baby
C. Mother with caries pass caries-causing bacteria D. Dental x-rays are rarely needed during 9. Amalgam restorations placed during
to their infants early in life via saliva pregnancy pregnancy can lead to which negative
transmission outcome in the fetus?
D. All of the above 6. What oral health guidance should
you give a pregnant patient? A.  Birth defects
3. A pregnancy granuloma: A.  Brush twice daily with fluoridated toothpaste B.  Neurologic sequelae
A.  Has malignant potential and should be biopsied B.  Use chlorhexidene mouthwash three times per C.  Spontaneous abortions
B.  Should be excised during pregnancy even if day D. None of the above
asymptomatic to avoid complications C.  Avoid sugary drinks and snacks between meals
C.  Can be observed D. Take fluoride dietary supplements 10. What could pregnant women do
D. Is not likely to recur if excised E.  A and C only after vomiting to reduce the risk of
4. A pregnant patient asks you for guidance enamel erosion?
about having dental treatment during her 7. All of the following conditions can cause
worsening gingivitis EXCEPT: A.  Swish with baking soda and water
pregnancy. What would you say?
A.  Onset of puberty B.  Vigorously brush her teeth
A.  Dental treatment should only be done
during the second and third trimester B.  Monthly menses C.  Immediately take a dose of a proton
B.  Dental treatment should only be done C.  Menopause pump inhibitor
during the third trimester because D. Use of oral contraceptives D. Immediately take 3-4 antacid tablets
organogenesis is complete E.  Pregnancy
(Clark et al, 2010)
 APPENDIX 6 Health Assessment Across Lifespan

Smiles for Life Module 7 Quiz: Oral Examination

S   1.  What constitutes a tooth’s outer layer? 5. Oral cancer is most common in which area 8. When examining a 9 month old child’s
  A.  Enamel of the mouth? mouth, what is a reason for an early referral to
a dentist?
B.  Dentin A.  Hard palate
  C.  Pulp B.  Surface of tongue
A.  The child has only 4 incisors
B.  Developmental tooth defects are present
  C.  Inside of cheek
C.  No molars have erupted
2.  What is a full complement of adult teeth? D. Posterolateral tongue
  A.  26
D. No canine teeth have erupted
E.  Counting less than 20 teeth
  B.  28 6. When performing the “knee-to-knee” oral
C.  30 exam on a young child, in what position
9. You are performing an oral exam on your
D. 32 should the child start? 21 year old patient who has been using
A.  Facing the examiner smokeless tobacco for 4 years. What part of
3. A caregiver asks you how many teeth B.  Standing up this patient’s oral cavity is especially
her 3 year old child should have. What C.  Sitting on the exam table important for you to examine?
would you respond? D. Facing the caregiver A.  The sun-exposed areas of the patient’s cheeks
A.  20 B.  The inner aspect of the patient’s lips and cheeks
B.  22 7. Which of the following is NOT needed by a C.  Any discoloration or pitting of the patient’s teeth
C.  24 primary care clinician to conduct a thorough D. Any plaque build-up along the patient’s gum line
D. 28 oral exam? E.  The patient’s posterior pharynx
A.  An exam light to illuminate key
4. At what age do teeth typically features in the mouth 10. A complete oral examination includes each
begin to erupt in children? B.  Tongue depressors to lift the lip of the following EXCEPT:
A.  3-9 months and retract the cheek A.  Temporomandibular joint (TMJ) exam
B.  9-15 months C.  A mouth mirror to view lingual surfaces of B.  Cervical node exam
C.  15-21 months teeth C.  Palpation of the floor of the mouth
D. 21-27 months D. Dental explorer D. Sinus exam
E.  Gauze pads to grasp the tongue E.  Exam of the skin around the mouth

(Clark et al, 2010)

 APPENDIX 7 Health Assessment Across Lifespan

Smiles for Life Module 8 Quiz: Geriatric Oral Health (part I)

S  
1.  What is the most common site 4. Which statement is true regarding 6. What is the most significant reason why complete tooth loss
  for caries in the elderly? dental prostheses? has declined in the US from 50% to 18% in the last 60 years?
  A.  Site of a previous restoration
(filling)
A.  Implants are commonly placed in a
jaw to replace teeth lost due to severe
A.  Increased use of dental insurance in the elderly
B.  Increased use of bottled and filtered water products among adults
  B.  On a root that is exposed due to osteoporosis C.  Addition of fluoride to most community water systems
  gingival recession
C.  On coronal surface of tooth
B.  Dentures should be removed and
cleaned daily
D.  Increased use of multiple prescription medications in the elderly

  D. On the buccal surface of molars C.  Bridges should be removed daily to
7. While performing an oral exam on a 72 year old patient, you
facilitate cleaning of teeth
2. Which of the following is an D. A partial denture is permanently fixed observe the finding in the photograph. How should you manage
absolute contraindication for to adjacent teeth and therefore does this finding?
placing dental implants? not need to be removed to perform a A.  Refer the patient to an oral surgeon for immediate biopsy of
A.  Diabetes mellitus that is complete oral assessment probable oral cancer
controlled B.  Schedule the patient to return in 2 weeks to reassess the lesion.
B.  Root caries in the teeth that are to 5. HPV influenced oral cancers have If the lesion is still present, you should then refer the patient for
be replaced which of the following biopsy
C.  Use of IV bisphosphonates characteristics? C.  Treat the patient with an antifungal solution and reassess in 2
D. Use of medication known to cause A.  Account for the rise in oral cancers in weeks
xerostamia younger individuals , age 40-64 D.  Document this finding as sublingual varicosities that are normal
B.  Are usually seen in the anterior in this age group and require no further evaluation
3. What is the adverse intraoral
effect with which calcium channel portion of the mouth, especially the
blockers are most associated buccal mucosa or the lip
with? C.  Epidemiologically related to exposure
A.  Stomatitis to HPV 18
B.  Thrush D. Less likely to be associated with oral
C.  Gingival hyperplasia cancer than other sexually
transmitted infections such as syphilis
D. Osteonecrosis of mandible
and gonorrhea

(Clark et al, 2010)

 APPENDIX 7 Health Assessment Across Lifespan

Smiles for Life Module 8 Quiz: Geriatric Oral Health (part II)
S   8. Which of the following statements is true 10. Elderly with poor oral hygiene, missing teeth 11. Which of the following is an
  regarding the oral health of elderly patients with
dementia?
and dental pain are at risk for worsening oral
health due to which of the following nutritional
appropriate use of fluoride in older
adults?
  A.  Aging alone is the major contributor to poor oral factors? A.  Topical fluoride treatments for
health of older individuals with dementia A.  Lack of foods rich in vitamins such as vitamin C exposed roots
  B.  Medications used to treat hypertension, and beta carotene B.  Oral fluoride supplementation for
  depression and behavioral disturbances seen in
this population have little effect on their oral
B.  Compensating for taste alteration due to
prescribed medication with soft, sugared foods
patients with multiple carious lesions
C.  Oral fluoride supplementation for
  health such as ice cream, pudding and white bread patients with multiple carious lesions
C.  Since this population struggles with Activities of which can lead to caries in remaining teeth D.  Topical fluoride for gingival
Daily Living (ADLs), they are at high risk for poor C.  Use of mints or sweetened beverages to relieve hyperplasia caused by phenytoin
oral health unless caregivers assist with oral care dry mouth therapy
D.  Reminding these individuals to brush their teeth D.  All of the above E.  Topical fluoride as a routine
each day is adequate to achieve and maintain preventive measure in patients with
good oral health excellent oral care (no caries or
periodontal disease)
9. After a hip fracture, a 76 year old woman is
admitted to a long-term care facility for
rehabilitation. While examining her mouth
shortly thereafter, you see the condition in the
photograph. What is the most likely cause of
what you see?
A.  The patient developed cellulitis of her palate
during her recent hospital stay
B.  The patient’s palate was damaged during
intubation for anesthesia
C.  The patient’s dentures were improperly cleaned
while she was in the hospital
D.  The patient probably has an oral cancer

(Clark et al, 2010)

 APPENDIX 1-7 Health Assessment Across Lifespan

Smiles for Life Answer Key

S  
  Module 8:
Module 1: Module 2: Module 3: Module 5: Module 6: Module 7:
  1.  A 1.  A
1.  C 1.  B 1.  C 1.  C 1.  B
  2.  C
2.  A 2.  A 2.  C 2.  C 2.  D 2.  D
  3.  A 3.  C
3.  B 3.  D 3.  C 3.  C 3.  D
  4.  B
4.  A 4.  A 4.  A 4.  D 4.  C 4.  B
5.  A 5.  B 5.  D 5.  C 5.  A 5.  D 5.  A
6.  B 6.  C 6.  B 6.  E 6.  A 6.  D 6.  C
7.  C 7.  C 7.  B 7.  C 7.  B 7.  D 7.  D
8.  A 8.  B 8.  E 8.  C 8.  B 8.  B 8.  C
9.  D 9.  D 9.  A 9.  D 9.  C 9.  B 9.  C
10.  C 10.  C 10.  C 10.  A 10.  D 10.  D 10.  D
11.  A

(Clark et al, 2010)

 APPENDIX 8 Health Assessment Across Lifespan
American Academy of Pediatrics Oral Health Risk Assessment Tool

S  
 
 
 
 
 

www2.aap.org/oralhealth/docs/RiskAssessmentTool.pdf
 APPENDIX 8 Health Assessment Across Lifespan
American Dental Association Caries Risk Assessment Form (Age 0-6)

S  
 
 
 
 
 

www.ada.org/~/media/ADA/Public Programs/Files/topics_caries_educational_under6_GKAS.ashx
 APPENDIX 8 Health Assessment Across Lifespan

American Academy of Pediatric Dentistry Caries Risk Assessment Tool

S  
 
 
 
 
 

http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment.pdf
=
APPENDIX 9 Health Assessment Across Lifespan
Pediatric Oral Health Checklist

S  
 
Please identify each item:
 
Decalcification of teeth (A)
 
Early childhood decay (B)
 
  Mucocele (C)
Enlarged tonsils (D)
Short frenulum (E)
Gingivitis (F)
Plaque accumulation (G)

Images from:
Rangeeth, B. N., Moses, J., & Reddy, V. K. K. (2010). A rare presentation of mucocele and irritation fibroma of the lower lip. Contemporary clinical dentistry, 1(2), 111.
Verma, S. K., Maheshwari, S., Sharma, N. K., & Prabhat, K. C. (2010). Role of oral health professional in pediatric obstructive sleep apnea. National journal of maxillofacial surgery, 1(1), 35.
Chaubal, T. V., & Dixit, M. B. (2011). Ankyloglossia and its management. Journal of Indian Society of Periodontology, 15(3), 270.
Hagan J.F., Shaw J.S., Duncan P.M. (2008). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (3rd, Ed).Elk Grove Village, IL: American Academy of Pediatrics.
=
APPENDIX 9 Health Assessment Across Lifespan
Pediatric Oral Health Answer Key

S  

  Answers
  Decalcification of teeth (A)
Early childhood decay (B)
  Plaque accumulation (C)
  Enlarged tonsils (D)
A   B  
  Mucocele (E)
Ankyloglossia (tongue-tie) (F)
D  
Gingivitis (G)

C  
E   F  

Images from:
G  
Rangeeth, B. N., Moses, J., & Reddy, V. K. K. (2010). A rare presentation of mucocele and irritation fibroma of the lower lip. Contemporary clinical dentistry, 1(2), 111.
Verma, S. K., Maheshwari, S., Sharma, N. K., & Prabhat, K. C. (2010). Role of oral health professional in pediatric obstructive sleep apnea. National journal of maxillofacial surgery, 1(1), 35.
Chaubal, T. V., & Dixit, M. B. (2011). Ankyloglossia and its management. Journal of Indian Society of Periodontology, 15(3), 270.
Hagan J.F., Shaw J.S., Duncan P.M. (2008). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (3rd, Ed).Elk Grove Village, IL: American Academy of Pediatrics.
 APPENDIX 10 Health Assessment Across Lifespan

American Dental Association Caries Risk Assessment Form (Ages >6)

S  
 
 
 
 
 

www.ada.org/~/media/ADA/Public Programs/Files/topics_caries_educational_over6.ashx
 APPENDIX 11 Health Assessment Across Lifespan
Adult Oral Health Checklist

S   Please check as you identify each item:

  Strep throat (A)
  Periodontal disease (B)
  Black hairy tongue (C)
  Herpetic lesion (D)
Gingival recession (E)
 
Canker sore (F)
Angular cheilitis (G)
Tori madibularis (H)

Images from:
CDC public health images library
Gujral, D. M., Bhattacharyya, S., Hargreaves, P., & Middleton, G. W. (2008). Periodontal disease in a patient receiving Bevacizumab: a case report. Journal of medical case reports, 2(1), 47.
Jain, A., & Kabi, D. (2013). Severe periodontitis associated with chronic kidney disease. Journal of Indian Society of Periodontology, 17(1), 128.
Jeong, J. S., Lee, J. Y., Kim, M. K., & Yoon, T. Y. (2011). Black hairy tongue associated with erlotinib treatment in a patient with advanced lung cancer. Annals of dermatology, 23(4), 526-528.
Khuller, N. (2009). Coverage of gingival recession using tunnel connective tissue graft technique. Journal of Indian Society of Periodontology, 13(2), 101.
Kwon, K. H., Lee, D. G., Koo, S. H., Jo, M. S., Shin, H., & Seul, J. H. (2012). Usefulness of vy advancement flap for defects after skin tumor excision. Archives of plastic surgery, 39(6), 619-625.
Lee, K. H., Lee, J. H., & Lee, H. J. (2013). Concurrence of Torus Mandibularis with Multiple Buccal Exostoses. Archives of plastic surgery, 40(4), 466-468.
 APPENDIX 11 Health Assessment Across Lifespan
Adult Oral Health Answer Key

S  
  Answers A  
  Strep throat (A)
Periodontal disease (B)
 
Black hairy tongue (C)
  Herpetic lesion (D) B   C  
  Gingival recession (E)
Canker sore (F)
Angular cheiltis (G) E   F  
Tori madibularis (H) D

H  

Images from: G  
CDC public health images library
Gujral, D. M., Bhattacharyya, S., Hargreaves, P., & Middleton, G. W. (2008). Periodontal disease in a patient receiving Bevacizumab: a case report. Journal of medical case reports, 2(1), 47.
Jain, A., & Kabi, D. (2013). Severe periodontitis associated with chronic kidney disease. Journal of Indian Society of Periodontology, 17(1), 128.
Jeong, J. S., Lee, J. Y., Kim, M. K., & Yoon, T. Y. (2011). Black hairy tongue associated with erlotinib treatment in a patient with advanced lung cancer. Annals of dermatology, 23(4), 526-528.
Khuller, N. (2009). Coverage of gingival recession using tunnel connective tissue graft technique. Journal of Indian Society of Periodontology, 13(2), 101.
Kwon, K. H., Lee, D. G., Koo, S. H., Jo, M. S., Shin, H., & Seul, J. H. (2012). Usefulness of vy advancement flap for defects after skin tumor excision. Archives of plastic surgery, 39(6), 619-625.
Lee, K. H., Lee, J. H., & Lee, H. J. (2013). Concurrence of Torus Mandibularis with Multiple Buccal Exostoses. Archives of plastic surgery, 40(4), 466-468.
 APPENDIX 12 Health Assessment Across Lifespan
Geriatric Oral Health Checklist

S  
Please check as you identify each item:
 
Melanoma (A)
 
  Candidiasis (B)
  Denture sores (C)
  Denture Stomatitis (D)

Images from
CDC Public Health Images Library
Clark M.B., Douglass A.B., Maier R., Deutchman M., Douglass J.M., Gonsalves W., Silk H., Tysinger J.W., Wrightson A.S., & Quinonez R. (2010). Smiles for life: a national oral health
curriculum. 3rd Edition. Society of Teachers of Family Medicine. Retrieved from smilesforlifeoralhealth.com

 
 APPENDIX 12 Health Assessment Across Lifespan
Geriatric Oral Health Checklist

S  
  Answers  
  Melanoma (A)
  Candidiasis (B) A  
  Denture sores (C)
  Denture Stomatitis (D)

C  

B   D  

Images from
CDC Public Health Images Library
Clark M.B., Douglass A.B., Maier R., Deutchman M., Douglass J.M., Gonsalves W., Silk H., Tysinger J.W., Wrightson A.S., & Quinonez R. (2010). Smiles for life: a national oral health
curriculum. 3rd Edition. Society of Teachers of Family Medicine. Retrieved from smilesforlifeoralhealth.com
 
FNP Curriculum Integration of Interprofessional Oral Health Competencies in Health Promotion of Families

HEALTH 1) EXPOSURE: INTRODUCTION 2) IMMERSION: DEVELOPMENT 3) COMPETENCE: ENTRY-TO-PRACTICE

PROMOTION KNOWLEDGE: HEALTH PROMOTION IN CHILDREN Goal:
OF FAMILIES SKILL/BEHAVIOR SKILL/BEHAVIOR
Understand importance of maintaining good oral health in Goal: Advocate for oral public health within your community
Goal: Integrate oral health into care of children
children
•  Review Smiles for Life Modules #1, 2, 6 • Read
•  Read: • Write advice column in parenting journal Water Fluoridation, Dentition Status and Bone Health of
• Getting Fluoride for Your Child (Appendix 1)

INTER-PROFESSIONAL PARTNERSHIP & COLLABORATIVE PRACTICE FOR

detailing specific oral health issue Older People in Ireland (O’Sullivan & O’Connell, 2014)
IPEC Competencies: (National Center on Health, 2014) commonly encountered by parents/ • Sources of Drinking Water in a Pediatric Population
Values and Ethics, • Lift the Lip (Appendix 2) (Horowitz, 2013)
Roles and caregivers (Jadav et al, 2014)
• Let’s Talk Teeth & Let’s Set Goals (Appendix 3)
Responsibilities • Participate in interprofessional oral health • Visit Oral Health Advocates (AAP), access your state’s
• Oral Health Self-Management Goals for Parents/
Interprofessional Caregivers (AAP) clinical experience with medical and resource page and determine any fluoridation issues in
Communication, E • Visiting the Dental Clinic with your Child dental students in head start, community your state
Teams & Teamwork S
N (Appendix 4) (National Center on Health, 2014) health center, pre-school health fairs or U • Develop and present an evidence-based campaign for

OPTIMIZATION OF CIENT/PATIENT HEALTH OUTCOMES

T •  Watch Partners in Prevention (NYU College school-based clinic M community water fluoridation
R of Dentistry)
M
Y KNOWLEDGE: HEALTH PROMOTION IN A
SKILL/BEHAVIOR T SKILL/BEHAVIOR
L ADULTS I Goal: Advocate for smoking cessation in adults
E Goal: Understand importance of maintaining Goal: Integrate oral health into care of V
HRSA Oral Health V adults E
good oral health in adults • Develop and engage smoking adults in
Competencies: E
Oral Health Risk L • Review Smiles for Life Modules #3, 5, 7 evidence-based smoking cessation
• Read A
Assessment, Oral • Read: S program
Health Evaluation, A • Maintaining Oral Health Across the Evaluation and Managing Dental S
Oral Health Preventive Complaints in Primary and Urgent • Develop and implement evidence-based
S Life Span (Jablonski et al, 2014) E oral cancer screening program with dental
Intervention, S Care (Idzik & Krauss, 2013) S
Communication • Surgeon General’s Fact Sheets students for smoking adults
E • Using health literacy principles, plan S
and Education S • Promoting Smoking Cessation evidence-based oral health education M
S (Larzelere & Williams, 2012) program with dental students for E
M • Help Your Patients Quit (ADA) adults with type 2 diabetes N
E (Appendix 5) T
N
T SKILL/BEHAVIOR
KNOWLEDGE: HEALTH PROMOTION IN SKILL/BEHAVIOR
NONPF OLDER ADULTS Goal: Integrate oral health into care of Goal: Promote good oral health habits in
Competencies: older adults older adults
Delivers evidence-
Goal: Understand importance of
based practice for maintaining good oral health in older
patients throughout adults • Read • Engage older adults in an evidence-
lifespan; Distinguishes Tooth Loss and Its Association with based nutrition and oral health
between normal and education program at senior center
• Review Smiles for Life Module #8 Dietary Intake and Dietary Quality in
abnormal change
• Read American Adults (Zhu & Hollis, 2014) • Develop list of dental providers in
across lifespan; the area to whom you can refer
Identifies and plans Systemic Diseases and Oral Health • Plan evidence-based nutrition and oral
interventions to proote (Tavares, 2014) health education program with dental patients who accept Medicaid or
students for older adults sliding scale
health with families at
risk
CONSTRUCTS

© Oral Health Nursing Education and Practice (OHNEP)

 APPENDIX 1 Health Promotion of Families
Healthy Habits for Healthy Smiles
S  

http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/oral-health/PDFs/getting-flouride.pdf (National Center on Health, 2014)

 APPENDIX 2 Health Promotion of Families

Lift the Lip

S  

http://phpa.dhmh.maryland.gov/oralhealth/docs1/LifttheLip-English.pdf (Herschel S. Horowitz Center for Health Literacy, 2013)

 APPENDIX 3 Health Promotion of Families
Cavity Free Kids Let’s Talk Teeth & Let’s Set Goals
S  

http://cavityfreekids.org/resources/home-visiting-resource/ (Washington Dental Service Foundation, 2014)

 APPENDIX 4 Health Promotion of Families
Healthy Habits for Healthy Smiles
S  

http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/oral-health/PDFs/visiting-dentist.pdf (National Center on Health, 2014)

 APPENDIX 5 Health Promotion of Families
Help Your Patients Quit (part I)

S   Tobacco  Cessa*on  

(American Dental Association)

 APPENDIX 5 Health Promotion of Families
Help Your Patients Quit (part II)

S  
Pharmacotherapy  

(American Dental Association)

FNP Curriculum Integration of Interprofessional Oral Health Competencies in Primary Care of Families

PRIMARY 1) EXPOSURE: INTRODUCTION 2) IMMERSION: DEVELOPMENT 3) COMPETENCE: ENTRY-TO-PRACTICE

CARE OF
FAMILIES KNOWLEDGE: ADULT WITH CHRONIC SKILL/BEHAVIOR COLLABORATIVE CASE PRESENTATION- ADULT
DISEASE Goal: Provide comprehensive health maintenance Goal: Collaborate interprofessionally on adult chronic
services to adults with chronic diseases disease case with oral health needs
Goal: Recognize oral manifestations of
chronic disease in adults • Review adult oral health photographs (Appendix 1)

INTER-PROFESSIONAL PARTNERSHIP & COLLABORATIVE PRACTICE FOR

IPEC Competencies: • Read: • FNP and dental students to collaborate on
Values and Ethics, • Read • Oral manifestations of gastroesophageal developing a management plan for adult with Celiac
Roles and Association between Celiac Disease, reflux disease (Ranjitkar et al, 2012)
Responsibilities
Disease and oral health needs(Appendix 6)
dental enamel defects and apthous • Oral Hygiene Status of Individuals with
Interprofessional Cardiovascular Disease (Shetty et al, 2012) • FNP and dental students to present one article from
Communication,
ulcers in a U.S. cohort (Cheng et al,
E 2010) • Develop care plan for patient with either chronic S list (Appendix 7) on Celiac Disease and report
Teams & Teamwork N U

OPTIMIZATION OF CIENT/PATIENT HEALTH OUTCOMES

disease and include HEENOT in history, risk findings on oral health
T M
R assessment, exam and plan
M
Y SKILL/BEHAVIOR A
KNOWLEDGE: ADOLESCENT WITH COLLABORATIVE CASE STUDY- CHILD/
T
L INFECTIOUS DISEASE Goal: Provide comprehensive health I ADOLESCENT
E Goal: Recognize oral manifestations of maintenance services to children/adolescents V Goal: Collaborate interprofessionally on
HRSA Oral Health V with infectious diseases E pediatric infectious disease case with oral
Competencies: E
infectious diseases in adolescents
• Review pediatric oral health health needs
Oral Health Risk L A
Assessment, Oral photographs(Appendix 2) S
• Read :
Health Evaluation, A • Collaborate together on discussion board on S • FNP and dental students to collaborate on
Oral Health Preventive S • Oral Manifestations of STIs (DePaola, 2013) E
Intervention,
case study of child with Kawasaki Disease developing a management plan for:
S • HPV and Oropharyngeal Cancer (CDC 2013) and oral health issues (Appendix 3) S
Communication E S • Child with infectious disease and oral
and Education S • Statement on HPV and Squamous Cell • Develop evidence-based brochure on M health needs (Appendix 8)
S Cancers of the Oropharynx (ADA) benefits of HPV vaccination for pre- E
M N • Adolescent with STI and oral health
E • HPV Vaccine Hesitancy (McRee et al, 2014 adolescents T needs (Appendix 9)
N
T COLLABORATIVE CASE STUDY- OLDER ADULT
KNOWLEDGE: PRIMARY CARE IN OLDER SKILL/BEHAVIOR Goal: Collaborate interprofessionally on geriatric
NONPF Competencies: ADULT Goal: Provide comprehensive health case with cognitive decline and oral health needs
Delivers evidence- based
Goal: Recognize oral health needs of older maintenance services to older adults • Read
practice for patients
throughout lifespan; adults • Review older adult oral health Opportunities for Nursing-Dental Collaboration:
Develops patient- photographs (Appendix 4) Addressing Oral Health Needs Among the Elderly
appropriate educational • Collaborate together on (Coleman, 2005)
Read discussion board on case study
materials that address
• Reducing care-resistant behaviors during • FNP and dental students to collaborate on
language and cultural of older adult with diabetes developing management plans for
beliefs of patient; Works oral hygiene in persons with dementia (Appendix 5) case studies of older adults with cognitive
with individuals of other (Jablonski et al, 2011) • Develop oral health management decline and oral health needs
professions to maintain plan for older adult with diabetes
climate of mutual respect • Ensuring Oral Health for Older Individuals • FNP and dental students to develop one
and periodontal disease and interprofessional strategy to decrease care
and shared values with Intellectual and Development include HEENOT in history, risk
Disabilities (Waldman & Perlman, 2012) resistant behaviors for older adults with dementia
CONSTRUCTS assessment, exam and plan

© Oral Health Nursing Education and Practice (OHNEP)

 APPENDIX 1 Family Primary Care
Adult Oral Health Checklist

S  
  A  
  Strep throat (A)
Periodontal disease (B)
 
Black hairy tongue (C)
  Herpetic lesion (D) B   C  
  Gingival recession (E)
Canker sore (F)
Angular cheiltis (G) E   F  
Tori madibularis (H) D

H  

Images from: G  
CDC public health images library
Gujral, D. M., Bhattacharyya, S., Hargreaves, P., & Middleton, G. W. (2008). Periodontal disease in a patient receiving Bevacizumab: a case report. Journal of medical case reports, 2(1), 47.
Jain, A., & Kabi, D. (2013). Severe periodontitis associated with chronic kidney disease. Journal of Indian Society of Periodontology, 17(1), 128.
Jeong, J. S., Lee, J. Y., Kim, M. K., & Yoon, T. Y. (2011). Black hairy tongue associated with erlotinib treatment in a patient with advanced lung cancer. Annals of dermatology, 23(4), 526-528.
Khuller, N. (2009). Coverage of gingival recession using tunnel connective tissue graft technique. Journal of Indian Society of Periodontology, 13(2), 101.
Kwon, K. H., Lee, D. G., Koo, S. H., Jo, M. S., Shin, H., & Seul, J. H. (2012). Usefulness of vy advancement flap for defects after skin tumor excision. Archives of plastic surgery, 39(6), 619-625.
Lee, K. H., Lee, J. H., & Lee, H. J. (2013). Concurrence of Torus Mandibularis with Multiple Buccal Exostoses. Archives of plastic surgery, 40(4), 466-468.
=
APPENDIX 2 Family Primary Care
Pediatric Oral Health Checklist

S  
 
  Decalcification of teeth (A)
Early childhood decay (B)
  Plaque accumulation (C)
  Enlarged tonsils (D)
A   B  
  Mucocele (E)
Ankyloglossia (tongue-tie) (F)
D  
Gingivitis (G)

C  
E   F  

Images from:
G  
Rangeeth, B. N., Moses, J., & Reddy, V. K. K. (2010). A rare presentation of mucocele and irritation fibroma of the lower lip. Contemporary clinical dentistry, 1(2), 111.
Verma, S. K., Maheshwari, S., Sharma, N. K., & Prabhat, K. C. (2010). Role of oral health professional in pediatric obstructive sleep apnea. National journal of maxillofacial surgery, 1(1), 35.
Chaubal, T. V., & Dixit, M. B. (2011). Ankyloglossia and its management. Journal of Indian Society of Periodontology, 15(3), 270.
Hagan J.F., Shaw J.S., Duncan P.M. (2008). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (3rd, Ed).Elk Grove Village, IL: American Academy of Pediatrics.
 APPENDIX 3 Family Primary Care

Kawasaki Disease Case Study

S  
 
  A 5-year-old girl presented with a 2-week
history of fever and rash. Peeling of the skin of
 
her fingers and toes had been noted over the
  past 2 days.
  On physical examination, the girl’s temperature
was 38.9°C. She was tired but interactive. An
erythematous tongue with prominent papillae
(Figure 1) and desquamation of the hands and
feet (Figures 2 and 3) were noted.

What is the differential?

What is your clinical diagnosis?
What is your treatment plan?
What are your follow-up recommendations?
 APPENDIX 4 Family Primary Care
Geriatric Oral Health Checklist

S  
 
  Melanoma (A)
  Candidiasis (B) A  
  Denture sores (C)
  Denture Stomatitis (D)

C  

B   D  

Images from
CDC Public Health Images Library
Clark M.B., Douglass A.B., Maier R., Deutchman M., Douglass J.M., Gonsalves W., Silk H., Tysinger J.W., Wrightson A.S., & Quinonez R. (2010). Smiles for life: a national oral health
curriculum. 3rd Edition. Society of Teachers of Family Medicine. Retrieved from smilesforlifeoralhealth.com
 
 APPENDIX 5 Family Primary Care

Diabetes Case Study

S  
A 65 year old Hispanic male Mr. M. was referred by the
  Dental clinic because of early evidence of periodontal • Oral Health History
  disease. The patient has family history of Type 2
  Diabetes (T2D) and history of caring for his diabetic • Physical Health Exam
  grandfather for many years. He described himself as an
  expert in diabetes because of the years of caring for his
• Oral-Systemic Risk Assessment
ailing diabetic grandfather. During the health history, he
complained of symptoms of hyperglycemia: fatigue,
thirst, and weight loss. On physical exam, his blood • Action Plan
pressure was 160/95, BMI of 31, random blood sugar
of 332 mg/dl, and HgbA1c > 13%. He was diagnosed
• Preventive Interventions
with T2D and obesity. He was started on Metformin
twice a day and was counseled on diet and physical
activity. The patient was referred back to dentistry for • Interventions
continued periodontal care in light of his new diagnosis
of T2D. • Collaboration
What is the follow-up nursing primary care action
plan for Mr. M.? • Referrals
What are the 3 months follow-up outcomes?  
 
   
 APPENDIX 6 Family Primary Care

Celiac Disease Case Study

S  
A 39-year-old woman presents with symptoms of diarrhea, nausea, flatulence, colic,
 
difficulty with falling asleep, lack of appetite and a weight loss of 20lbs in the last two
 
years.
 
 
She also complains of the appearance of lesions in the mouth, particularly on the
 
tongue.

She has had frequent dental problems over the years, including dental caries and root
canals.

What else would you like to know?

What is your differential?
What tests will you order?
What is your diagnosis?
What treatment will you prescribe?
Where do you refer patient?
What is your follow-up?
Adapted from da Silva et al. (2008). Oral manifestations of celiac disease. A case report and review of the literature.
 APPENDIX 7 Family Primary Care

Celiac Disease Reference List

S  
 
  Admou, B., Essaadouni, L., Krati, K., Zaher, K., Sbihi, M., Chabaa, L., . . . Alaoui-Yazidi, A. (2012). Atypical celiac disease: from
  recognizing to managing.Gastroenterol Res Pract, 2012, 637187. doi: 10.1155/2012/637187
 
Campisi, G., Di Liberto, C., Iacono, G., Compilato, D., Di Prima, L., Calvino, F., . . . Carroccio, A. (2007). Oral pathology in
  untreated coeliac [corrected] disease. Aliment Pharmacol Ther, 26(11-12), 1529-1536. doi: 10.1111/j.
1365-2036.2007.03535.x

Cheng, J., Malahias, T., Brar, P., Minaya, M. T., & Green, P. H. (2010). The association between celiac disease, dental enamel
defects, and aphthous ulcers in a United States cohort. J Clin Gastroenterol, 44(3), 191-194. doi: 10.1097/MCG.
0b013e3181ac9942

Rashid, M., Zarkadas, M., Anca, A., & Limeback, H. (2011b). Oral manifestations of celiac disease: a clinical guide for
dentists.J Can Dent Assoc, 77, b39. PMID: 21507289
 APPENDIX 8 Family Primary Care

Case Study: Infectious Disease

S  
Chief Complaint: 5 yo male Tim brought to clinic by parent, complaining of fever of 103 x 2 days,
  headache, muscle aches, sore throat and blisters on palms and soles of feet.
 
  Past History:
Prenatal: no problems.
  L&D: NSVD, Apgar 9,10
  Infancy: Breastfed until 12 months. Normal growth and development

Current Health Status:

Tim has no other health problems. He is in the 50% for height and weight.
Immunization: UTD
Medications: None
Family History: Only child, lives with both parents.
Physical Exam:
Alert, oriented, 5yo old male.
HEENOT – Eyes: Erythematous watery conjunctiva. Ears, nose and dentition normal. Throat: multiple erythematous blisters in pharynx
Abdomen – soft, nontender
MS – multiple erythematous blisters on palms and soles
Neuro – nl

What is your differential?

What tests will you order?
What is your diagnosis?
What treatment will you prescribe?
Where else should parents expect to see more lesions?
 APPENDIX 9 Family Primary Care

Case Study: STI

S  
  Chief Complaint: 18 yo female Lisa presents to clinic complaining of hoarseness of voice, sores in mouth
 
Current Health Status:
  Lisa has no other health problems.
 
  Immunization: Childhood immunizations UTD, has not had any immunizations since age 6
Medications: None
Sexual History: multiple partners over past 3 years, intermittent condom use.
Physical Exam:
Alert, oriented, 18 yo old female.
HEENOT – Eyes, Ears, nose and dentition normal. Scattered papillomas on tongue and pharynx
Abdomen – soft, nontender
MS – nl
Gyn – No visible lesions – cervical studies pending
Neuro – nl

What else would you like to know?

What is your differential?
What tests will you order?
What is your diagnosis?
What treatment will you prescribe?
Where do you refer patient?
What is your follow-up?
RESOURCES
Adamou, B., Essaadouni, L., Krati, K., Zaher, K., Sbihi, M., Chabaa, L., . . . Alaoui-Yazidi, A. (2012). Atypical
www.OHNEP.org
celiac disease: from recognizing to managing. Gastroenterol Res Pract, 2012, 637187. doi: www. SmilesforLifeOralHealth.org
10.1155/2012/637187 National Oral Health Curriculum
American Academy of Pediatrics. (n.d.). Oral Health Risk Assessment Tool. Retrieved from
http://www2.aap.org/oralhealth/docs/RiskAssessmentTool.pdf www.MCHOralHealth.org
American Academy of Pediatrics. (n.d.). Oral Health Self Management Goals for Parents/Caregivers. National Maternal & Child Oral Health
Retrieved from https://www2.aap.org/oralhealth/docs/GoalSheetEnglish.pdf O Resource Center
American Academy of Pediatric Dentistry. Council, O. (2014). Guideline on Caries-risk Assessment and L www.IPECollaborative.org
Management for Infants, Children, and Adolescents. Retrieved from I
http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment.pdf Interprofessional Educational
N
American Dental Association. (2009). ADA Caries Risk Assessment Form. E
Collaborative
Retrieved fromhttp://www.ada.org/en/member-center/oral-health-topics/caries www.APTRweb.org/?PHLM_15
American Dental Association. Statement on Human Papillomavirus and Squamous Cell Cancers of the R Oral Health Across Lifespan Module
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