POLICY BRIEF NOVEMBER 2014

Dental health in rural communities:

What is nursings role?

This policy brief explores dental healthcare issues facing rural communities and the role poor
dental health plays in chronic disease. Nurses are in a unique position to perform a risk
assessment, educate rural populations, and promote collaboration among dental healthcare
professionals to improve health outcomes.

ASSESSMENT AND NEED

Rural communities suffer numerous health inequalities. Lack of access to care, low socioeconomic status, lack of insurance, and education contribute to poor dental health and associated
outcomes. Bacteria in the mouth are systemically linked to heart disease, diabetes, respiratory
illness, kidney disease, and low birth weight babies (Duley, Fitzpatrick, Zornosa, & Barnes,
2012). Evidence links socio-economic status with heart disease risk factors including smoking
and hypertension (Pollack, Slaughter, Griffin, Dubowitz, & Bird, 2012). The first point of entry
for the health care of many in rural communities is at the doctors office, hospital, or urgent care
clinics.
How can nursing help? The prevalence of chronic disease visible in clinics, nursing homes,
hospitals, and doctors offices demands attention to prevention and education. Nurses often
complete the initial assessment: Many patients are unaware of a correlation between bacteria in
the mouth and that of chronic disease which promotes inflammation, infection, and illness.
Nurses in the clinical setting should ask patients about their last dental visit and maintenance
routines. Approximately 47% of adults over the age of 30 have gum disease (Dolce, 2014). This
increases the risk for chronic disease and poor health outcomes. Nurses can be a valuable source
of education and resources in the prevention of dental bacteria. Nursing curriculum must
incorporate education on the values of oral health and the role it plays in systemic disease.

ADVOCATE AND EDUCATE

Type of Registered Nurse:

Service:

Hospital/Clinic/Office setting

Risk assessment & prevention, printed

and verbal education regarding oral
bacteria and systemic disease, ask about
last dental tx/care, referral to dental
sources in area

Community Health

Risk assessment, dietary education for

families and children, printed and verbal
info, referral to dentists in community,
community health fairs

OB

Risk assessment, information regarding

gum disease and low birth weight babies,
referral to dentists

Pediatric

Risk assessments, dietary info regarding

sugar/decay rates, basic brushing
education, baby bottle syndrome,
referral to pediatric dentists in area

Nursing Homes

Risk assessments, family teaching,

dentures/partials, reduction of bacteria
to reduce respiratory illnesses, mobile
dentistry, observe nutritional intake due
to lack of teeth; understand adverse
effects of medications on oral health

School Nurse

Arrange for dental health awareness in

February (dental health month),
traveling dentist/ hygienist in school
setting: dental screenings and fluoride
application, referrals to local dental
resources

Educator

Add dental hygiene education within

nursing curriculum: promote holistic care
with inter professional collaboration;
stress impact oral hygiene has on
prevalent chronic disease

Lack of access and finances for dental health care puts rural communities at an increased
risk for serious medical conditions and reduced outcomes

Lack of knowledge and education related to the oral-systemic has been associated with
poor outcomes

Poor oral hygiene can translate in loss of tooth structure affecting nutritional intake for
optimal health

Promotion of regular dental check-ups can reduce harmful bacteria and infections
implicated in heart disease and diabetes

RECOMMENDATIONS
The profession of nursing understands the importance of holistic health and preventative care.
Oral health is no exception. Barriers to quality oral health care include inadequate education of
healthcare professionals such as nurses, pharmacists, and physicians in basic oral health (Dolce,
2014). It is imperative in the current climate of healthcare that nurses are educated in the values
of oral health promotion. Nursing educators should promote an educational environment that
includes inter-professional collaboration with dentists and dental hygienists. This concept
supports team-based practice that delivers patient-centered care to improve health outcomes
(Dolce, 2014). Nurses are in a pivotal positon to reduce oral health disparities by including an
oral risk assessment as part of their exam, by providing basic oral care education and
consequences, and by referring accordingly.
Promotion of nursing curriculum that includes inter-professional collaboration with dental
professionals improves communication and knowledge about the dynamics of disease processes.
A team approach to care can better address the needs of rural populations. This will improve
health outcomes and promote a culture of safe, quality care.

References
Dolce, M.C. (2014). Integrating oral health into professional practice: An interprofessional
faculty tool kit. Journal of Professional Nursing, 30, 63-71. doi:
10.1016/j.profnurs.2013.06.002
Duley, S.I., Fitzpatrick, P.G., Zornosa, X., & Barnes, W.G. (2012). A center for oral promotion:
Establishing an interprofessional paradigm for dental hygiene, health care management
and nursing education. The Journal of Dental Hygiene, 86, 63-70.
Pollack, C.E., Slaughter, M.E., Griffin, B.A., Dubowitz, T. & Bird, C.E. (2012). Neighborhood
socioeconomic status and coronary heart disease risk prediction in a nationally
representative sample. Public Health, 126, 827-835. doi: 10.1016/j.puhe.2012.05.028