Oral Health Education Interventions and Its Association With Behavioral Outcomes: A Clinical Trial
Phase: NA
Conditions: Quality of Life, Self Efficacy, Knowledge
Sponsor: Temple University

 
ORAL HEALTH EDUCATION SENIORS 
 
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Oral Health Education Interventions and Its Association with Behavioral Outcomes: 
A Clinical Trial  
 
 
Date August 16 2017 (Approved by IRB) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
ORAL HEALTH EDUCATION SENIORS 
 
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1) Abstract of the study 
 Introduction: Older adults have been described as one of the most underserved and 
vulnerable groups, who are at the highest risk for coronal and root caries, especially 
because more elderly adults are retaining their teeth. The Northeast Philadelphia 
KleinLife site is an important destination for the region’s Jewish population comprising 
of at least 6500 seniors, and assisting more than 4500 seniors through food security 
programs. Recently, Temple University Kornberg School of Dentistry (TUKSoD) 
purchased the dental center at the facility to expand the services provided to these 
underserved population and improve their oral health. The study aims to assess the 
efficacy of an oral health education group based activity versus an individual based oral 
health education activity in terms of changes in oral health related quality of life 
(OHRQoL), self-efficacy and oral health knowledge. Methods: A sample of 190 senior 
members will be invited to participate in the trial. Potential subjects will be obtained in 
person through the ongoing flow of patients at TUKSoD Clinic at Kleinlife and the dental 
school. Seniors who consent to participate in the study will be randomly allocated to one 
of the 3 groups (Control: subjects will continue receiving regular dental care at the clinic, 
Intervention 1: subjects will continue receiving regular dental care at the clinic and be 
invited to participate in 2 group based education sessions during a 12 month period, and 
Intervention 2: subjects will continue receiving regular dental care at the clinic and be 
invited to participate in an individual-based education and prevention activity over a 18 
month period. Randomization will be determined according to a predetermined random 
sequence, and neither the patient nor the research staff will be aware of the randomization 
outcome until after the patient has agreed to participate. Subjects who consent to 
participate will be entered into a raffle to receive a $350-dollar visa gift card, if they 
complete the baseline and follow up assessments. The OHIP-14 will be used to assess 
OHRQoL, and self-efficacy scores will be the primary outcomes. Initially, we will assess 
the differences between the interventions and control using 2-sample t-tests. The main 
analysis will be based on linear mixed-effects models for repeated measures (using the 
OHIP 14 and self-efficacy  scores as continuous outcome variables) to assess differences 
between intervention and control groups. Similar analyses will be conducted for 
secondary outcome measures Statistical significance will be set at p < .05.  
 
 
2) Protocol Title 
Oral Health Education Interventions and Its Association with Behavioral Outcomes: 
A Clinical Trial  
 
3) Investigators 

 
ORAL HEALTH EDUCATION SENIORS 
 
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• Marisol Tellez, BDS, MPH, PhD, Associate Professor, Department of Pediatric 
Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of 
Dentistry 
 
• Vinodh Bhoopathi, BDS,MPH, DScD, Assistant  Professor, Department of 
Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg 
School of Dentistry 
 
• Sheryl Neckritz, Public Health Dental Hygienist, Department of Pediatric 
Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of 
Dentistry 
 
 
 
4) Objectives 
• Primary Objective: 
The objective of this study is to test the efficacy of an oral health education group based 
activity versus an individual oral health education activity in terms of changes in oral 
health related quality of life (OHRQoL), self-efficacy and oral health knowledge.  
 
• Secondary Objective 
The secondary objective of this study is: 
a) To assess differences among intervention and control groups by senior’s oral health 
knowledge. 
 
• Overall Hypotheses 
Ho: There are no significant differences in the selected behavioral outcome measures 
between the interventions, either group-based or individual based education and the 
control. 
 
Ho: The two educational interventions are not equivalent in the selected behavioral 
outcome measures. 
 
 
5) Rationale and Significance  
 
Older adults or the elderly have been described as one of the most underserved and 
vulnerable groups. Many studies have shown that elderly adult population groups are at a 
higher risk for coronal and root caries, especially because more elderly adults are 
retaining their teeth. KleinLife is an important destination for the region’s Jewish 
population. KleinLife comprises of at least 6500 seniors, and has assisted more than 4500 
seniors through food security programs. The Northeast Philadelphia KleinLife site also 
has a dental center that provides routine care to the members who seek care. The Temple 
University Kornberg School of Dentistry (TUKSoD) recently purchased this dental center 
to expand the services provided to these underserved population and improve their oral 
health.  

 
ORAL HEALTH EDUCATION SENIORS 
 
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KleinLife is a vibrant community resource that provides social, educational and 
cultural programs, and vital health, wellness and social services to the multigenerational, 
ethnically diverse membership it serves. Individuals regularly come together to 
participate in enrichment offerings, receive vital services, enjoy each other’s company, 
and connect to additional resources and support. KleinLife is an important destination for 
the region’s Jewish population, both young and old. It serves as a lively home-away-
from-home for seniors and a welcoming gathering place for Russian Jews. More than 
7800 health care referrals to seniors and their families have been made through KleinLife. 
 
TUKSoD and KleinLife’s staff conducted a survey in December 2015 to develop a 
baseline needs assessment that would inform the development and implementation of a 
tailored oral health care model in this community. Two hundred oral health surveys were 
completed and from this initial survey, we learned that there were variations in 
knowledge, attitudes and practices related to oral hygiene among seniors and lack of 
understanding of key fundamental concepts in oral health education and oral health 
related quality of life.  
 
Recent studies on this area have mainly focused on the effects of oral health 
educational interventions for caregivers at improving dental health among seniors but 
very few interventions report on the oral health-related knowledge and other important 
behavioral outcomes of seniors themselves. MacEntee et al in 2007 reported no 
significant changes to oral health of seniors with a pyramid-based educational 
intervention, however, in 2012, De Visschere et al reported a small, but statistically 
significant improvement in denture plaque following a 6-month supervised educational 
intervention. 
 
A recent systematic review (Kay et al, 2016) showed that the motivational 
interviewing technique, which is based on the concept of autonomy support, has potential 
for helping patients with poor oral health. However, most of the studies appraised 
involved children and young adults or seniors with periodontal conditions and the 
outcomes examined were exclusively clinical.  Relying on clinical indicators becomes 
problematic when evaluating the efficacy of educational interventions among adults as 
often times these populations are edentulous or partially dentulous and do not reveal the 
impact on additional behavioral and cognitive outcomes which in turn may affect the 
overall well-being of the individual. Moreover, although low parental self-efficacy has 
been associated with adverse dental outcomes among children, there has been little 
documented evidence of the role of self-efficacy in adult oral health outcomes. Even less 
has been reported on groups known to be at high risk of dental disease such as the 
elderly.  There is a lack of information on how different types of oral health education 
activities may affect seniors oral health related quality of life and self-efficacy. These 
studies present a case for additional research on senior’s self-efficacy, and oral health 
care knowledge, along with training interventions aimed at improving the poor oral 
health of the elderly.  
 

 
ORAL HEALTH EDUCATION SENIORS 
 
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The objective of this study is to test the efficacy of an oral health education group 
based activity versus an individual based oral health education activity in terms of 
changes in oral health related quality of life (OHRQoL), and self-efficacy among seniors 
at Kleinlife and at the Dental School.  
 
 
6) Resources and Setting  
All patients will be identified and evaluated at the dental clinic of the Temple 
University Kornberg School of Dentistry (TUKSoD) located in Kleinlife and at 
the Dental School. All participants will be provided with consent forms. All 
research staff has CITI training and will be required to read all the documentation 
related to the study and discuss any questions with the investigators before 
initiation of activities. 
 
6) Prior Approvals 
Not Applicable 
 
7) Study Design 
a) Recruitment Methods 
Approximately 190 subjects, older than 55 years old will be recruited for the purpose of 
the study. There are no restrictions in terms of relative numbers of females and males.  
Potential subjects will be obtained in person through the ongoing flow of patients at 
TUKSoD Clinic at Kleinlife and at the Dental School. The research staff will also be 
available during regular operating hours to inform and recruit patients at the lobby at 
Kleinlife and at the Dental School. The consent form (See Appendix A) to participate in 
the study will be provided to the senior and if they decide to participate they will be 
entered into a raffle to receive a $350-dollar visa gift card, if they complete the baseline 
and follow up assessments. The information from the consent forms will only be used for 
the purpose of the raffle. This is required for compliance with Pennsylvania state laws. 
Information about the study will also be posted in a flyer (See Appendix B) in designated 
areas at Kleinlife and at the Dental School. 
 
b) Inclusion and Exclusion Criteria 
There are no restrictions on enrollment in terms of gender, economic status, race or ethnic 
group.   
 
Inclusion criteria 
Patients: 
1) Must be 55 years old or older.  
2) May be new, regular, emergency patients attending the TUKSoD clinic at 
Kleinlife or clinics at the Dental School or utilizing medical and social 
services at Kleinlife who have the intention to become patients of record at 
the dental clinic. 

 
ORAL HEALTH EDUCATION SENIORS 
 
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3) Must be able to speak and understand English. 
4) Must be willing to provide consent to participate in the study for 
himself/herself. 
 
Exclusion criteria: 
Patients:  
1) Subjects younger than 55 years old will be excluded from the study. 
2) Subjects who do not provide consent for participation will be excluded from 
the study. 
3) Subjects who do not speak and understand English. 
 
 
c) Study Timelines 
Table 1: Research Timelines 
Approximate Months/ Year 
Goals 
March 2017 
IRB submission    
Summer-Fall 2017 
Recruitment, implementation of 
educational interventions and baseline 
data collection  
Spring Summer 2018 
Follow up data collection  
Fall 2018 
Finalize manuscript for publication 
 
d) Study Procedures and Data Analysis 
Sample and Setting.  All research procedures will be performed in the TUKSoD 
Clinic at Kleinlife and at the Dental School. Participation in the research is expected 
to take 1 hour regardless of study group. Seniors meeting the inclusion criteria will 
constitute the sample for the purpose of this study. 
Sample Selection Procedures 
All assessments will be conducted after informed consent has been obtained in 
person. Patients deemed ineligible or who do not wish to participate in the research 
will be referred for clinical services as appropriate.  The decision to participate or not 
to participate in the research will have no effect on the dental treatment that the 
patient will receive. A sample of 190 seniors will be recruited from the TUKSoD 
Clinic at Kleinlife and at the Dental School for the purpose of this study. 
Study Procedure 
This will be a multi-center parallel group study with randomization to one of three 
arms as described below. The objective of this study is to test the efficacy of an oral 
health education group based activity versus an individual based oral health 
education activity in terms of changes in oral health related quality of life 

 
ORAL HEALTH EDUCATION SENIORS 
 
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(OHRQoL), and self-efficacy among seniors at Kleinlife and at the Dental School. A 
description of the activities to be conducted in the intervention and control groups is 
described below: 
 
Seniors who consent to participate in the study will be randomly allocated to one of 
the 3 following groups. Randomization will be determined according to a 
predetermined random sequence, and neither the patient nor the research staff will be 
aware of the randomization outcome until after the patient has agreed to 
participation.   
 
Control Group: (60 seniors).  
Seniors who are randomly assigned to the control group will continue receiving 
regular dental care under the standard clinic operation. Subjects in this group will 
complete intake forms to assess main behavioral outcomes, at baseline and after 12 
months. No other activities will be conducted in this group. 
 
Intervention Group 1: (60 seniors).  
Seniors who are randomly assigned to the intervention group 1 will continue 
receiving regular dental care under the standard clinic operation and will be invited 
to participate in 2 group based education activities over a 12 month period. The 
sessions will last for 1 hour each time and follow the guidelines established by the 
Oral Health America Curriculum. Baseline intake forms to assess changes in main 
behavioral outcomes will be administered before the first education session, after 6 
months and after 12 months. 
 
Intervention Group 2: (70 seniors (10 of these are calibration patients 
exclusively)).  
Seniors who are randomly assigned to the intervention group 2 will continue 
receiving regular dental care under the standard clinic operation and will also be 
invited to participate in an individual-based education activity over a 12 month 
period. The clinic visits will last for 1 hour each time and follow the guidelines 
established by TUKSoD to provide oral hygiene instruction using a Motivational 
Interviewing approach. Tailored education will be based on review of health related 
information to be extracted from medical (systemic diseases), dental chart (oral 
hygiene behaviors) and patient interview at time of initial examination. Seniors in 
this group will also receive basic preventative care (dental cleanings, fluoride 
varnish application (high caries risk individuals only) or referral to a supervised 
brushing program with high concentration fluoride under the care of the dentist at 
Kleinlife if needed. All individual based preventative activities will be provided by a 
Public Health Hygienist, and 3 dental visits will be conducted for subjects in this 
group during the course of a 18 month period. Baseline intake forms to assess 
changes in main behavioral outcomes will be administered before the first home 
based education session, at each follow up visit and after 18 months. 
 
Measurements: 
The following instruments (Appendix C) will serve as outcome measures for this 

 
ORAL HEALTH EDUCATION SENIORS 
 
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study: 
 
• Oral Health Related Quality of Life: The Short-Form Oral Health Impact Profile 
(OHIP-14; Slade, 1997) is a 14-item self-report measure that assesses individuals’ 
perceptions of the social impact of oral conditions on their well-being. This scale 
evaluates the consequences of oral conditions across dimensions of functional 
limitation, physical pain, psychological discomfort, physical disability, 
psychological disability, social disability, and handicap. Items are rated on a 5-
point Likert-type scale ranging from 0 (never) to 4 (very often), regarding how 
frequently impact has been experienced. The total score ranges from 0 to 56; 
higher OHIP-14 scores indicate greater impact, hence poorer oral-health-related 
quality of life. The OHIP-14 has been validated in two national surveys of 
populations in the UK and Australia (Kelly et al., 1998; Steele et al., 2004) and 
demonstrated good reliability, construct and discriminant validity, and internal 
consistency (Slade & Spencer, 1994; Slade, 1997).  
 
• Self-efficacy will be assessed based on a modified version of an instrument 
developed by Finlayson and colleagues (Finlayson et al, 2007). It will be 
measured using a 6-item scale, asking participants to indicate how confident they 
feel about their ability to brush their teeth at night when they were: (1) under a lot 
of stress; (2) depressed; (3) anxious; (4) feeling that they were too busy; (5) tired 
or; (6) worried about other things in their life. The four response options range 
from ‘very confident’ to ‘not at all confident’. The possible score range is 0 to 24, 
with high scores indicating high self-efficacy. Alpha was 0.91. Self-efficacy will 
be dichotomized based on a median split, with low self-efficacy pertaining to 
scores of 0 to 11 and high self-efficacy pertaining to scores of 12+. 
 
 
• Oral Health Knowledge: A 15-item questionnaire with a three-point Likert Scale 
(yes, no, and don’t know) will be used to assess the oral health 
information/knowledge of the seniors pre and post intervention. Its respective 
psychometric properties (validity and reliability) have already been reported 
(Khanagar et al, 2014).  
 
• Demographic Factors Questionnaire will identify key demographic factors such as 
age, sex, race, ethnicity, education and income level of seniors. 
 
Calibration: 
 
For purposes of calibration and assuring treatment fidelity of the dental public health 
hygienist when delivering the MI oral health session (Intervention 2), 10 patients will be 
recruited and consented to receive this intervention only. The sessions with these patients 
will be audio recorded so that research staff can check treatment fidelity and provide 
feedback to the hygienist as appropriate before data collection starts. These 10 patients 
will not be part of the research study and will be offered a $30 dollar visa gift card for 

 
ORAL HEALTH EDUCATION SENIORS 
 
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completing baseline and follow up assessments during the calibration exercise that may 
require an estimated 3 hours during a 1 month period. These follow up sessions will be 
scheduled based on the patients and the hygienist’s availability. The calibration group 
will also sign a HIPAA Authorization form. Please see Appendix D.  
 
 
Data Management:  
 
All demographic information and questionnaires will be administered in person. Data will 
be entered into an excel spreadsheet. Data will be downloaded to an IBM-compatible 
computer and stored on a password-protected account, and it will be exported to a 
computer data analysis program (SAS/SPSS). Data will be cleaned and checked for errors 
prior to the analysis; imputation procedures for handling missing data will be conducted 
depending on the number of cases with missing data. Participant names and 
corresponding identification numbers will be stored separately in a locked file cabinet or 
password-protected file. 
 
Data Analysis:  
 
Initial analyses will be conducted to determine normality of distributions of the 
continuous variables, and any necessary transformations will be conducted. Primary 
outcomes will be the OHIP 14 and the self-efficacy scores. All eligible patients will be 
randomly assigned to 1 of the 3 groups described above. Although randomization should 
provide relatively comparable groups, demographic variables that differ between groups 
and are correlated with the primary outcomes will be used as covariates. Preliminary 
analysis will include measures of central tendency and dispersion, as well as an 
examination of the bivariate relationships among the primary and secondary outcome 
variables, potential moderators, and demographic characteristics.  
Differences between the groups on baseline demographic, and psychological 
measures will be examined using χ2 (Pearson) or Student’s t-tests, as appropriate. 
Moreover, differences on the variables listed above among completers and drop-outs will 
also be explored. Intention to treat (ITT) analyses will then be conducted.  
OHIP 14 and self-efficacy scores will be the primary outcomes. Initially, we will 
assess the differences between the interventions and control using 2-sample t-tests. The 
main analysis will be based on linear mixed-effects models for repeated measures (using 
the OHIP 14 and self-efficacy  scores as continuous outcome variables) to assess 
differences between intervention and control groups. Similar analyses will be conducted 
for secondary outcome measures Statistical significance will be set at p < .05.  
 
 
 
e) Withdrawal of Subjects 
Subjects may be withdrawn from the study because of failure to follow 
instructions of the research staff or if the principal investigator decides that the 
research study is no longer in the subject’s best interest. Details are provided in 
the consent form. 
f) Privacy & Confidentiality 

 
ORAL HEALTH EDUCATION SENIORS 
 
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As in any type of treatment or clinical research program, patients' confidentiality must be 
carefully guarded and respected. The study will use Protected Health Information (PHI) 
and a HIPAA Authorization form is being submitted with this application (see Appendix 
D). 
There will be a separate file with identifiers in receipt of the principal investigator. All 
data with identifying information will be stored in locked files or encrypted, password-
protected electronic data storage. Data being analyzed will be identified by subject codes 
(using the subject identification number) and identifying information will be removed. 
The identity of patients will not be revealed in the presentation or publication of any 
results from this project. All assistants and others working on the project will be educated 
about the importance of strictly respecting patients’ rights to privacy and confidentiality 
and will have completed training concerning proper practice in accordance with HIPAA 
regulations. 
Protected Health Information that will be collected includes the patient’s name, date they 
were seen for the study, phone number, and age. In addition, dental record number, 
medical and dental chart information related to oral hygiene behaviors and systemic 
diseases will be accessed from the dental chart for those assigned to intervention group 2.  
Only those subjects assigned to intervention group 2 will be given the HIPAA 
Authorization form to sign. The electronic PHI data will be downloaded to a computer 
using encrypted, password- protected storage of electronic data. All participants will 
receive a unique random identification number, which will correspond to that person’s 
data. Participant names and corresponding identification numbers will be stored 
separately in a locked file cabinet or encrypted, password-protected storage of electronic 
data. 
 
8) Risks to Subjects 
No risks are expected to the subjects. All clinical activities are part of regular dental 
treatment provided to patients in the normal course of dental treatment. 
 
9) Potential Benefits to Subjects 
Patients will be educated about oral health risky behaviors and oral hygiene 
techniques in this study. There are no other direct benefits to the subject from this 
study.  
10) Costs to Subjects 
Not Applicable 
11) Informed Consent  
See Consent Form (Appendix A and D) submitted with this protocol. Study will 
follow “HRP-802 INVESTIGATOR GUIDANCE: Informed Consent” to obtain 
informed consent.  
Seniors who provide consent and complete entire participation in the study will be 
entered into a raffle to receive a $350-dollar gift card. This information has been 
included into the consent form.  
 
12) Vulnerable Populations 

 
ORAL HEALTH EDUCATION SENIORS 
 
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The study involves does not involve a vulnerable population as defined by IRB 
regulations.  
 
13) Compensation for Research-Related Injury 
Not applicable 
 
14) Economic Burden to Subjects 
Not applicable  
 
15) Drugs or Devices 
Not applicable. 
 
16) Multi-Site Human Research 
Not applicable 
 
17) Sharing of Results with Subjects 
Results of the study can be provided to the participants, if requested. No other data 
will be shared with the subjects. 
 
 
 
 
 
References 
 
 
L. De Visschere, J. Schols, G.-J. van der Putten, C. de Baat, J. Vanobbergen. Effect 
evaluation of a supervised versus non-supervised implementation of an oral health care 
guideline in nursing homes: a cluster randomised controlled clinical trial Gerodontology, 
29 (2) (2012 Jun), pp. e96–e106 http://dx.doi.org/10.1111/j.1741-
2358.2010.00418.x [Epub 2010 Sep 14] 
 
Kay EJ, Vascott D, Hocking A, Nield H.Motivational interviewing in general dental 
practice: A review of the evidence. Br Dent J. 2016 Dec 16;221(12):785-791. doi: 
10.1038/sj.bdj.2016.952. 
 
M. Albrecht, R. Kupfer, D.R. Reissmann, I. Mühlhauser, S. Köpke. Oral health 
educational interventions for nursing home staff and residents. Cochrane Database Syst 
Rev, 9 (2016 Sep 30), p. CD010535 [Epub ahead of print] 
 
M.I. MacEntee, C.C.L. Wyatt, B.L. Beattie, et al.Provision of mouth-care in long-term 
care facilities: an educational trial. Commun Dent Oral Epidemiol, 35 (1) (2007 Feb), pp. 
25–34 
 

 
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Sanjeev Khanagar, Amit Kumar, Vasuda Rajanna, Bhumika Kamal Badiyani, Vinod 
Rakesh Jathanna, and Prajna V. Kini. Oral health care education and its effect on 
caregivers’ knowledge, attitudes, and practices: A randomized controlled trial. J Int Soc 
Prev Community Dent. 2014 May-Aug; 4(2): 122–128. doi:  10.4103/2231-0762.139843 
 
Finlayson TL, Siefert K, Ismail AI, Sohn W.Maternal self-efficacy and 1-5-year-old 
children's brushing habits. Community Dent Oral Epidemiol. 2007 Aug;35(4):272-81. 
 
Slade, G. D, & Spencer, A. J. (1994). Development and evaluation of the Oral Health 
Impact Profile. Community Dental Health, 11, 3–11. Retrieved from 
http://www.cdhjournal.org/journals/ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Appendix (B) 
Flyer 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Interested in joining a 
research study? 
If so, you may be eligible to participate in a research study investigating the efficacy of various oral health 
education strategies 
For your participation, you will be entered in a contest to win a $350 gift card. 
Seniors 55  years old and older may be eligible for participation 
 
 
   
For more information, contact: 
 
Marisol Tellez M PhD. - Principal Investigator 
                 Maurice H. Kornberg School of Dentistry Temple University. 
3223 N. Broad Street, Philadelphia, PA 19140 
215 707 1773

 
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Appendix C Measurement Instruments 
 (Demographics) 
 
A1. What is the 5-digit ZIP code at your home address?       
 
 
[__ ___ ___ ___ ___ ]     
 
A2. What is your gender?  
 
 
 
 
 
[___] 
1) __Male 
2) __Female 
 
A3. What is your age in years? 
 
[___________] 
 
 
 
A5. What is the highest grade of school that you completed?   
 
 
 
[___] 
1) 
__ less than high school (grades 0-8 )  

 
ORAL HEALTH EDUCATION SENIORS 
 
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2) 
__ Some high school (grades 9-11)  
3) 
__ High school graduate (grades 12 or GED) 
4) 
__ Some college (include vocational, trade, or technical 
school after college, associate degree, No four-year degree ) 
5) 
__ College graduate ( BS or other four year degree) 
6) 
__ Post graduate or professional school after college  
 
A6. What is your family’s income level? 
 
 
 
 
[___] 
1) 
__ Less than $19,999 
2) 
__ $20,000 - $49,999 
3) 
__ More than $50,000   
 
 
 
A9. What race do you consider yourself to be? (Place a check next to the correct answer) 
 
[____] 
1) 
__ White or Caucasian or European American 
2) 
__ Black or African American 
3) 
__ American Indian or Alaska Native 
4) 
__ Asian 
5) 
__ Native Hawaiian or Other Pacific Islander 
6) 
__ Other  (___________________________)  
 
A10. Are you of Hispanic or Latino origin or descent? 
 
 
 
[____] 
1) ___Yes 
2) ___ No  
 
 
 
 
 
 
 
 
 
 

 
ORAL HEALTH EDUCATION SENIORS 
 
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Oral Health Self Efficacy Scale 
Seniors oral health self-efficacy measure: 
Oral Health Self-efficacy (OHSE) - Scale: 4=very confident, 1=not at all confident. 
1. under a lot of stress 
2. depressed 
3. anxious 
4. feeling like you do not have the time (too busy) 
5. tired 
6. worrying about other things in your life 
7. bothered by your crying child 
8. bothered because your child doesn’t stay still when you want him or her to brush 

 
ORAL HEALTH EDUCATION SENIORS 
 
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9. told by your child that he/she does not feel like brushing right now 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ORAL HEALTH IMPACT PROFILE SHORT VERSION OHIP-14* 
 
 Question 
1. Have you had trouble pronouncing any words because of problems with 
limitation your teeth, mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very 
Often                                       
 
2. Have you felt that your seti.se of taste has worsened because of problems with 
your teeth, mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
3. Have you had painful aching in your mouth? 

 
ORAL HEALTH EDUCATION SENIORS 
 
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      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
4. Have you found it uncomfortable to eat any foods because of problems with 
your teeth, mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
5. Have you been self-conscious because of your teeth, mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
6. Have you felt tense because of problems with your teeth, mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
7. Has your diet been unsatisfactory because of problems with your teeth, disability 
mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
8. Have you had to interrupt meals because of problems with your teeth, mouth or 
dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
9. Have you found it difficult to relax because of problems with your teeth, 
disability mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
10. Have you been a bit embarrassed because of problems with your teeth, mouth 
or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
11. Have you been a bit irritable with other people because of problems with 
disability your teeth, mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
12. Have you had difficulty doing your usual jobs because of problems with your 
teeth, mouth or dentures? 

 
ORAL HEALTH EDUCATION SENIORS 
 
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      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
13. Have you felt that life in general was less satisfying because of problems with 
your teeth, mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
14. Have you been totally unable to function because of problems with your teeth, 
mouth or dentures? 
      0              
1                    2                3                        4  
 Never   
    Hardly Ever    Occasionally    Fairly Often     Very Often 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Seniors Oral Health Knowledge Assessment 
 
Statements to be evaluated with a three-point Likert Scale (yes, no, and don’t know) 
 
1. “Health of mouth is directly related to body” 
2. “You can chew just as well with denture tooth as with your natural teeth”  
3. “When gums bleed during brushing, it is best to leave them alone”  
4. “Older adults with dry mouth get more cavities”  
5.  “The most common cause of dry mouth is medication”  
6. “Older adults with teeth need to use fluorides”  
7.  “Mouth rinsing is a good alternative to daily tooth brushing”  
8.  “People with no teeth need to be seen by a dentist” 
9.  “Dentures should be removed for few hours every day”  
10. “Dentures those don’t fit well can cause oral cancer”  
11. “It is normal for residents to have pain and sores in their mouth”  
12. “Residents who do not cooperate for daily mouth care are best left alone” 

 
ORAL HEALTH EDUCATION SENIORS 
 
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13. “Dental check-ups are as important as medical” 
14. “Residents can lose their teeth if they remain dirty”  
15.  “As people get old they naturally lose their teeth”