Oral Health Education: A Guide for Dental Nurses

ohe-guide-to-courseWhat is oral health? What is oral health education?

According to the World Health Organisation, oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss and other diseases and disorders that limit an individual's capacity in biting, chewing, smiling, speaking and psychological well-being.

Oral health education is information transfer from trained or training professionals to one patient or a small group of patients, whilst oral health promotion relates to a larger scale.

What is the Oral Health Education certificate?

The Oral Health Education (OHE) certificate from the National Examining Board for Dental Nurses (NEBDN) aims to allow Dental Care Professionals (DCPs) to competently and confidently deliver oral health messages in practice, community or hospital settings. Oral health messages include advice on preventing periodontal disease and decay, minimising cancer risk and educating regarding the use of fluoride. In order to undertake the OHE qualification, the DCP must be registered with the General Dental Council (GDC), have full support from a GDC-registered supervising dentist, and be registered at a training establishment.

How long does the course take?

Generally speaking, the course takes between six and twelve months. There are a range of courses available throughout the country. These include both online/correspondence courses and classroom-based courses held at training establishments. The first phase of the course usually consists of theory/homework to ensure that the DCP has good baseline knowledge and can therefore deliver oral health messages effectively.

What is covered on the course? 

  • Delivering oral health messages: the effect of oral health messages on patients, healthcare professionals and the media. 
  • Communication: methods of communication, barriers to effective communication and principles of education.
  • Dental anatomy and physiology – the structure and function of hard and soft tissues within the oral cavity, oral cavity in health and disease, saliva, eruption dates and function of the dentition.
  • Oral diseases and conditions – caries and periodontal disease, conditions such as candida and oral cancer, disease prevention, fluoride, fissure sealants, orthodontics and dentures.
  • Oral health target groups – identifying specific oral health messages for a variety of individuals.
  • Society and oral health – epidemiology, evidence-based care and indices.

How much time do I need to invest whilst undertaking the course?

The NEBDN suggests that around 45 hours is sufficient to cover the theoretical and practical sides of the course.

What is included within the Record of Experience?

Once a DCP feels ready and confident, (s)he can embark on the Record of Experience (RoE) and begin seeing patients. 

Part A of the RoE involves the DCP providing oral health education to ten patients on at least two separate occasions for each patient. The DCP must target at least six specific patient categories including: 

  • Pregnant/nursing mothers.
  • Parents of pre-school age children.
  • Parents of school age children.
  • Adolescents.
  • Adults.
  • Elderly people.
  • People with special needs.
  • Health professionals.
  • Medically compromised people.
  • People from ethnic minority backgrounds.

For each OHE session, specific aims and objectives should be set. It is important not to overwhelm the patient with too much information, so start off simply! An aim describes an overall goal from the sessions, whereas objectives are steps as to how you will achieve the aim. 

Lesson planning can help ensure the effective delivery of the session and will help you keep on track with time. It is important to consult the patient's medical history prior to a session with them. This will allow you time to look up any relevant medications in the British National Formulary and check the effect on oral health (if necessary). Patients may also experience communication barriers (e.g. sensory or language-related barriers). If so, preparatory steps should be taken to ensure a successful session.

An example of a lesson plan includes:

Location: A dental practice.

Date: 12/08/2015.

Duration of session: 20 minutes.

Aim: to improve the patient's oral hygiene/knowledge in order to prevent further tooth surface loss and decrease sensitivity.

Objectives: Patient to list the causes of erosion.

Patient to state the intention of using a desensitising toothpaste.

The DCP should also take into account appropriate keywords to use, which method of communication to adopt and which aids or resources will be most suitable for the session. After the OHE session, the DCP should write a conclusion and self-evaluate. The supervising dentist may wish to offer peer evaluation.

Part B of the RoE involves writing case studies on two patients (one child and one adult) for whom the DCP has provided an OHE session. The recommended word count for this aspect of the RoE is 2000 words, and it should include the following sections: 

Introduction – Medical/social/dental history.

Method

Needs of the patient, patient's knowledge/skills/attitude.

Aims and objectives from each session.

Content from each session.

Resources/teaching aids used.

Sources of evidence.

Evaluation - Methods of evaluation.

Results.

Self/peer-evaluation.

Appendices - Any relevant photos/diagrams used.

Part C of the RoE involves producing a display or exhibition relating to oral health; for example, oral cancer awareness and prevention. This exhibition does not necessarily have to take place in the student's place of work; suitable options include care homes, nurseries, schools, community centres or colleges. After producing the exhibition, the student must then evaluate their work. The evaluation can be in the form of questionnaires or surveys.

Where should OHE sessions take place?

This depends entirely on which sort of environment you are working in. Ideally, there would be a specific time and dedicated room or preventative dental unit (PDU) where OHE sessions can take place. Most purpose-designed OHE rooms are fairly non-clinical and consist of notice boards, mirrors, a sink, a table and chairs, and plenty of room for displays. However, being realistic about the time and space constraints that we can all face, some GDPs may be happy to 'tag' a session onto the end of an examination appointment. Similarly, a hygienist/therapist may be also be happy for you to provide OHE to their patient(s).

What does the examination process involve? 

Once the RoE has been submitted to the exam board, the student may be entered to take the OHE examination. Two examinations are held each year. They are in March and September and are held in various locations such as Belfast, Manchester, London, Bristol and Edinburgh.

The examination is currently comprised of a 90-minute written paper and an oral examination. The written paper is in two parts. Part A consists of 30 multiple choice questions and short answer questions. Part B contains three longer questions. The oral examination begins with a 5-minute presentation of one of the expanded case studies from the RoE (NEBDN will notify students which case study to prepare for in sufficient time prior to the exam). After the presentation, two examiners will discuss the case study and assess your knowledge of oral health. 

What is the fee for the course and the examination?

The cost of examination entry is £175. Course fees vary with providers, taking into account whether it is a correspondence course or one held face-to-face. Fees can range from £400-£800.

Students are notified of their examination results by post a few weeks after the examination day. Once qualified, it is important to notify your indemnity provider as there may be a small increase in cost due to the extra responsibilities you now hold. 

Which books should I buy?

Suitable books include:

  • Notes on Oral Health, by A.S. Blinkhorn and E.J. Kay.
  • Basic guide to Oral Health Education and Promotion, by A. Felton, A. Chapman and S. Felton.
  • The Scientific Basis of Oral Health Education, by R.S. Levine and C.R. Stillman-Lowe.

Which type of course is better - correspondence or classroom-based?

There are benefits to each. Correspondence courses can be less expensive, can fit around work and life, and no travel/parking costs are incurred. With classroom-based learning there will be interaction with other students, formal dates which may keep you on track with the course, and any issues or queries regarding the course will generally be answered straight away.

Who offers the qualification and where can I study?

The qualification is offered by many course providers, whether through classroom-based learning or correspondence courses. A full list of course providers is available to view via the NEBDN website.

The British Dental Association also offers a course in OHE. As with the NEBDN, the course is comprised of theory-based learning, a practical portfolio and then an examination. The online theory aspect of the course runs for 8 weeks. A period of 20 weeks is given to complete the practical portfolio, and a 7-week revision period leads up to the exam. The course starts on several dates throughout the year and there are also several examination dates available. As with the NEBDN qualification, students must be registered with the GDC and have the full support of a GDC-registered dentist (as well as internet access!)

Who is responsible for paying for the qualification?

It is always worth asking employers whether they will consider paying for the course. Some employers are unaware of the benefits to the practice that having a dedicated Oral Health Educator can bring. Some employers may fund the course initially and then take back the payment in increments from wages. Other employers may simply not see the benefit nor have the funds available to pay for the course. It is important to remember that once you have qualified as an Oral Health Educator you will have a skill that you will carry for the rest of your working life - so it may be worth investing in. 

What future opportunities are there for me once I qualify as an Oral Health Educator?

Once you are qualified as an Oral Health Educator, there may be opportunities to set up regular sessions within the dental environment - for example, 'kids’ clubs' in the school holidays. Outside of the dental environment, some Oral Health Educators take their work and passion with them to visit schools and care homes in the community. Your employer may even supply you with resources. Some Oral Health Educators combine the qualification with the certificate in fluoride varnish application. From time to time, employed work may arise in the primary dental care service. These vacancies appear on the NHS jobs website.

Dental nurses who possess an OHE certificate may see it as a stepping stone to studying dental hygiene with or without therapy. Some universities accept this professional qualification alongside academic qualifications as a means of meeting candidate requirements.

Will I earn more money when qualified?

Most Oral Health Educators do it for the satisfaction and enjoyment that it brings them. If your employer requests that you train as an OHE then it's likely that they will reward you for this financially. However, should you start the course of your own accord, it may be the case that your wage/salary remains the same. Some corporate companies used to (and may still) increase wages for every post-qualification earnt. It's always worth asking though, especially when employers appreciate what an asset having an Oral Health Educator can be to a dental setting; patients can be incredibly responsive to somebody who appears less clinical and intimidating (think about 'white coat syndrome'!).

What can't I do as an Oral Health Educator?

You are not permitted to 'practise dentistry' and should work within the GDC's scope of practice. Oral Health Educators do not diagnose disease nor create treatment plans. 

What is the future of OHE?

Greater and greater focus is being placed on good oral health. The media plays a large part in educating the public via the internet, magazine articles and documentaries. In recent years, the links that have been made between oral health and systemic health have definitely made the general public more aware. Established links between poor oral health/periodontal disease and other systemic conditions include diabetes, cardiovascular disease, bacterial pneumonia, low birth weights/adverse pregnancy outcomes, degenerative brain disorders and rheumatoid arthritis. Aside from these physical links, psychological and confidence issues can be generated by poor oral health. Improved public perception and education can only be positive things, and may mean that patients are more likely to be receptive to Oral Health Educators.

Further information on the NEBDN OHE certificate can be found at: http://nebdn.org/oral-health-education-0.

 

Author: Katy Amber, RDH, RDN

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