Papers by Heather Frenkel
British Dental Journal, Jul 1, 2009
A health education intervention to improve oral health among institutionalised elderly people : a... more A health education intervention to improve oral health among institutionalised elderly people : a randomised controlled trial.
Dentistry from the back of a covered wagon
PubMed, 1997
Gerodontology, Jul 1, 2000
To assess personal oral health care standards among frail, elderly and infirm nursing home reside... more To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention. Design: Descriptive survey, interview and clinical data. Setting: 22 randomly selected nursing homes in the Bristol area. Method: 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries. Results: Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects. Conchisions: Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.
Community Dentistry and Oral Epidemiology, Apr 1, 2002
Objectives: The effect of an oral health care education programme (OHCE) upon nursing home caregi... more Objectives: The effect of an oral health care education programme (OHCE) upon nursing home caregivers was assessed in a randomised controlled trial. Methods: A self-administered questionnaire assessed oral health care knowledge and attitudes at baseline among 369 caregivers working in 22 nursing homes. Homes were randomly allocated to two groups. The intervention was a workplace OHCE. Caregivers assessed the value of the presentations. Questionnaires were re-administered 1 month (time 2) and 6 months (time 3) after the OHCE was delivered. The knowledge and attitude score means of the groups were compared. Open-ended questions solicited qualitative data. Results: Questionnaire response rates at the three time points ranged from 76.3% to 85.4%. Two-thirds of caregivers employed at the time of the intervention attended the presentations. The OHCE was favourably assessed in 79% of responses. The intervention group Key words: caregivers; dental health significantly improved their scores over the control group at times 2 and 3 for education; nursing homes; randomised knowledge (PϽ0.003) and attitude (PϽ0.001). Analysed across both arms at basecontrolled trial line, the main predictors for knowledge and attitude scores were age and dental Dr Heather Frenkel, Bristol Dental Hospital, attendance pattern. Qualitative responses showed an acceptance of caregivers' Lower Maudlin Street, Bristol BS1 2LY, UK roles in oral health care and criticism of existing provision within homes. Conclu
Journal of Dental Education, Aug 1, 2004
Special Care in Dentistry, 2004
Community Dentistry and Oral Epidemiology, Aug 1, 2001
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of an oral health care education (OHCE) programme for nursing home caregivers, aimed at improving the clients' oral health. A health promoter with 15 years' experience presented the intervention. The intervention consisted of sessions lasting approximately one hour, covering the role of plaque in oral disease and including demonstrations of cleaning techniques for dentures and natural teeth. Caregivers demonstrated the practice of these techniques using a manikin head, models and other teaching aids. Type of intervention Other: caregiver education programme. Economic study type Cost-effectiveness analysis. Study population The study population comprised institutionalised elderly people, wearing dentures or having natural teeth. Patients were not eligible if they presented with significant cognitive impairment. Setting The setting was a nursing home. The economic study was carried out in the UK.
Journal of Dental Education, 2004
This cluster-randomised controlled trial evaluated an oral health care education programme (OHEP)... more This cluster-randomised controlled trial evaluated an oral health care education programme (OHEP) for carers of nursing-home clients. Outcome measures were carers' knowledge and attitude scores (assessed by questionnaire) and clients' oral health status (clinically assessed). Data were collected at baseline, and at one-month and six-months after OHEP. The sample, comprising 412 clients and 295 carers in 22 homes, showed acceptable baseline comparability. Clients' baseline oral health was poor. After OHEP, several intervention group oral health scores improved significantly. Reductions in intervention group denture plaque scores (0-4 scale) exceeded those of the control group by 1.14 (95%CI 1.28 to 1.01) at one month and by 1.46 (95%CI 1.64 to 1.29) at six months. Denture-induced stomatitis prevalence reduced over 6 months by 20.3% in the intervention group compared to 4% in the control. For dental plaque (0-3 scale), group differences in favour of the intervention group ...
Oral health care: can training improve its quality?
Nursing and Residential Care, 2003
Today, many residents have retained some or all of their teeth. Heather Frenkel discusses the wid... more Today, many residents have retained some or all of their teeth. Heather Frenkel discusses the widespread neglect of oral health care, and how training can improve care standards.
Alzheimer's Disease and Oral Care
Dental Update, 2004
Alzheimer's disease (AD) is the commonest form of dementia, closely associated with age, but ... more Alzheimer's disease (AD) is the commonest form of dementia, closely associated with age, but also with other causative factors. AD affects half a million people in the UK, and presents dentists with numerous behavioural and clinical challenges. The aetiology, diagnosis and medical treatment for persons with AD are discussed, together with communication strategies and issues related to families and care-givers. Realistic dental treatment planning for patients in early, moderate and late stage AD is considered in conjunction with relevant ethical issues. Dentists have the potential to improve markedly the quality of life for people with AD.
Prevention of Oral Diseases for a Dependent Population
A Clinical Perspective, 2013
... Furthermore, the legal status of physical restraint has been challenged in the United States ... more ... Furthermore, the legal status of physical restraint has been challenged in the United States where the courts in North Carolina, for example, have ruled that physical restraint on a handicapped patient infringes the patient's autonomy and violates the principle of social justice ...
Special Care in Dentistry, 2004
Gerodontology, 2000
To assess personal oral health care standards among frail, elderly and infirm nursing home reside... more To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention. Design: Descriptive survey, interview and clinical data. Setting: 22 randomly selected nursing homes in the Bristol area. Method: 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries. Results: Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects. Conchisions: Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.
Gerodontology, 2005
Oral care and stroke units Objective: To investigate oral care provision reported by senior nurse... more Oral care and stroke units Objective: To investigate oral care provision reported by senior nurses in stroke care settings in Scotland. Background: Stroke can have adverse effects on oral care and health. Little is known about current oral care practices in stroke care settings. Materials and methods: We designed a postal survey to be completed by ward managers or senior nurses. After piloting, the survey was distributed to all 71 units in Scotland, identified as providing specialist care for patients in the acute or rehabilitation stages following stroke. Pre-notification and reminder letters were circulated. Responses were anonymous. Results: All but one survey was completed and returned. Help from dental professionals was available to most units (64/70) mostly on request. Only a third of units received oral care training in the last year (23/ 70). The majority of this training was ward based (20/23). The use of oral care assessment tools and protocols was limited (16/70 and 15/70 units respectively). Not all units had access to toothbrushes, toothpaste or chlorhexidine. For patients unable to perform oral care independently, senior nurses expected the patients' teeth or dentures to be cleaned at least twice a day in 59 of 70 and 49 of 70 units respectively. Conclusion: The response rate was excellent and has provided a national overview of oral care provision for patients in stroke care settings. Access to staff training, assessments, protocols and oral hygiene material varied considerably. This information provides a valuable baseline from which to develop and evaluate the effectiveness of ward-based oral care interventions for stroke patients.
Gerodontology, 1999
To identify qualitatively carer staff attitudes, practices and ciilieal comments related to oral ... more To identify qualitatively carer staff attitudes, practices and ciilieal comments related to oral health care ol' functionally dependent nursing home clients. Design: Open-ended questions included in a longer quantitative questionnaire. Setting: 22 randomly selected nursing homes in the Bristol area. Subjects: 416 carers employed in these homes. Results: The majority of carers thought that clients had a right to good oral health, accepted the carers' role in helping clients with oral and denture hygiene, but recogni.sed that oral health care provision was deficient. However, some carers believed oral health care to be solely the clients' responsibility despite high disability levels. Main barriers to providing oral health care were low prioritisation of oral health by nursing management, lack of cooperation from cognitively impaired clients, and lack of training. Carers were critical of homes' lack of arrangements for routine professional dental cheeks, lack of commitment to staff training, low standards of oral health care by colleagues, and lack of provision of oral hygiene aids and cleansing materials for clients. Many responses indicated ways in which nursing home oral health care could be improved. Carers reported eontrasting experiences of dental treatment, and deplored recent decreased availability of subsidised dental care. Conclusions: Carers' generally positive attitudes towards elients' oral health care should encourage health educators. Insights gained from qualitative data can help to identify the less obvious causes for poor oral care delivery, which can then be addressed in education and training initiatives in nursing home settings.
Community Dentistry and Oral Epidemiology, 2001
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of an oral health care education (OHCE) programme for nursing home caregivers, aimed at improving the clients' oral health. A health promoter with 15 years' experience presented the intervention. The intervention consisted of sessions lasting approximately one hour, covering the role of plaque in oral disease and including demonstrations of cleaning techniques for dentures and natural teeth. Caregivers demonstrated the practice of these techniques using a manikin head, models and other teaching aids. Type of intervention Other: caregiver education programme. Economic study type Cost-effectiveness analysis. Study population The study population comprised institutionalised elderly people, wearing dentures or having natural teeth. Patients were not eligible if they presented with significant cognitive impairment. Setting The setting was a nursing home. The economic study was carried out in the UK.
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Papers by Heather Frenkel