Document Type


Date of Degree

Summer 2018

Access Restrictions

Access restricted until 08/31/2020

Degree Name

MS (Master of Science)

Degree In

Dental Public Health

First Advisor

McQuistan, Michelle

First Committee Member

Qian, Fang

Second Committee Member

Cowen, Howard

Third Committee Member

Newman, Larry

Fourth Committee Member

Warren, John


Objectives: To evaluate the oral health knowledge of legally authorized representatives of long term care facility residents to assess whether oral health knowledge is associated with the representatives’ understanding of the residents’ oral health status and treatment needs.

Methods: The study participants were legally authorized representatives (LARs) of long term care facility (LTCF) residents who were visited by the Geriatric Mobile Unit (GMU) of the University of Iowa College of Dentistry & Dental Clinics. Once IRB approval was obtained, a mailing was sent out to the LARs after the GMU visited the LTCF. LARs were asked to complete a survey and were also asked permission to obtain dental records of the LTCF resident they represented. The survey contained questions pertaining to the LAR as well as the LTCF resident. With respect to the LAR, questions on socio-demographics, oral health literacy, oral health knowledge, oral health behavior and oral health status were asked. For questions about the LTCF resident, the LARs were asked about the resident’s prior oral health behavior, current oral health status, oral health treatment needs, and dental insurance status. They were also asked what factors would influence their decision to seek oral health care for the LTCF resident, and when they last spoke to the LTCF resident about their oral health. Bivariate analyses were conducted using Chi-square and Cochran-Mantel-Haenszel tests with LARs knowledge about the LTCF residents’ missing teeth and various oral health treatment needs being the outcome variables. Significant variables were entered into a multiple logistic regression model for each outcome variables. Statistical significance was set at p<0.05 and p=0.05-0.2.

Results: Four hundred and thirty-one surveys were mailed out to the LARs. One hundred LARs consented to participate in the study and returned the completed questionnaire. Fifty-two percent of the LARs got all nine oral health knowledge questions correct. The questions that were the most frequently missed included “Losing teeth is a natural process of aging” (77% answered correctly), and “Blood on your toothbrush is a sign of gum disease” (74% answered in correctly). Thirty-eight percent of the LARs said they were extremely confident filling out medical forms by themselves, and 37% said they were quite a bit confident. When asked about the missing teeth of the LTCF resident, ten LARs reported that their LTCF resident had all teeth missing, while only 9 LTCF residents had all teeth missing as per chart review. Seventy-six residents had some upper back teeth missing and 71 residents had some lower back teeth missing. Twenty-eight LARs reported some upper back teeth were missing in their resident and 24 LARs reported some lower back teeth was missing. Treatment needs of the resident were in general underestimated by the LAR. Thirty-five LTCF residents needed a filling and 15 needed extractions, however LARs reported 21 residents needed fillings, and 8 needed extractions. Fifty-six LARs did not know if the resident needed a filling, and 49 LARs did not know if the resident needed an extraction. Bivariate analyses reported a number of significant variables in each domain for p values <0.05 and between 0.05 and 0.2. In the final logistic regression model, retirement status of the LAR and LARs’ confidence filling out medical forms were most commonly significant for LARs’ knowledge about treatment needs of the LTCF resident; and self-reported oral health status, age of the resident, and physical health status of the resident influencing the LARs decision to seek care dental care for the resident were significant for LARs’ knowledge about missing teeth of the LTCF resident.

Conclusion: Although the majority of LARs indicated that oral health is important for nursing home residents, many LARs were unaware of the oral health status and the treatment needs of the LTCF residents. While a single variable was not found to be commonly associated across LARs’ knowledge of the oral health status and treatment needs of the residents, several variables were associated with the knowledge of one treatment need only as opposed to the knowledge of multiple treatment needs. Understanding if and how oral health literacy and oral health knowledge influence LARs’ and as well as nursing home caregivers’ decisions to seek dental care for LTCF residents may help address the gaps in oral health care for LTCF residents, thereby improving their quality of life.


xiii, 142 pages


Includes bibliographical references (pages 138-142).


Copyright © 2018 Nyla Balakrishnan

Available for download on Monday, August 31, 2020