Providing Oral Health Care to Patients with Traumatic Brain Injury: The Challenges and Barriers Faced by their Caregivers

Abstract

Background: Access to dental care for the disabled population remains a challenge, and in some cases is almost non-existent within large numbers of the disabled population. The current literature lacks information on perceived challenges, barriers, strategies and enablers encountered by group home caregivers who provide daily oral care for individuals with traumatic brain injury. Objective: This survey was designed to identify the enablers and barriers caregivers experience in providing daily oral to patients with traumatic brain injury patients and to assess the self-perception of caregivers regarding their own personal oral care. Subjects: A total of 53 caregivers working at Snohomish Chalet (88% response rate), meeting the inclusion participated in the survey. Methods: The study used a descriptive, cross-sectional survey to evaluate caregivers' challenges, strategies, barriers and knowledge of the dental needs of their disabled clients. The response format on the survey included fifteen general knowledge questions, seven Likert items and two open-ended questions to gather information on knowledge, attitudes, and practices regarding provision of oral care. Statistical analyses: Descriptive statistics were the primary analysis for the results from the survey. Frequencies and percentages were used to summarize the responses for qualitative factors, and means, standard deviations, minimum and maximum values were used to summarize the responses for quantitative factors. A thematic approach was taken to organize and explore the responses from the open-ended questions that were collected. Results: Eighty three percent of the caregivers had received some type of dental training, and 66% of the caregiving staff had received dental training as part of their orientation. Only 4% of the caregivers had received dental training through dental in-service. The most common resident behaviors that may present a barrier to oral care delivery were mild in nature. Sixty six percent of caregivers reported residents not opening their mouth occasionally to very frequently, 51% reported residents being orally defensive or refusing oral care, and 49% reported residents moving their head to avoid oral care. Over 80% of the caregivers reported brushing teeth once or more day for both cooperative (85%) and uncooperative residents (83%), but less than 15% reported flossing teeth once or more a day for either cooperative individuals (13%) or uncooperative individuals (10%). Most caregivers reported brushing their teeth (96%) and tongue (99%) 1 or more times a day, but, only 58% of caregivers reporting flossing their teeth 1 or more times a day, and 17% reported flossing their teeth less than once a week or never. Conclusions: Although most caregivers had received some type of dental training, more education and routine dental in-services is needed to overcome common barriers and better serve oral care needs of residents. More collaboration with dental health professionals and frequent in-service is critical in providing better care to this population.