Episode Description

Access to oral health care remains one of the biggest challenges facing older adults living in skilled nursing and long-term care facilities. In this episode of the RDH Magazine Podcast, Jackie Sanders and Andrew Johnston sit down with educator and researcher Tracee Dahm to discuss a scoping review examining how medical professionals perceive oral health care in institutionalized geriatric settings—and why meaningful change remains difficult.

Tracee shares how a research question that began during her master's program evolved into a multiyear collaborative project exploring provider attitudes, barriers to care, and opportunities for advocacy. The conversation also offers a behind-the-scenes look at conducting dental hygiene research, building collaborative research teams, and why expanding access for mobile dental hygienists may be one of the profession's greatest opportunities to improve oral health for aging populations.

Improving oral health in geriatric care: Why this research matters

Jackie Sanders:
Welcome to the RDH Magazine podcast, recorded live from RDH Under One Roof. I'm Jackie Sanders, joined by my cohost, Andrew Johnston, and our special guest, Tracee Dahm.

Andrew Johnston:
Tracee, how many Under One Roof conferences have you been to?

Tracee Dahm:
This is my third time, and every year it just gets better and better.

Andrew Johnston:
You're in for a ride. I've probably been to 14 or 15, and I still get energized every time I come. I love podcasting on the exhibit floor because everyone is walking by, everyone's excited to be here, and that energy carries through the whole event.

Tracee Dahm:
I love the exhibit hall. I haven't had much time to explore because I've been learning so much, but I could spend all day here. It's like the Disney World of dental hygiene.

Jackie Sanders:
It's packed.

Andrew Johnston:
It really is the Super Bowl of hygiene conferences.

Tracee Dahm:
I also love that people can buy a ticket just to walk the exhibit floor. That experience alone can inspire and motivate your career.

Jackie Sanders:
We've even started seeing more dentists, office managers, and dental assistants attending. The event just keeps growing.

A research project more than a decade in the making

Andrew Johnston:
One of the reasons we wanted to have you on today is because your team recently presented research at the International Symposium on Dental Hygiene in Milan. Your presentation explored how medical professionals view oral health care in institutionalized geriatric care facilities.

We don't often spend time talking about research on this podcast, but these kinds of projects can have a huge impact on patient care. Tell us about the project and your research team.

Tracee Dahm:
This project has really been building for more than a decade.

When I completed my Master of Science in dental hygiene education in 2012, my non-thesis literature review focused on geriatric adults and the lack of access to dental hygiene care. At the time, I was documenting what many of us already knew—that dental hygienists are often prevented by state regulations and licensure barriers from providing care to people who desperately need it.

Geriatric adults often have multiple medical conditions connected to oral health, and it has always been difficult for me to watch people suffer simply because they cannot access oral care.

The research confirmed there was a need, and even then we knew the aging baby boom generation would create additional challenges. What no one anticipated was COVID-19. The pandemic dramatically changed provider availability, and now we're caring for an older population that's living longer and retaining their natural teeth longer.

All of those factors led us back to the original question: What has changed? What needs to be discussed now? How can we improve care?

Personally, I also wanted to become a better researcher. Moving from a literature review to a scoping review allowed me to gain experience conducting original research.

The project took about two to three years to complete. Some delays were personal, but original research simply takes time.

I worked with three outstanding dental hygiene professors from Old Dominion University and Virginia Commonwealth University, along with the health sciences librarian from Virginia Commonwealth University. While I was employed at North Idaho College, we came together as a team to complete this work.

Additional reading: Why patients still don't "get" the oral-systemic link

Building a research team through mentorship

Andrew Johnston:
Did you personally recruit everyone for the project?

Tracee Dahm:
It was a combination of things.

I've been fortunate to have wonderful mentors throughout my career. Many of these women are people I've met through conferences, previous research, and other writing projects.

Two of them had actually been faculty members during my graduate program. Since they had helped me previously, it felt natural to invite them to continue the journey with me. They were excited to do it.

Another colleague at Virginia Commonwealth University knew I wanted to strengthen my research skills and suggested we complete a scoping review together. She also introduced me to Erica, the health sciences librarian who became an important member of our team.

Jackie Sanders:
That's a great reminder that mentorship doesn't stop after school. Throughout your career, you can continue reaching out to people who have experience and learn alongside them.

What does a research collaboration actually look like?

Andrew Johnston:
I've always imagined what it would be like to work in a writer's room where people are constantly brainstorming ideas. Research feels completely different.

You're spread across the country, so what does collaboration actually look like?

Tracee Dahm:
We don't have a physical room—we're all working remotely.

I'm in Coeur d'Alene, Idaho, while the rest of the team is in Virginia, so everything happens digitally through scheduled meetings.

For anyone interested in research, my biggest advice is to find a topic you're passionate about. My passion has always been improving care for institutionalized geriatric patients.

Research takes a long time, and eventually you'll get tired of any topic if you're working on it every day. Having genuine passion keeps you motivated.

The next step is narrowing your focus into a clear research question. We knew where my previous work had ended, and we asked ourselves what had changed over the past decade.

Building a team isn't about knowing everything yourself. It's about surrounding yourself with people who bring different strengths.

Jackie Sanders:
That's going to be a challenge for Andrew.

Tracee Dahm:
He's actually a wonderful writer. I enjoy reading his work.

Andrew Johnston:
Thank you. It's just not technical writing.

Leadership, teamwork, and trusting your coauthors

Andrew Johnston:
When you're leading a research project, are you also acting as the project manager? Are you assigning everyone's responsibilities?

Tracee Dahm:
In my experience, it starts by asking everyone about their strengths.

What do you enjoy doing? What do you want to learn? How can we help each other?

Our librarian had a clearly defined responsibility gathering the literature. I served as the lead author, and Dr. Kimberly Lintag and I developed the workflow together, dividing responsibilities based on everyone's strengths.

If someone needed help, another team member stepped in.

That's really the beauty of collaboration. Everyone supports one another while contributing their individual expertise.

Andrew Johnston:
Another question I've always wondered about: When multiple people are writing different sections, who's responsible for making sure everything is accurate?

Tracee Dahm:
The librarian gathers research exclusively from credible sources, so every section is grounded in published evidence.

There's certainly trust involved, but everyone on our team has published extensively in evidence-based dental journals. You're working with experienced professionals.

Jackie Sanders:
So they all have excellent CVs.

Tracee Dahm:
Absolutely. They're rock stars.

Why isn't oral health a higher priority in long-term care?

Andrew Johnston:
One of the findings from your review stood out to me.

Many medical providers recognize that oral health is important, yet knowledge levels and actual oral care practices remain inconsistent.

Why do you think that disconnect exists?

Tracee Dahm:
The biggest factor is time.

It's very similar to what dental hygienists experience every day. You schedule the perfect appointment, but once you see the patient, priorities shift and you have to adapt.

In skilled nursing facilities, performance measures focus on falls, bathing, weight maintenance, medications, and similar benchmarks. Oral hygiene isn't typically included in those evaluations.

The providers absolutely understand that oral health matters. They know poor oral hygiene contributes to disease. Unfortunately, they often report simply running out of time—or even running out of supplies.

Jackie Sanders:
And sometimes the supplies they do have aren't appropriate.

My mother spent time in hospice earlier this year, and honestly, both the products they had available and the oral care she received were very disappointing.

Andrew Johnston:
That's incredibly frustrating.

The time issue sounds exactly like what hygienists face every day.

Is there another layer of health care that could help? Is there a way to expand our profession? It feels like there has to be a solution.

Jackie Sanders:
The facilities are already understaffed.

Tracee Dahm:
They are.

But one thing that's encouraging is that I've met many people at this conference who have started mobile dental hygiene practices.

When people say we need another layer of care, I would argue we already have it. Those dental hygienists are walking around this conference today.

The problem is they aren't always allowed into nursing homes because of state regulations.

We need more people advocating with governors and legislators so hygienists can provide care where it's desperately needed.

Andrew Johnston:
That's really the sad part.

Tracee Dahm:
It is.

We're ready to help. That's what dental hygienists want to do.

Additional reading: Mobile RDH: Starting a mobile dental hygiene business

Looking ahead

Andrew Johnston:
I actually have about 20 more questions written down, but unfortunately I spent too much time asking about research itself.

We'll definitely have to bring you back for a part two.

If people want to connect with you or ask questions, where can they find you?

Tracee Dahm:
You can find me on social media as TDahm—that's D-A-H-M.

You can also email me at [email protected].

Jackie Sanders:
And where can everyone read your research?

Tracee Dahm:
At RDH Magazine. I also have another article in the July issue, so hopefully everyone checks that out as well.

Andrew Johnston:
Awesome. Thank you.

Jackie Sanders:
Thanks, Tracee.