Running head: HOMELESSNESS & ORAL HYGIENE

Community Dental Health Project: Assessment, Diagnosis, Planning, Implementation, and

Evaluation Phases

Laurie Molvar

Alina Shchuchik

Leena Ung

DHYG425: Community Dental Health IV

Winter Quarter, 2018

2/10/18
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Assessment

For our community health project, we implemented our event at the Friends of Youth in

Redmond, WA for homeless families. Homelessness is a proactive concern that needs to be

addressed by dental professionals to increase overall education on oral health. It is evident that

this sample group struggles with the following barriers to care: structural, financial, and cultural.

The structural barrier is associated with the lack of access to dental care. The financial barrier is

due to the fact that the homeless population does not have the same financial advantages as other

socioeconomic classes. The cultural barrier regards the fact that the sample group may not see

any significance in dental care and how it affects them systemically. We were able to collect our

data by scheduling a meeting with our main contact, Carmen Wilson, who is the case manager

for Hopelink and the Friends of Youth center. We discussed potential age groups for the

potential program participants and the expected number of attendees.

Community Profile

According to our meeting with the case managers of Hopelink and Friends of Youth, our

target population consists of homeless families. The age demographic of our target population

ranges from 18-24 years old with various ages of children. Ethnicities consist mainly of

Caucasians, Indians, and Hispanics. The languages spoken include their own native languages

and English. Education levels are equivalent to 4th grade literacy.

Needs Assessment

The objectives for our presentation involve educating the target population on oral

hygiene, systemic diseases related to the oral cavity, and malnutrition. Our primary data was

collected from the meeting with the case manager and later through the pre-and post-tests. Our
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secondary data will be supported by research articles related to our topic, available community

dental clinics serving near the area, and the water fluoridation status in Redmond, WA. The

different needs addressed in our presentation include risk behaviors, such as alcohol use, drugs,

and smoking. Instructions for implementing behavioral changes for these risks will also be

addressed.

Literature Review

Education is the first step to improving a health situation. A main theme relating to the

homeless population is anxiety to dental treatment. The connection between oral and systemic

health will also be discussed in addition to providing resources to community clinics, which will

also benefit this population. The need for oral care is evident, therefore, improving health

literacy is the main goal when educating this population.

In Collins and Freeman’s journal entry, the concern of oral health needs for the homeless

population was highlighted (Collins, J., & Freeman, R., 2007). From this study, they found many

factors influencing data for a heterogeneous group. These factors include the individual’s chaotic

lifestyles, deprivation, social exclusion, psychosocial factors, and physical factors. Based on

these barriers to dental care, appropriate recommendations for oral health services may vary. The

study also showed the link between dental anxiety and dental disease experience, which had a

negative impact on quality of life. About half of the participants in the study felt self-conscious

and/or ashamed by the appearance of their teeth. Collins and Freeman stated in their article that

this particular homeless population had significantly more dental anxiety than the general public.

However, “it is possible that their dental phobia was a consequence of falsely connecting past

and possibly frightening life events with fearful treatment experiences, but it is equally likely
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that their dental fears were exacerbated by their mental health status” (Collins, J., & Freeman, R.,

2007). In addition, the homeless population live a chaotic lifestyle, meaning that “a combination

of treatment opportunities (such as mobile clinics with other health professionals in hostel

localities) must be provided in conjunction with consultation and essential assistance from

healthcare co-ordinators for homeless populations” (Collins, J., & Freeman, R., 2007).

Therefore, this article encourages the emotional understanding of the oral health status amongst

the homeless. It is important to incorporate context-sensitive oral healthcare for this population.

In the British Dental Journal, authors, Caton, S., Greenhalgh, F., & Goodacre, L.,

determine the tools to bridge the gap between oral health and the homeless population. The study

focused on, “Dental experiences; Reaching out; Accommodating chaotic lives; Behavior change;

Looking forward” (Caton, S., Greenhalgh, F., & Goodacre, L., 2016). Research shows involving

stakeholders to promote outreach programs available for the homeless population is statistically

proven to be beneficial for their oral health needs. The study concluded compassion to those with

addiction will ease their dental fears and failed appointments for dental treatment completion for

the homeless population.

Collectively, the sources synopsis is to improve the health care system that will benefit

the greater community. In the other study, “dental problems are significantly higher among

homeless individuals compared with low-income” (Figueiredo, R., Dempster, L., Quiñonez, C.,

Hwang, S., 2016 p.865). These sources contribute to the project by providing useful information

about dental outreach programs in the communities. The sources also depict the importance of

following up with procedures so homeless people will be seen to completion of treatment and to

cut cost of emergency expenditures.

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Many of the individuals in this target group experience anxiety in the dental office. In the

article, Oral health care needs and oral health-related quality of life (OHIP-14) in homeless

people, the authors talk about the negative impact of lack of dentistry to the oral cavity.

Specifically, it stated “The most commonly experienced oral health-related quality of life

impacts were in the dimension of pain, with aching in the mouth having a prevalence of 65% and

discomfort while eating foods having a prevalence of 62%.” (Daly, B., Newton, T., Batchelor, P.,

& Jones, K., 2010). This shows how urgent it is for this population to be educated about oral

health and understanding overall quality of life is impacted due to the lack of care. It will be

important to educate them on how oral pain results in malnutrition which leads to other systemic

deficiencies. Accessibility to dental offices who accept these type of patients is very limited in

the society. The article “Developing dental services for homeless people in east london.”

discusses a “significant need for services providing oral healthcare for this population and

highlighted that flexibly delivered dental services, embedded in local health and social networks,

seemed to promote uptake in these clients who normally find it extremely difficult to find dental

care services elsewhere” (Simons, D., Pearson, N., & Movasaghi, Z., 2012). When presenting to

our population, fliers should be available with information for different community clinics. This

will act as a guide, whereas the next step would be their responsibility to schedule an

appointment.

A huge concern for lack of care in this population is due to low health literacy. Once

educated on proper oral home care and importance of routine cleanings, they will understand the

need for care. For many of these individuals, their number one priority is shelter and food. Our

responsibility is to integrate the importance of oral health and quality of life as two factors that

depend on each other. The first step is to decrease anxiety in visiting the dental office, then
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describe different impacts that oral health has with lifestyle and physical health. In conclusion,

providing them with resources will help them make the first step in the direction towards better

overall health.

Diagnosis

Our target population consists of adults from ages 18-24 with children of various ages.

The Friends of Youth and Hopelink are organizations that help young adults improve their

emotional stability and independence. Our goal is to educate and motivate our target population

about the importance of oral hygiene and behavioral risks and changes. Our first priority will

address basic oral hygiene care for both children and adults. The second priority will regard

behavioral risks that influence various oral manifestations and diseases. The final priority will

include information about malnutrition and its consequences on the oral cavity.

Planning

Project Goals and Objectives

Our goal, and first objective, is to increase knowledge of oral health at the Friends of

Youth Center in Redmond, WA for adults, ranging from 18-24 years old, and their children of

various ages. Our second objective is to increase their knowledge by addressing the link between

oral health and nutrition in both adults and their children at the Friends of Youth Center. Finally,

we would like to increase awareness of how systemic diseases affect the oral cavity.

Timeline

We initially met with a coordinator in Kirkland for the Friends of Youth organization on

April 24th, 2017. She referred us to Carmen Wilson, a case manager in the Redmond location. On
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May 22nd we had a meeting with all the case mangers and discussed our plans for our

presentation. Since then, we remained in contact with Carmen through email and agreed to

implement on November 10th 2017 at 12:00 pm.

Lesson Plan

First, we will distribute the pre-test and allow 15 minutes for participants to complete the

test. In addition, each participant will receive an index card to enter his or her name for the raffle

drawing at the end of the presentation. Next, we will give a 20-minute power point presentation

discussing basic oral hygiene home care for both adults and children, the link between nutrition

and various oral manifestations, and how systemic diseases affect the oral cavity. During the

presentation, we will include a demo to educate participants about acid attacks on the teeth from

acidic beverages, such as soda. Following the presentation, we will allow a 10-minute question

and answer session if necessary. Then, we will hand out the post-test and allow 15 minutes for

completion. After that, we will collectively review the questions from the post-test and allow

participants to volunteer to answer questions correctly and to win free toothbrushes. Lastly, we

will draw names for the prize baskets—making sure that each family receives at least one basket.

Every participant will also leave with a goodie bag of basic dental supplies.

Budget

Proposed Cost Actual Cost

Prizes $80 $82.81
Food $30 $28.64
Pre/Post tests, brochures, flyers $10 $5
TOTAL $120 $116.45
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Summary

Homelessness is a concern that needs recognition by dental professionals to better overall

education on preventive care. We implemented our presentation on November 10th, 2017 at 3:30-

5:00pm. After implementing our first presentation, we plan to use our experience to better and

critique future presentations for the following year. We will take notes on areas that worked well,

as well as areas that lacked significance in our presentation. Our main contact will serve as a

resource to gauge the effectiveness of our presentation, since she is able to receive feedback from

the residents once the event is over. Therefore, if the first year dental hygiene students decide to

begin a tradition to present at the Friends of Youth Center for their community health project, we

will be able to provide them with our own summative evaluation for an effective presentation.

Implementation

Our three main objectives for presenting were to educate our population on the link

between the oral cavity and systemic diseases, the importance of oral hygiene, and nutrition. Our

presentation was completed on November 9th, 2017 at 3:00 pm. We had 15 participants, which

were a combination of mothers and children. Specifically, there were 5 mothers, 1 father, and 9

children. Our education was delivered through a PowerPoint, poster board, and demonstrations.

At the end of our presentation, we conducted a question and answer session. After the post-test,

volunteers who answered questions were rewarded with prizes. To conclude the event, each

resident was drawn to take a gift basket home as an appreciation for coming to the presentation.

The outcome of our educational session was evaluated through the post-test that we gave to each

participant.
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Summary

Our intentions for going to Hope link and Friends of Youth was to educate the homeless

population on the importance of oral care and the various ways it can be affected. Our group

discussed homecare, healthy food choices, and how systemic diseases can affect the oral cavity.

In addition to our PowerPoint, we used a poster board to show the participants “sometimes” and

“always” foods. We also showed demos on proper flossing and brushing technique. A demo of

“coin versus soda” was also done to show the impact of sweet drinks to the oral cavity. In

conclusion, we did not leave any residents empty handed by giving them gift baskets. We will

further access our accomplishments by evaluating the pre-and post-tests. With the results, we can

determine if the presentation increased the knowledge of oral health for our target population in

the next phase, evaluation.

Evaluation

During the evaluation phase the formative evaluations included an attendance chart that

showed the demographics of the target population. In addition, the summative evaluations used

pre and post-test to acknowledge a base line and show if knowledge was gained. Unfortunately,

the results were not statistically significant because the p value was not 5 or less. Overall the

project objectives were met based off the outcomes of the post tests. Our participants retained the

main points of the presentation and answered trivia questions to win raffle prizes at the end. The

strengths of the project were having an organized powerpoint to offer visual aids to keep the

audience entertained and presenting the information in a fun, professional way. The weaknesses

of the project were health literacy to the children and the lack of advertising the presentation to

ensure a larger number of participants. We were able to create a sustainable project by educating

single mothers of possible dental issues that could affect their children. Participants were able to
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grasp the concept of improving their nutrition and brushing, flossing techniques. For future

presentations, there will be more success if we are more prepared for technological issues,

specifically, projector and computer software compatibility. The modifications of the project

include more hands-on demos for the kids, so they stay involved in the presentation.
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References

Caton, S., Greenhalgh, F., & Goodacre, L. (2016). Evaluation of a community dental service for

homeless and 'hard to reach' people. British Dental Journal, 220(2), 67-70.

doi:http://dx.doi.org/10.1038/sj.bdj.2016.56

Collins, J., & Freeman, R. (2007). Homeless in north and west belfast: An oral health needs

assessment. British Dental Journal, 202(12), 6.

doi:http://dx.doi.org/10.1038/bdj.2007.473

Daly, B., Newton, T., Batchelor, P., & Jones, K. (2010). Oral health care needs and oral health-

related quality of life (OHIP-14) in homeless people. Community Dentistry & Oral

Epidemiology, 38(2), 136-144. doi:10.1111/j.1600-0528.2009.00516.x

Figueiredo, Rafael, BDS,M.Sc, F.R.C.D.(C.), Dempster, Laura, DH,M.Sc, PhD., Quiñonez,

Carlos, DMS, MSc, PhD, FRCD(C), & Hwang, Stephen W,M.D., PhD. (2016).

Emergency department use for dental problems among homeless individuals: A

population-based cohort study. Journal of Health Care for the Poor and Underserved,

27(2), 860-868. Retrieved from

http://168.156.198.98:2048/login?url=http://search.proquest.com/docview/1831801348?a

ccountid=1553

Pritchett, R. M., Hine, C. E., Franks, M. A., & Fisher-brown, L. (2014). Student-led oral health

education for the homeless community of east london. British Dental Journal, 217(2),

85-8. doi:http://dx.doi.org/10.1038/sj.bdj.2014.595
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Simons, D., Pearson, N., & Movasaghi, Z. (2012). Developing dental services for homeless

people in east london. British Dental Journal, 213(7), 7.

doi:http://dx.doi.org/10.1038/sj.bdj.2012.891
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Appendix A

Lesson Plan

TITLE: Oral Health Education TARGET GROUP: Homeless population in Redmond,

WA (ages: 18-24 years)

ESTIMATED LENGTH: 90 minutes, evening INSTRUCTIONAL METHOD:

Discussion, education, and activities

EDUCATIONAL GOAL: Increase knowledge of oral health at the Friends of Youth Center in
Redmond, WA for adults 18-24 years old

INSTRUCTIONAL OBJECTIVES:
1. To increase nutrition knowledge in adults (18-24 years old) at the Friends of Youth
Center
2. To increase the knowledge of how systemic diseases can affect the oral cavity in adults
(18-24 years old) at the Friends of Youth Center.
3. To increase the knowledge of importance of oral hygiene for adults (18-24 years old) at
the Friends of Youth Center.

INSTRUCTIONAL MATERIALS:
 Pre-test and post-test
 Brochures showing correct “C” shaped flossing technique and modified bass tooth
brushing technique
 Power point presentation
 Game/activities materials (white board, sticky notes, soda, eggs, yeast, sugar, plastic
cups, bean bags, poster board)

LEARNING ACTIVITY:
 Plaque attack demo/experiment
 Too much soda demo
 “What do we use our teeth for?” game
 Healthy foods bean bag tossing game
 Bass brushing & “C” shaped flossing technique demo on dentoform

Instructional Set:
We are all excited to share information about the importance of oral hygiene and how to care for
your child’s teeth!

Body
1. Distribute pre-test. We will allow 15 minutes for participants to complete pre-test.
2. Give 15 minute power point presentation. Discuss to highlight and explain:
a. Nutrition
b. Systemic
c. Homecare
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3. Allow total of 30 minutes for all activities/games/demos

4. Handout post test. Allow 15 minutes for participants to complete.
5. Read out answers to the pre/post test. Question and answer session with residents for total
of 15 minutes.
6. Handout prizes and goodie bags (about 5-10 minutes)

Closure:
We want to thank you for attending and letting us come and give our presentation on oral
hygiene! We will be happy to keep in touch and feel free to ask us any questions. Please come
visit our clinic, our class will be excited to work with you.
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Appendix B

Pre-test

1. What type of foods cause cavities?

a. Broccoli
b. bread
c. Yogurt
d. Popcorn

2. True/False: Fluoride can be found in food and the water we drink.

3. True/False: Smoking can cause negative effects to your teeth.

4. True/False: You can prevent cavities from forming

5. How long should you be brushing your teeth for?

a. 1 minute
b. 2 minutes
c. 5 minutes
d. 45 seconds

6. Why is it important to keep baby teeth clean?

a. To prevent cavities for adult teeth that will come in
b. So they have teeth to chew with
c. Is not important at all
d. All of the above

7. What does it mean if your gums bleed when flossing/brushing?

a. Grinding teeth at night
b. Genetics/Family history
c. Flossing causes gum irritation
d. Bacteria from not brushing/flossing daily

8. True/False: It is not necessary to brush your tongue

9. How does alcohol affect the mouth/teeth?

a. Causes cavities
b. Tooth loss
c. Dry mouth
d. Cancer in the mouth
e. All of the above

10. True/False: There are both good and bad bacteria present in the mouth.

11. Can you pass on possibility to get cavities to your newborn child by kissing them?
a. No
b. Yes
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Appendix C

Post-test

1. What type of foods cause cavities?

a. Broccoli
b. Bread
c. Yogurt
d. Popcorn

2. True/False: Fluoride can be found in food and the water we drink.

3. True/False: Smoking can cause negative effects to your teeth.

4. True/False: You can prevent from getting cavities

5. How long should you be brushing your teeth for?

a. 1 minute
b. 2 minutes
c. 5 minutes
d. 45 seconds

6. Why is it important to keep baby teeth clean?

a. To prevent cavities for adult teeth that will come in
b. So they have teeth to chew with
c. Is not important at all
d. All of the above

7. What does it mean if your gums bleed when flossing/brushing?

a. Grinding teeth at night
b. Genetics/Family history
c. Flossing causes gum irritation
d. Bacteria from not brushing/flossing daily

8. True/False: It is not necessary to brush your tongue

9. How does alcohol affect the mouth/teeth?

a. Causes cavities
b. Tooth loss
c. Dry mouth
d. Cancer in the mouth
e. All of the above

10. True/False: There are both good and bad bacteria present in the mouth.

11. Can you pass on possibility to get cavities to your newborn child by kissing them?
a. No
b. Yes