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Running head: HOPE PLACE – WOMEN IN RECOVERY

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


Evaluation Phases

Noelle Ohlinger

Carrie Porter

Madi Robinson

Community Dental Health IV

Winter Quarter, 2018

February 22, 2018


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Assessment

Seattle, Washington is facing a lack of education regarding oral health. More specifi-

cally, there is a lack of information provided to women of low socio-economic status. This

group is under-educated on the importance of oral health, its link with systemic health, along

with the negative health effects of tobacco use. Due to common low health literacy, it is im-

portant to educate and demonstrate the importance of oral health. We chose Hope Place in Seat-

tle, Washington as our location for this community health project. Hope Place is a facility in

which low income women who are in recovery can live with their children long term. We chose

this location after watching the presentation of the previous class and researching online. We

reached out to Hope Place, communicating with Collin Thompson (Cell: 208-949-5092) and

Marvin Eng (206-723-0767 ext:523). Collin connected us with Annette Smiley, the recovery pro-

gram administrator, who gave us the information we needed about the facility for our presenta-

tion.

Community Profile

We were able to determine this is a non-profit, long-term homeless shelter and recovery

program for women and their children. This information was retrieved from the Hope Place

website via ugm.org. We met with a former resident named Stormy who gave us a tour of the

facility. She was very informative and answered our questions regarding Hope Place residents.

She explained the diversity of these women who vary in age, ethnicity, education, and language

spoken.

Needs Assessment
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Our contacts, Collin and Stormy, furnished our primary data. He explained Hope Place is

a homeless shelter for women recovering from drug abuse, substance abuse, and domestic abuse.

Seattle’s Union Gospel Mission runs this shelter which provides these women with food, shelter,

church, faith, counselors, and case workers. During our tour with Stormy, she pointed out most

of these women smoke cigarettes. This information along with information gathered from an ar-

ticle by Vivek Ratnankar led us to the conclusion that tobacco should be one of our main topics

of education. Vivek stated, “Clinical Studies suggest that smokers have a higher than average

risk of periodontal disease and poor oral health status” (2017, p. 1). Stressing the connection be-

tween oral and systemic health is extremely relevant to this group. From our secondary data,

which was online research, we found out that the community of Hope Place has access to dental

services, medical services, mental health services, and legal services all through the Union Gos-

pel Mission. We discovered that they are not allowed to use any substances or show violence

while living here, but they can smoke cigarettes if it is outside of the building. They accept any

ethnicity, although they only accommodate for English and Spanish languages. This population

has a low socioeconomic status. They are homeless and living in a shelter where they are not al-

lowed to work. There is a huge need for oral health education and preventive dental services in

this population. Most of this population has a history of drug and substance abuse and currently

smoke tobacco, putting them at a higher risk for periodontal disease and caries.

Literature Review

Homeless women are on the rise in the United States. Working with this population to

provide them insight and education on the importance of oral health is extremely important. So-

cial Determinants of Children’s Health, Volume II, published a study emphasizing homeless

mothers and children are particularly vulnerable to decay also called the “silent epidemic” due to
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access barriers such as: lack of health knowledge, financial status, mental health, oral health be-

liefs, substance abuse, physical illness, victimization, and access to care. The mothers age, num-

ber of children at the shelter, and race also plays a significant role. “Eighty percent of all dental

decay occurs in low-income, homeless, and/or minority families.” (DiMarco, Ludington, &

Menke, 2010). Lack of oral health care also plays a role in the quality of life of these women:

Lack of access to care and untreated dental conditions in homeless individuals contribute

to emergency room visits, expensive treatments, dysfunctional speech, compromised nu-

trition and growth, an estimated 52 million missed hours of school per year, 189 million

hours of lost work for parents, unquantified pain and suffering, lack of self-esteem, be-

havioral problems, learning problems, can contribute to or aggravate other medical prob-

lems (such as diabetes, HIV/AIDS, heart disease, and other infectious and inflammatory

diseases). (DiMarco, Ludington, & Menke, 2010)

With our groups plan to present a power-point presentation on the importance of oral health, the

negative effects of tobacco, and the link between oral and systemic health, I feel this will be a

great opportunity to provide support and education to the women at Hope Place.

Low-income women in the United States continue to lack in education, prevention, and

treatment of oral health needs. A journal article posted in Health Affairs Magazine called

Strengthening children’s oral health: Views from the field, talks about the lack of “public outcry”

and the “under-valuing of oral health” that play a part of the ongoing dental caries disease. This

article mentions a twelve-year old Maryland boy who died from a massive untreated tooth infec-

tion, which he described as a “toothache.” Concentrating on educating these mothers on preven-

tion (fluoride), proper homecare, nutrition, and seeking regular checkups for themselves and
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their children will improve the quality of their lives. In addition, this article explains how educat-

ing mothers during pregnancy could help “reduce the impact of untreated dental disease,” and

“could reduce or prevent oral disease in young children, because when parents understand and

value oral health, they will more likely seek care for their children.” (Behrens & Lear, 2011, p.

2211). As dental hygiene students, we can educate these mothers on how, when, and why it is

important to take care of their oral health, therefore helping to educate on the importance of re-

ducing the caries disease within this population.

During our tour of Hope Place with Stormy, she mentioned many of the residents are

smokers. “With tobacco use emerging as one of the biggest public health concerns around the

world, it is important that people be made aware of health issues associated with smoking”

(Ratnakar, 2017, p. 1). Tobacco can cause many health issues, both systemically and in the oral

cavity. Potential oral health issues include tooth staining, bad breath, tooth decay, gum disease,

tooth loss, oral cancer and lung cancer (Terrades, Coulter, Clarke, Mullally, & Stevenson, 2009).

“Smokers are bound to have dental problems and the more one smokes, the worse they will get”

(Ratnakar, 2017, p. 1) Knowing this, it is important to educate the residents of Hope Place who

are smokers on the risks of smoking tobacco and urge them to quit. Especially because, “smokers

are significantly less aware than non-smokers of the relationship between smoking and gum dis-

ease, oral cancer or impaired wound healing” (Terrades et al., 2009, p. 1).

The oral cavity is directly related to the overall systemic health. Chronic inflammatory

diseases are found worldwide and are among the most prevalent chronic infection in humans.

The bacteria that are present in periodontal disease are motile, meaning they can move around

the body and dig deeper into the tissues. Individuals with severe chronic periodontitis (chronic
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inflammation of tissues, bleeding gums, deep pockets, and bone loss) have a significantly in-

creased risk of developing cardiovascular disease. Oral health is significantly correlated and is a

risk indicator of death from a type of cardiovascular disease (such as atherosclerosis, stroke, etc).

A bacterial infection of the heart valves or endothelium of the heart is known as infective endo-

carditis. This occurs when the bacteria (such as the ones from periodontal disease) enter the

bloodstream and can lodge onto abnormal heart valves or damaged heart tissue. This usually oc-

curs on someone with previous heart conditions.

In both type 1 and type 2 diabetes, there is a greater prevalence, incidence, severity, and

extent in at least one manifestation of periodontal disease. Poor glycemic control can also con-

tribute to even worse periodontal health. Patients with diabetes require a thorough oral exam and

the necessary periodontal care consisting of prevention and treatment. Dental plaque and biofilm

can be a reservoir for infections. Teeth of patients in both the ICU and nursing homes have

shown to become more colonized with respiratory pathogens, which commonly cause pneumonia

(Teng et al., 2002). A superinfection from these bacteria can occur due to antibiotics, which can

suppress the normal bacteria flora and allows pathogenic bacteria from the environment into the

mouth. Daily mechanical removal of this bacteria reduces the colonization of these pathogens

and the rate of pneumonia. There is also a correlation between poor oral health and Chronic Ob-

structive Pulmonary Disease, which worsens lung function. Women who have gum disease have

a 14% overall higher chance of getting breast cancer than those with good oral health. If you also

area current or previous smoker, that risk increases to 30% (Gregg, 2016). The mouth can some-

times be a warning sign for another part of the body.

Diagnosis
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Our target population is women, mostly mothers, of low socio-economic status. We

chose this population because these women are at a point in life where they are striving to im-

prove their lives for both themselves and their children. It is the reason they are living in a re-

covery center. We believe the oral health information we will provide them will help them to

improve their lives even more. These women reside at Hope Place in Seattle, WA with their

children. They are responsible for their daily personal oral care along with the care of their chil-

dren. A partner for our project is Dr. Geoffrey Chan, from Sammamish, WA. He is providing us

with supplies for our goodie bags, such as toothbrushes, floss, and toothpaste. We will also be

using Amazon website to purchase an adult Sonicare toothbrush to be raffled off at the end of

our presentation. There are 60 women currently living at Hope Place in Seattle, WA. This shelter

is organized by the Seattle Union Gospel Mission. They have access to medical care, dental care,

legal services, and mental health services all through Hope Place. They are not allowed to have

jobs and do not have insurance.

Planning

The first thing we did before doing too much planning was going to visit Hope Place. We

wanted to make sure this was the right place for us, and it was. We loved the environment, and

everyone was very nice and respectful. After we visited Hope Place, we set a presentation date

and contacted Dr. Chan to see if he would donate the goodie bags. We started to make our Pow-

erpoint presentation based off of our research articles, focusing on three topics, which were to-

bacco, systemic health, and general oral health/home care. After the presentation was completed,

we put together the pre-test and post-test based on what information we were covering in the

presentation. We also got the items we were going to give away during a drawing after the

presentation. When we arrived early the morning of our presentation, we started to set up the
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presentation onto the TV they had in the room where we would be presenting. We also put

goodie bags and the pre-test on the tables to make it faster when everyone got in the room.

Project Goal and Objectives

The goal of our presentation is to increase the knowledge of oral health in low income women at

Hope Place in Seattle, WA. Our objectives are as follows:

1. Increase the knowledge of the importance of oral hygiene in low income mothers

2. Increase the knowledge of the link between oral and systemic health in low income

mothers

3. Increase the knowledge of the effects of tobacco on oral health in low income mothers

Timeline

- May 16, 2017: We contacted Collin to ask if they would be interested in having us

come in and do a presentation.

- May 17, 2017: Collin responded and said they would be interested in having us present

to them.

- October 10, 2017: Collin contacted us and asked if we could come down to Hope Place

to tour around and discuss the presentation.

- October 20, 2017: We went to visit Hope Place. Stormy (resident who is now doing an

internship) showed us around and gave us information about what actually happens at Hope

Place. She gave us the phone number to Annette Smiley and told us to contact her to talk more.
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- October 23, 2017: Set a date and time for the presentation with Annette Smiley, the re-

covery program administrator at Hope Place. Carrie asked Dr. Chan, who she used to work for,

to donate 60 goodie bags including a toothbrush, floss, and toothpaste. He said he would.

- October 27, 2017: Carrie met with Dr. Chan at SKCC to pick up the goodie bags that

he donated to us

- November 12, 2017: Carrie purchased a sonicare to give away after the presentation

- November 17, 2017: Presented at Hope Place in Seattle, WA at 9:00 am.

- January 30, 2018: Calculated pre/post tests

- February 1, 2018: Turning in our final draft of the ADPIE paper

- March 14, 2018: Community health oral presentation to the class

Lesson Plan

We will use a powerpoint presentation. We are presenting November 17, 2017 at 9:00 am

in the dining hall at Hope Place in Seattle. There will be sixty women attending. We will also be

using a pre-test and post-test which will assess the knowledge gained by these women from our

presentation. The required resources for this presentation are a computer, a TV and HDMI cord,

pens, goodie bags, and a microphone for speaking to the group.

Budget

Expense Projected Cost Actual Cost


Supply’s $5.00 $5.00
Printing $5.00 $0 (free at library)
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Toothbrushes $120.00 $0 (donated from Dr. Chan)
Toothpaste $50.00 $0 (donated from Dr. Chan)
Dental Floss $ 80.00 $0 (donated from Dr. Chan)
Raffle Prize $75.00 $52.55
Thank you cards $12.00 $12.00
Gas $60.00 $50.00

Summary
This population lacks education on oral health and the impact it can have on the overall

health. These are low income, homeless women who are recovering from either drug abuse, sub-

stance abuse, or domestic abuse. Most of them have children and need to be informed on what is

best for their children’s teeth. They have access to care through Hope Place, which is the shelter

they reside at. We want to do a presentation to inform them about the effects of tobacco use, the

link between oral and systemic health, and overall oral health/home care. Our next step is to pre-

sent to the women at Hope Place in Seattle, WA and educate them.

Implementation

Our goal is to increase the knowledge of oral health in low income women at Hope Place

in Seattle, WA. Our three objectives were to increase the knowledge of the importance of oral

hygiene in low income mothers, to increase the knowledge of the link between oral health and

systemic health in low income mothers, and to increase the knowledge of the effects of tobacco

use in low income mothers. We implemented our project by providing information shown in a

power-point presentation. We used an HDMI cord to get the presentation from the computer to

the TV so the women could read along. We also used a pre-test before the presentation, then

asked the same exact questions on the post-test to see what they learned from the presentation.

We presented to about 40 women in the dining hall at Hope Place in Seattle, WA. Our method of
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delivery was by talking though the presentation using a microphone so everyone in the room

could hear us. We took questions at the end. We did not conduct any interviews. Our main con-

tact was Collin. After visiting Hope Place, the contact switched to the recovery program adminis-

trator, Annette Smiley. We will evaluate the outcome by grading the pre-test and post-test, and

calculating the difference between them.

Summary

We presented to women in recovery that are staying at the Hope Place shelter in Seattle,

WA. We wanted to increase their knowledge of the effects of tobacco on the body, the link be-

tween oral health and systemic health, and general oral health/home care. Our next step is to cal-

culate the pre-test and post-test to evaluate the outcome of the presentation and see what the

women learned.

Evaluation

Our presentation was somewhat successful. Toward the end, the group seemed to

get uninterested and they were ready to leave. The thing that kept them there was the fact that we

were doing a drawing for some items we had to give away. To make them stay interested, we

should have waited until the end to give them the goody bags. This way they could focus on the

presentation. We also could have saved the goody bags to use as an incentive if they took the

post-test, since only 28 people turned one in compared to the 38 people that turned in a pre-test.

For the pre-test, the mode was 80%, the median was 70%, and the mean was 66.58%. For the

post-test, the mode was 70%, the median was 80%, and the mean was 77.14%. Some of the

post-test’s questions were left unanswered. This is most likely due to the fact that they were only

turning it in to be part of the drawing. The average post-test score was 10.56% higher than the
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average pre-test score. We feel the difference in average scores might be different if more people

had participated in the post-test. To make the presentation more interesting, we could add more

pictures/videos and throw in more information we feel they would care more about. We could

also find a way to make the presentation more interactive, so they weren’t listening to us talk the

entire time. Overall, our goals/objectives were met since their knowledge did increase by an av-

erage of 10%, but we were hoping for better results.


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References

Behrens, D., & Lear, J. G. (2011). Strengthening children's oral health: Views from the field.

Health Affairs, 30(11), 2208-13. Retrieved from

http://lmcproxy.lwtech.edu:2507/login?url=https://lmcproxy.lwtech.edu:2482/docview/908419464?ac-

countid=1553

DiMarco, Marguerite Ann, PhD, MSN,R.N., C.P.N.P., Ludington, Susan M,PhD., C.N.M., & Menke,

Edna M,R.N., PhD. (2010). Access to and utilization of oral health care by homeless Children/Families.

Journal of Health Care for the Poor and Underserved, 21(2), 67-81. Retrieved from

http://lmcproxy.lwtech.edu:2507/login?url=https://lmcproxy.lwtech.edu:2482/docview/603850677?ac-

countid=1553

Gregg II, R. H., DDS, MSc. (2016, September 22). The Surprising Link Between Gum

Disease and Systemic Disease. Retrieved October 10, 2017, from

https://www.lanap.com/2016/09/22/surprising-link-between-gum-disease-and-systemic-disease/

Mofidi, M., Zeldin, L. P., & Rozier, R. (2009). Oral health of early head start children: A

qualitative study of staff, parents, and pregnant women. American Journal of Public

Health, 99(2), 245-251. Retrieved from http://168.156.198.98:2059/ehost/de-

tail?vid=8&sid=2185aecb-0d63-483a-9dba-72e40fcc9335%40ses-

sionmgr111&hid=103&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=36300877

Ratnakar, V. (2017, May 31). Impact of smoking on your oral health. EHealth, Retrieved from

http://lmcproxy.lwtech.edu:2507/login?url=https://lmcproxy.lwtech.edu:2482/docview/1

904301121?accountid=1553
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Teng, Y. A., DDS, MS,PhD , Taylor, G. W., DMD, DrPH, Scannapieco, F., DMD, PhD,

Kinane, D. F., BDS, PhD, Curtis, M., PhD, Beck, J. D., PhD, & Kogon, S., DDS, MSc.

(2002, March). Periodontal Health and Systemic Disorders. Retrieved October 10, 2017,

from http://www.cda-adc.ca/jcda/vol-68/issue-3/188.pdf

Terrades, M., Coulter, W. A., Clarke, H., Mullally, B. H., & Stevenson, M. (2009). Patients'

knowledge and views about the effects of smoking on their mouths and the involvement

of their dentists in smoking cessation activities. British Dental Journal, 207(11), E22;

discussion 542-3. doi:http://lmcproxy.lwtech.edu:2091/10.1038/sj.bdj.2009.1135

What We Do. (2017). Retrieved November 28, 2017, from https://www.ugm.org/what-

we-do/In text citation overview


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Appendix A

Lesson Plan

TITLE: “Knowledge of Oral Health”

TARGET GROUP: Low income

ESTIMATED LENGTH: 30 minutes

INSTRUCTIONAL METHOD: Presentation/Discussion

EDUCATIONAL GOAL: To increase the knowledge of low income women of the importance of good
oral hygiene and its link between overall health

INSTRUCTIONAL OBJECTIVES:
1. Demonstrate a technique for effective brushing and flossing
2. Discuss the effects of smoking tobacco
3. Explain the correlation between oral health and systemic health

INSTRUCTIONAL MATERIALS:
- Educational PowerPoint
- Toothbrush and floss for technique demonstration
- Pre-test and post-test

LEARNING ACTIVITY:
Quiz—“Knowledge of Oral Health” with multiple choice questions about general oral health, homecare,
tobacco, and systemic health

Instructional Set:
We are excited about to teach you about the importance of oral health and how it can affect your life.

Body
1. Distribute quiz and allow 5-10 minutes for participants to complete
2. Present the power-point
3. Distribute post-test and allow 5-10 minutes to complete
4. Collect tests and do a drawing to win prizes. Review the main points:
a. The effect tobacco can have on oral health
b. Link between oral and systemic health
c. Oral homecare importance
d. Basic Brushing and flossing techniques (discussion and demonstrations)
5. Allow time for questions

Closure:
We have covered quite a few topics today. The main points we want to leave you with are:
- Oral health can have a direct effect on your overall health
- Tobacco can affect your oral health and systemic health
- Proper and consistent homecare is vital to maintaining good oral health
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Appendix B

Pre-test
1. Is gingivitis reversible?

a. Yes

b. No

2. Is periodontitis reversible?

a. Yes

b. No

3. How long should you brush your teeth?

a. Until they feel clean

b. 30 seconds

c. 2 minutes

d. It doesn’t matter, as long as you brush

4. How is fluoride beneficial?

a. It is not beneficial

b. It helps prevent decay

c. Heals gingivitis

d. It whitens your teeth

5. Gum disease can be a risk factor for many systemic diseases.

a. True

b. False

6. Can an oral lesion be a sign of a systemic health problem?

a. Yes

b. No
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c. I don’t know

d. Depends on the person

7. How can gum disease affect someone with a heart condition?

a. Can cause infective endocarditis

b. It can’t affect them

c. Depends on which heart condition they have

d. The disease will spread to their heart

8. How does smoking affect oral health?

a. Tooth staining

b. Bad breath

c. Tooth decay

d. Tooth loss

e. All of the above

9. What percentage of oral cancer patients are smokers?

a. 50%

b. 75%

c. 80%

d. 90%

10. Smoking increases the risk for periodontal disease by how much?

a. 2 times

b. 3 times

c. 4 times

d. There is no higher risk for people who smoke


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Appendix C

Post-test

1. Is gingivitis reversible?

a. Yes

b. No

2. Is periodontitis reversible?

a. Yes

b. No

3. How long should you brush your teeth?

a. Until they feel clean

b. 30 seconds

c. 2 minutes

d. It doesn’t matter, as long as you brush

4. How is fluoride beneficial?

a. It is not beneficial

b. It helps prevent decay

c. Heals gingivitis

d. It whitens your teeth

5. Gum disease can be a risk factor for many systemic diseases.

a. True

b. False

6. Can an oral lesion be a sign of a systemic health problem?

a. Yes

b. No

c. I don’t know

d. Depends on the person


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7. How can gum disease affect someone with a heart condition?

a. Can cause infective endocarditis

b. It can’t affect them

c. Depends on which heart condition they have

d. The disease will spread to their heart

8. How does smoking affect oral health?

a. Tooth staining

b. Bad breath

c. Tooth decay

d. Tooth loss

e. All of the above

9. What percentage of oral cancer patients are smokers?

a. 50%

b. 75%

c. 80%

d. 90%

10. Smoking increases the risk for periodontal disease by how much?

a. 2 times

b. 3 times

c. 4 times

d. There is no higher risk for people who smoke


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Appendix D

# of tests Mode Median Mean

Pre-test 38 80% 70% 66.58%

Post-test 28 70% 80% 77.14%

Pre-test Post-test

100

80

60

40

20

0
Mode Median Mean

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