Running head: COMMUNITY DENTAL HEALTH PROJECT: L’ARCHE

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

Alicia Gardner

Kat Mundell

Lillias Ojala

Community Dental Health III

Fall Quarter, 2017

11/29/17
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Assessment

Our target population was people with developmental disabilities. This population has

little access to oral health resources. We chose to do this project because one way to increase

their resources is to teach their caregivers about oral health. A group member had worked as a

caregiver for people with disabilities and was taught very little about oral health or how to

properly take care of her client’s teeth. We contacted her old supervisor from L’Arche Tahoma

Hope and she agreed to let us do a presentation during one of their weekly meetings.

Community profile

According to a review of studies from the Washington State Institute for Public Policy,

the population of people with disabilities is diverse (Lee & Miller, 2009). In other words, a

description that fits one individual may not fit another. Therefore, it is difficult to pinpoint a

community profile on this diverse community. According to this same study, in 1971, the state of

Washington decided children with disabilities have a right to a free education, meaning all

people with disabilities went through school. Also around this time, funding started going

towards more local, residential homes, versus state institutions. People with developmental and

intellectual disabilities now live more in residential homes instead of institutions. This

community receives money through programs such as Division of Developmental Disabilities

(DDD) and the Department of Social and Health Services (DSHS). About 79,000 people with

intellectual disabilities live in Washington State. After age 21, they can receive money from

DDD through employment and day programs. They can also receive money through Medicaid.

According to Stephanie Lee and Marna Miller, out of the people that receive developmental
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disabilities services in Washington State, 62% are non-Hispanic white, and 36% are a minority.

81% non-Hispanic whites that receive services live in residential communities similar to the

community we served (Lee, Stephanie and Miller, Marna., 2009).

Needs Assessment

Our contact for L’Arche Tahoma Hope was Teresa Hershberger. She mentioned the core

members, or residents, sometimes do not let the caregivers brush their teeth for more than 30

seconds. The caregivers go through 75 hours of training to become Home Care Aids, but the only

training on oral health they receive is how to brush dentures. There is a need for the caregivers to

be educated on proper oral hygiene of their clients in order to increase the knowledge and health

of this community.

L’Arche Tahoma Hope is in Tacoma, WA. This city has fluoridated water. This specific

community mostly goes to public dental clinics, such as DECOD at the University of

Washington. This community has a very low income due to their disabilities and inability to

work. As a result, they receive money from state programs that support them and their needs.

This population does not get a specific stipend for hygiene products, specifically, oral hygiene

products such as toothbrush, toothpaste, dental floss, etc.

Literature Review

People with developmental disabilities are prone to dental decay and have a higher

chance of periodontal disease. Caregivers as a whole are severely under trained in oral health.
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This population is also at a greater risk for oral pathology since it can be difficult to detect. All

these topics made us concerned for this population and want to help in educating caregivers.

One article demonstrated a definite link between periodontal infection and cardiovascular

disease. It showed that inflammatory factors from periodontitis and poor oral hygiene may be the

cause of cardiac and cerebrovascular problems, including myocardial infarction and pulmonary

disease. The disabled population would be at a greater risk of these health problems because

they tend to have worse oral hygiene (Arigbede, A., Babatope, B., etc., 2012).

Dental caries is a widespread disease, and the presence of specific bacteria in the oral

environment leads to the development of caries. Dental plaque is a contributing factor in the

development of dental caries. Good oral hygiene leads to a reduction in caries, which is why we

would like to teach oral hygiene to the caregivers. Being educated on the decay process and how

to give proper oral hygiene care should significantly improve the outcome of dental disease

(Peterson, S., Snesrud, E., etc., 2013).

One of the articles we looked at before completing our presentation​ compares disparities

between adults with different types of disabilities. This article by Minihan, P.M., Morgan, J.P.,

Park, A, ect. also compares people with and without disabilities. According to this article, people

with disabilities were 1.4 times less inclined to see a dentist in a year compared with a person

without a disability. People with intellectual disabilities (IDD) are more inclined to see a dentist

when compared to someone without a disability. On the other hand, the article also states people

with intellectual disabilities are more likely to have oral health troubles. The article concluded

“caregivers play an important role in providing at-home oral care, and they must be included in
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efforts to improve oral health outcomes for people with DDs [developmental disabilities].”

(Minihan, P.M., Morgan, J.P., Park, A, ect., 2014).

Another article we found discussed oral hygiene disparities people with

disabilities face. “People with disabilities experience worse health and poorer access to health

care compared to people without disability.” (Havercamp, Sm.M. and Scott, H.M.). People with

disabilities may need assistance in their daily dental routine. Little is known about how trained in

oral hygiene the caregivers are. Caregivers reported brushing their clients teeth less than twice a

day. When asked about flossing, the caregivers reported that flossing was most likely not

completed. Some of the reasons caregivers did not complete a dental hygiene routine were their

clients behavior and physical obstacles. The article concluded that there are challenges,

especially in flossing that prevent people with disabilities getting satisfactory dental hygiene.

(Havercamp, Sm.M. and Scott, H.M., 2014)

In another article the authors aim to identify factors which influence the oral status of

patients with mental disabilities by assessing the type and degree of their mental disability, the

mood, motivation, and behavior of the patients and/ or their caregivers, side effects of

medications, lifestyle factors that could influence their oral health status, and the training level of

caretakers. Their goal is to make aware the reason for the increased need for routine oral

hygiene care due to the high levels of periodontal disease and dental caries often seen in mentally

disabled people (Solanki, Khentan, Gupta, Tomar, Singh, 2015).

The authors of this article thoroughly explained the information they wanted to convey.

They provided complete and accurate definitions of what mental disabilities are with resources to
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back up the information they provided. This article is useful for my project because my goal is to

make the caregivers I will be presenting to aware of the oral diseases that can occur in mentally

disabled people, and this article helps to back up the information I want to give to the caregivers.

In the last article we looked at, the authors’ goal is to determine whether dental caries and

periodontal disease is more prevalent in patients with cerebral palsy as compared to patients

without cerebral palsy and who are otherwise healthy. The authors conducted research on

participants aged 2-18 with varying levels and types of cerebral palsy, taking into consideration

demographics, socioeconomic status, health perception, and systemic characteristics (Cardoso, et

al., 2014).

The authors of this article had a clear idea of the information they hoped to discover

when conducting their research. They made aware the parts of their research that were not useful

and the parts they had to exclude for various reasons. The findings of the research were clearly

explained and easy to understand. This article is useful in my project because it establishes that

people with mental and physical disorders (cerebral palsy in this case) are more prone to dental

caries and periodontal disease, which is what I would like to convey to the caregivers I will be

presenting to.

Based on our research, we became concerned with people with developmental disabilities

because they are an underserved population. They have an increased rate of caries and

periodontal disease. In order to reach this community, we decided to increase the oral health

knowledge of caregivers.
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Diagnosis

The most important need is that the caregivers of this population are lacking proper

training in oral hygiene so they may be practicing poor oral homecare on their clients. A

secondary need is that this population needs assistance in oral healthcare. Some need reminders

to take care of their teeth, others may need their teeth brushed and flossed for them. Most of this

population needs help in going to the store to purchase oral hygiene products. Programs already

serving this population are Medicare, Medicaid, DSHS, and DECOD.

Our target population is the residents at L’Arche Tahoma Hope. The residents are

developmentally disabled adults that live in a residential setting. We selected this group because

one of our group members used to work at this community facility and was aware of the need of

increased oral hygiene education. The size of the target population is approximately 20 people.

To access this target population, we presented to the caregivers at L’Arche Tahoma Hope in

Tacoma, Washington. At the presentation there were 17 caregivers.

Planning

To plan for our community health project, Kat emailed a community coordinator in April

that she previously worked with, and asked if they would be interested in being the host of our

project. They emailed back and stated they would be interested. The community coordinator

requested we provide a test for the caregivers we would be presenting to so they could receive

continuing education credits toward their license. The next phase of our planning involved the

kind of presentation we wanted to do. We decided on a visual and oral presentation with some
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hands-on demonstrations. We sent an outline to the coordinator at her request. We wrote an

initial quiz with information from our PowerPoint. The community coordinator decided she

wanted a PowerPoint presentation to turn into the state to get the presentation approved for

continuing education credits. One of our group members contacted her employer, a dentist, and

asked if he would be willing to donate oral hygiene products and let us borrow dentoforms. We

also emailed the Oral B/Crest representative that we had previously talked to at the Pacific

Northwest Dental Conference to ask if he would still be willing to donate hygiene products as

well. We started to develop our goals of the presentation. We brainstormed on what activities

and demonstrations we would do. Our group finalized the presentation by finishing the

PowerPoint and practicing our presentation. We edited our pre and post-test so that it coincided

with the material from our PowerPoint. Our group members each gathered materials for the

presentation which included dentoforms, goodie bags, and snacks a few days prior to the

presentation.

Project Goal and Objectives

Our goal for this presentation was to educate the caregivers at L’Arche Tahoma Hope

about oral health. We had three objectives. The first objective was to increase the knowledge

about oral hygiene of the caregivers at L’Arche Tahoma Hope.The second objective was to

increase the knowledge of the caregivers at L’Arche Tahoma Hope about oral pathologies. Our

third and final objective was to increase the knowledge of the caregivers at L’Arche Tahoma

Hope about the relationship of overall health and oral health.

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Timeline

April 12, 2017- We emailed Teresa Hershburger, one of the community coordinators at L’Arche

Tahoma Hope, asking whether the community would be interested in a presentation about oral

health.

April 18, 2017- Teresa emailed us back agreeing to the presentation.

May 15th, 2017- Emailed Mark Hedgeberg, Oral B representative, about donating homecare aids

for our project.

Spring 2017- During Community Dental Health classes, we formed the goal and objectives of

our presentation.

July 25, 2017- We created an agenda and wrote a pre-and post test and emailed it to our contact.

Aug 10, 2017- Messaged Lillias’ previous employer to ask to borrow dentoforms and if he was

willing to donate any toothbrushes

Aug 24, 2017- Finalized power point presentation, interactive activities, and edited the pre-post

test.

Sept 6, 2017- Presented to L’Arche Tahoma Hope.

Spring 2018- Present about our experience to staff and first years.

Lesson Plan
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We planned to present our project on September 6th, 2017 at 10:00 AM at L’Arche

Tahoma Hope in Tacoma, WA. The room we presented in was a living room with a small

projector set up. There were thirteen people who participated in the presentation. By the end, a

couple more people had joined the group. The resources we needed for the presentation were a

laptop, a projector, goodie bag supplies (toothpaste, toothbrushes, floss), dentoforms (big and

regular sized), masks, and gloves. The method that we used to teach our group was a visual and

oral presentation using a Powerpoint. During the Powerpoint presentation we demonstrated how

to brush teeth properly on dentoforms. We passed around three dentoforms and toothbrushes so

everyone could practice. We also demonstrated how to floss using the C shape method by

bringing up a couple of volunteers to stand side by side (acting as teeth) and using a rope (acting

as the floss) and floss in between the two “teeth”. Anyone who wanted to try flossing was

encouraged to go up and practice.

*For the full lesson plan see the appendix.

Budget

The proposed budget for our project: our goal was under $51.50

The final budget for our project: $47.39

Total Difference between proposed and actual budget: $4.11

Flossers Brushes Floss Toothpaste Activity Snacks Gas

Supplies

Estimated 1.50 0 0 0 5 20 25
Budget (donated)
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Actual 2.20 0 0 0 0 20.19 25

Budget

Summary

The population we presented to is a group of caregivers that aids disabled people in

everyday life. They go through a short training course to learn the basics of how to care for

people with disabilities, but they do not receive much education in oral health. The only oral

health information they are taught is how to clean a denture properly. In order to better care for

their patients, it is important that the caregivers know the basics of periodontal disease, how to

properly brush and floss, and the connection between oral health and systemic health. The next

phase in our program planning is Implementation.

Implementation

Our first objective was to increase the knowledge about oral hygiene of the caregivers at

L’Arche Tahoma Hope. Our second objective was to increase the knowledge of the caregivers at

L’Arche Tahoma Hope about oral pathologies. Our third and final objective was to increase the

knowledge of the caregivers at L’Arche Tahoma Hope about the relationship of overall health

and oral health.We planned to present our project on September 6th, 2017 at 10:00 AM at

L’Arche Tahoma Hope in Tacoma, WA. We presented to about thirteen people. The method that

we used to teach our group was to visually and orally present with a Powerpoint. During the
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Powerpoint presentation we demonstrated how to brush teeth properly on dentoforms. We passed

around three dentoforms and toothbrushes so everyone could practice. We also demonstrated

how to floss using the C shape method by bringing up a couple of volunteers to stand side by

side (acting as teeth) and using a rope (acting as the floss) and floss in between the two “teeth”.

See lesson plan (Appendix A). We plan to evaluate the outcome of our community project by

comparing a pretest and posttest that we gave to the caregivers to complete before and after our

presentation (Appendix B and C, respectively).

Summary

We completed a presentation to caregivers of people with developmental disabilities in hope of

increasing their knowledge of oral hygiene and why it is important. We plan to evaluate the

success of our presentation by comparing the pre and post test the caregivers completed. The

next phase of our community health project is the evaluation phase.

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References

Arigbede, A., Babatope, B., & Bamidele, M. (2012). Periodontitis and systemic diseases: A

literature review.​ Journal of Indian Society of Periodontology, 16​(4), 487-491.

doi:​http://dx.doi.org/10.4103/0972-124X.106878

Cardoso, A. M. R., Gomes, L. N., Silva, C. R. D., de S. C. Soares, R., de Abreu, M. H. N. G.,

Padilha, W. W. N., Cavalcanti, A. L. (2014). Dental caries and periodontal disease in

Brazilian children and adolescents with cerebral palsy. ​Int J Environ Res Public Health​.

Retrieved from ​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306865/

Havercamp, S., Scott, M.A. (2014). National Health surveillance of adults with

disabilities, adults with intellectual and developmental disabilities, and adults with no

disabilities. ​Disability and Health Journal​, 8(2), 165-72. doi: 10.1016/j.dhjo.

2014.11.002

Lee, Stephanie and Miller, Marna. (2009). ​Children and adults with developmental disabilities:

Services in Washington, research evidence.​ Olympia: Washington State Institute for

Public Policy, Document No. 09-10-3901.

Minihan PM, Morgan JP, Park A, et al. (2014). At-home oral care for adults with

developmental disabilities: A survey of caregivers. ​Journal of the American Dental

Association, ​45(10):1018-1025. doi:10.14219/jada.2014.64.

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Peterson, S. N., Snesrud, E., Liu, J., Ong, A. C., Kilian, M., Schork, N. J., & Bretz, W. (2013).

The dental plaque microbiome in health and disease.​ PLoS One, 8​(3).

doi:​http://dx.doi.org/10.1371/journal.pone​. 0058487

Solanki, J., Khentan, J., Gupta, S., Tomar, D., Singh, M. (2015). Oral rehabilitation and

management of mentally retarded. Journal of Clinical and Diagnostic Research. Retrieved

from ​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347189/
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Appendix A

Lesson Plan

I) Oral Health Knowledge

1) Areas that are easily missed areas while tooth brushing

i. Tongue
-Tongue scrapers
- Bacteria on tongue
ii. Palate
iii. Tips to reduce missed areas
-Tip head back
Iv. inside of lower front teeth
-hold toothbrush vertically
V. cheek side of upper molars
-have patient close halfway to increase elasticity of cheeks

2) If you only have 30 secs to complete tooth brushing

i. Give distraction
- Toy or something to hold
- For Core Members that brush independently, assistant can say reminders
like, “Make sure to get _____ really well!”

3) Brush Technology
i. Get into sulcus (between gums and teeth) using brushing techniques
ii. Brush lower teeth at night, upper teeth in the morning
iii. Focus on back side of teeth toward the tongue, and lower front teeth
iv. To clean brush: Put in very warm water for 30-60 mins
-Replace toothbrushes after 3 months or if the bristles are splayed out
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II) Pathology/ Periodontal Disease

1. Intraoral signs of disease

i. What to look for: patches, white spots, abnormal growths, tongue coating
ii. Areas of mouth to check: inner cheeks, tongue, inner lip/lips

1. Periodontal disease process

i. How disease begins - Gingivitis occurs first and is reversible.
● Lack of good home care can lead to gingivitis.
● Takes 10-21 days to develop gingivitis
● Takes about a week to reduce inflammation
Ii. Periodontal disease occurs next. Gingiva starts detaching from tooth. Bone loss can
occur and is not reversible.
iii. Periodontal disease is a source of chronic inflammation
iiii. How disease progresses

III) Link between oral health and overall health

1. Medications
i. Most common symptom is xerostomia (dry mouth)
● Xerostomia increases caries risk
● Suggest saliva substitute
● Rinse with water after taking medication

Ii. Gingival hyperplasia (gum overgrowth) caused by certain medications (Dilantin)

Ii. Candidiasis (fungal infections) - caused by corticosteroids or antibiotics

2) How disease of the mouth can affect the rest of the body, and vice versa
i. Periodontal disease may lead to systemic disease through
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a.Plaque accumulation (biofilm)

b.Inflammatory mediators - endotoxins enter blood circulation
c.Shared risk factors

ii. How systemic disease can affect the mouth/ signs

1. Increased risk for cavities
2. Increased biofilm (plaque)
3. bleeding of gums
4. Oral infections
5. Xerostomia (dry mouth)
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Appendix B

Pre-test

1. What color should gums be?

a. Rose Red
b. Coral Pink
c. Hot Pink
d. Blood Orange

2) What shape should your floss be while flossing around a tooth?

a. C
b. L
c. V
d. T

4) How often should a toothbrush be replaced?

a. Once a week
b. Once a year
c. Once every 3 months
d. Once every 6 months

5) If a patient has dry mouth, can their oral health be affected as a result?
a. Yes
b. No

6) Which two are the most common areas to find signs of oral cancer? (Choose 2 answers)
a. Inner lip
b. Tongue
c. Inner cheeks
d. Roof of mouth
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7) What is the most important factor of brushing your teeth?

a. Type of toothpaste (baking soda, fluoride, etc.)
b. Brushing technique and frequency
c. Using an electric toothbrush

8) What causes tooth decay?

a. Food
b. Acid
c. Hormones
d. Hard, crunchy foods

9) Periodontal disease (gum disease) is reversible.

a. True
b. False

10) Gingivitis is reversible:

a. True
b. False

11) How is plaque removed?

a. Rinsing with water
b. Using mouth rinses
c. Mechanically with toothbrush
d. Chewing forces while eating

12) Which periodontal condition affects the bone in the mouth?

a. Gingivitis
b. Periodontal disease
c. candidiasis
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Appendix C

Post-test

1. What color should gums be?

a. Rose Red
b. Coral Pink
c. Hot Pink
d. Blood Orange

2) What shape should your floss be while flossing around a tooth?

a. C
b. L
c. V
d. T

4) How often should a toothbrush be replaced?

a. Once a week
b. Once a year
c. Once every 3 months
d. Once every 6 months

5) If a patient has dry mouth, can their oral health be affected as a result?
a. Yes
b. No

6) Which two are the most common areas to find signs of oral cancer? (Choose 2 answers)
a. Inner lip
b. Tongue
c. Inner cheeks
d. Roof of mouth
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7) What is the most important factor of brushing your teeth?

a. Type of toothpaste (baking soda, fluoride, etc.)
b. Brushing technique and frequency
c. Using an electric toothbrush

8) What causes tooth decay?

a. Food
b. Acid
c. Hormones
d. Hard, crunchy foods

9) Periodontal disease (gum disease) is reversible.

a. True
b. False

10) Gingivitis is reversible:

a. True
b. False

11) How is plaque removed?

a. Rinsing with water
b. Using mouth rinses
c. Mechanically with toothbrush
d. Chewing forces while eating

12) Which periodontal condition affects the bone in the mouth?

a. Gingivitis
b. Periodontal disease
c. candidiasis