Exam #2 Review

Reliability

consistent and repeatable

Specificity

correctly identifies absence of the variable

Summative

evaluation at the end

Formative

evaluation throughout •Opportunity to implement changes to improve assessment results

F

filled, because of caries, with no new or recurrent decay

N = NEGOTIATE

finding mutually acceptable options that do not contradict, but incorporate patient's beliefs

H = HEALERS

previous advice sought from alterative healers/friends

T = TRUST

take time and consciously work to establish trust and fulfill promises

def

• d= decayed with no recurrent caries • e= severe caries and indicated for extraction • f= filled because of caries •Missing teeth are not scored

dmf

• d= decayed with no recurrent caries • m = missing because of caries (not due to exfoliation) • f= filled because of caries

Community profile

detailed, comprehensive description

Question Format

1.Question 2.Completion 3.Negative 4.Double true-false

E = EXPLANATION

patient's perception of the illness/problem (the cause)

Assessment Definition

"The regular and systematic collection, assemblage, and analysis of data resulting in communication regarding the health of the community." •Collecting data to determine what the community needs

Assessment is also referred to as?

"needs assessment"

To improve the oral health amount those with disabilites

1. The oral health coalition will approve an oral health campaign for those with cognitive disabilities within 3 months. 2. Caries incidence of those with cognitive disabilities will be reduced by 25% within 5 years A. The city council will implement a free dental care event for individuals with cognitive disabilities within 3 years B. 50% of caregivers will self-report performing oral hygiene care daily 1 year after the program C. 75% of caregivers of an individual with cognitive disabilities will describe 3 oral health disparities among those with cognitive disabilities by the end of the program

Our Role in Each Stage

1.Precontemplation—explain the need for change; personalizing information on risks and benefits 2.Contemplation—encourage making plans for change 3.Decision/Determination—assist with plans and setting goals; develop gradual, reachable goals 4.Action—provide support, feedback, and motivational reminders 5.Maintenance—offer reminders and help avoid relapses

Water Equity - Nat'l Framework

(with some Virginia tweaks!) Our Mission: All Virginians have access to safe, trusted, affordable, fluoridated water - and they drink it!

It's Complicated

-Fluoride is great and all but my water is brown -Huh? -Fluoride makes kids stupid -32 oz of glacier water a day -I can barely pay my water bill

The community health program planning process

1. Assessment 2. Planning 3. Selecting Intervention 4. Implementation 5. Evaluation

6 stages of cultural competence continuum

1. Cultural Destructiveness •Policies and practices within a system that are destructive to a cultural group 2. Cultural Incapacity •Ineffectively responding to the needs of the cultural group •Not destructive, but ineffective 3. Cultural Blindness •Treating all people the same •Ignoring cultural differences •Lack of workforce diversity •No resources dedicated to cultural knowledge 4. Cultural Pre Competence •Awareness of strengths and areas of improvement needed to respond to diverse populations •Diverse workforce, but no clear plan for achieving organizational cultural competence 5. Cultural Competence •Demonstrate an acceptance and respect for cultural differences 6. Cultural Proficiency •Systems and organizations hold culture in high esteem •Foundation that guides all their endeavors

Community Organization Theory: Key Components

1. Empowerment •Gaining power over oneself or one's community to produce change 2. Community Competence •Community's ability to engage in effective problem solving 3. Participation Relevance •Community as the active participant 4. Issue Selection •Identifying concerns as the focus of action 5. Critical Consciousness •Developing the understanding of root causes of problems

Stage of Change Theory

1. Precontemplation •Unaware of problem; no thought of changing 2. Contemplation •Thinking about change in the near future 3. Decision/Determination •Making a plan to change 4. Action •Implementing specific action or plans 5. Maintenance •Continuing desirable actions

Intrapersonal Level: Stages of Change Theory Focuses on STRATEGIES

1. Precontemplation: I don't have a problem 2. Contemplation: I'm thinking about it 3. Decision/Determination: I'm ready 4. Action: I'm taking action 5. Maintenance: I'm doing it

What is Wet?

1. Public Health 2. Policy 3. Clinical & community care 4. Comprehensive health 5. Public Awareness

Cultural competence Education Model: 3 Steps to becoming culturally competent

1. Self-assessment/Self-exploration •Become aware of one's own culture •Accept different values, attitudes, and beliefs 2. Knowledge •Understand one's culture is not superior to another •Recognize similarities and differences 3. Skill •Mastering communication with persons from different cultures •Seeking information about different cultures in the society

WET Tackforce: Biannual meetings (you're here)

1. Steering Committee: Quarterly meetings, Crosspollination 2. Workgroup:Virtual meetings, Regular communication, Workplans, Shared goals 3. Workgroup:Virtual meetings, Regular communication, Workplans, Shared goals

Four different locations

1.Park Place Dental Clinic—Norfolk (1:00-4:00—arrival time of 12:30) 2.Hampton Roads Community Health Center—Norfolk (8:45-12:00 and 1:00-3:30—arrival time of 8:15) 3.Chesapeake Care Clinic—Chesapeake (12:30-4:30—arrival time of 12:00) 4.Western Tidewater Free Clinic—Suffolk (8:00-12:00—arrival time of 7:30; 1:00-4:00—arrival time of 12:30)

Examples of information for a Community Profile

1.Physical and spatial characteristics •Ex. Geographic boundaries, population, physical condition of neighborhood, transportation 2.Community inventory •Ex. History of the community, traditions, social norms, dominant beliefs, support 3.Sociodemographic characteristics •Community demographic data—population age, gender, race, ethnicity, etc. •Social demographic data—civic engagement, enrollment in government and public assistance programs 4.Vital events •Ex. Birth rates, life expectance, mortality rate, morbidity rates, marriages •Leads to the development of programs that advocate for change or educate the community •By this phase, assets, gaps, needs, problems, resources, solutions, and partnerships have been considered

How could you navigate a perio patient through the Stages of Change Theory?

1.Precontemplation 2.Contemplation 3.Decision/Determination 4.Action 5.Maintenance

DNTH 419 Sign ups and Requirements

1.15-16 hours at assigned public health site 2.Participation in an Interprofessional Experience 3.Head Start Site 4.Two oral health literacy forums with lesson plans 5.Two community events 6.One SADHA event

WorkGroups

1.Access and Affordability: All people have access to clean, safe, affordable water •Affordability •Access to infrastructure •Water quality 2.Consumer Literacy: Virginians choose tap water as their preferred beverage •Trust •Literacy •Promotion 3.There is community resilience in the face of a changing climate 4.The community and economic benefits of water infrastructure investment are maximized

Factors that Influence Culture

1.Age 2.Socioeconomic Status (SES) 3.Gender 4.Educational attainment 5.Geography 6.Family 7.Place of birth 8.Length of residence in the U.S. 9.Religious beliefs 10.Individual experiences 11.Sexual preference 12.Power relationships

Process to develop cultural sensitivity

1.Assess your own cultural beliefs and values 2.Recognize your own cultural influences affecting communication 3.Recognize your own cultural biases 4.Be knowledgeable of the patient's belief system 5.Be sensitive to gestures, concerns, and questions 6.Be able to collect culturally relevant data 7.Listen and observe 8.Be aware and respectful of cultural differences

Steps to determine and prioritize community oral health issues

1.Develop prioritization process •Need community input 2.Clear determination of oral health priorities •WITH the community 3.Determine community's capacity to address the priorities •What resources are available? How can they be expanded and maximized? 4.Likelihood priority will lead to a change •What is the realistic degree of change to be achieved in a time period? 5.Assess economic, social and political issues •May have to expand partnerships 6.Identify best practices to determine effective approaches Report the Findings •Present results to the target audience •These results used for program planning •Advisory committee creates a research report to present findings, including a Community Profile •Community snapshot= broad, initial description •Community profile= detailed, comprehensive description •Helps stakeholders and funders visualize the community

Two parts of this step

1.Developing program goals and objectives 2.Selecting and planning the intervention for the community

Methods of Conducting a Needs Assessment

1.Direct Observation •Time consuming, not cost effective for large groups 2.Interview •Time consuming, not cost effective for large groups 3.Questionnaire •Must be well written and easy to understand 4.Survey •BEST choice for large groups, must be well written 5.Epidemiological Surveys •Research based 6.Records, documents, charts •Review of documented records

Experiences that WILL count toward this requirement

1.Eastern Shore Head Start 2.Center for Global Diplomacy Community Fair 3.Chesapeake Care Clinic Dental Access Days 4.Senior Oral Screenings Event 5.Holiday House ANOTICE: If you have not participated in at least TWO events advertised by course director, you will be responsible for finding an event on your own

Phase 3: Information falls into 3 categories

1.Health status •Births, illnesses, deaths 2.Health risks and protective factors •Self-reported health status, health knowledge, use of preventive health services 3.Access to public health, healthcare, and social service •Access to preventive services, access to health professionals •Categories of Data Collected: •Quantitative •Numerical data •Demographics, statistics, incidence or prevalence rates of disease •Ex. Health status data—births, illness, deaths •Qualitative •Adds meaning to quantitative data •Gives answer to the "why" problems exist •Personal interviews, participant observations, focus groups •Ex. Self-reported health status—collected in the form of a personal interview •Also includes compiling existing data •Government agencies, private organizations, and nonprofit organizations •Reports on oral health status and trends •NHANES—National Health and Nutrition Survey •Local information •Reports, magazines, newspapers •Previous assessments conducted in the community

Elements of a program plan

1.Identification of program goals and objectives 2.Strategies and specific activities to meet objectives 3.Resources required 4.Timetables and deadlines clearly outlined, with some flexibility 5.Projected budget and budget justification 6.Program promotion and marketing 7.Identification of Strengths, Weaknesses, Opportunities, and Threats (SWOT analysis)

Guidelines for delivering oral health care to diverse populations

1.Incorporate cultural practices into education and treatment when appropriate 2.Sensitively discourage harmful practices 3.Incorporate culturally competent communication into oral health education 4.Deliver dental hygiene services in a culturally sensitive manner and environment 5.Develop relationships with health professionals from other ethnic and minority groups to promote a collaborative effort to improve the groups' oral health

Role of the Dental Hygienist in Community Health Planning and Practice

1.Program planner or initiator 2.Consultant and resource person 3.Service provider 4.Administrator, manager, or both 5.Researcher and data collector 6.Educator and oral health promoter 7.Consumer advocate 8.Politician

CDC steps for Effective Health Communication

1.Review background information to describe the public health problem 2.Define specific desired behavior-change goals and set communication objectives 3.Segment target audience and perform market research to analyze the population 4.Identify and pretest message concepts that need to be communicated 5.Select, create, and pretest messages and products 6.Develop a production and promotion plan to launch the communication program 7.Implement communication strategies and evaluate process 8.Conduct outcome and impact evaluation to determine if change took place

Same Steps used for an Oral Health Program?

1.Review background information to describe the public health problem 2.Define specific desired behavior-change goals and set communication objectives 3.Segment target audience and perform market research to analyze the population 4.Identify and pretest message concepts that need to be communicated 5.Select, create, and pretest messages and products 6.Develop a production and promotion plan to launch the communication program 7.Implement communication strategies and evaluate process 8.Conduct outcome and impact evaluation to determine if change took place

Potential purposes of the Community Needs Assessment

1.Target resources to specific populations 2.Educate decision makers 3.Build a constituency for oral health issues 4.Establish baseline data or update data 5.Evaluate existing programs 6.Prioritize programs or justify a budget 7.Generalize findings to the target population

Characteristic of an Effective Dental Indices

1.Validity—accurately measures what is intended 2.Reliability—consistent and repeatable 3.Simple—clear criteria, objective, easy to understand, simple to use and calculate, requires minimal equipment 4.Sensitivity—can detect small shifts in disease 5.Specificity—correctly identifies absence of the variable 6.Acceptability—application is not unnecessarily painful, time demanding, or demeaning to participants 7.Quantifiability—statistics can be applied to data collected with the index 8.Clinical significance—index criteria are clinically meaningful Categories of Dental Indices: •Reversible •Measures conditions that can be reversed or resolved •Irreversible •Measures cumulative conditions that cannot be reversed •Simple •Measures presence or absence of a condition •Cumulative •Measures all the evidence of a condition, both past and present

Competencies divided in 4 categories

1.Values/Ethics for Interprofessional Practice 2.Roles/Responsibilities 3.Interprofessional Communication 4.Teams and Teamwork

Questions to Answer During a Community Assessment

1.What community strengths, assets, and resources influence oral health in the community? 2.What are the oral health problems, concerns, and obstacles faced by the community? 3.What are the potential solutions? 4.What capacities, resources, and interventions are available within the community to promote oral health? 5.What factors contribute to the community oral health gaps and needs? 6.What partnerships in the community can support strategies to ensure future health improvement?

Determining Health Priorities: •Questions to consider

1.What is the magnitude of the problem? 2.How many people are affected? 3.What types of resources are available?—personnel, money, facilities 4.What has already been done in the community? 5.What are the prevailing attitudes toward the problem? 6.Which groups are expressing the most interest in the problem? 7.What are the legal constraints?

How many americans are considered to have low health literacy?

90 Million

A

Achievable; objective is possible and able to be attained

N = NEGOTIATE

Agreement

A = ACKNOWLEDGE

And discuss the differences and similarities between these perceptions

What are some examples of differences in communication among cultures?

Body language (no personal space), Hand gestures, Eye contact

C

Challenging; stretches the group to focus on a significant improvement

Phase 4

Collect Data

Participation Relevance

Community as the active participant

Community Competence

Community's ability to engage in effective problem solving

Phase 2

Complete a self-assessment to establish the purpose of the Community Needs Assessment

Type I

Complete exam using all examination instruments, full set of x-rays, and when needed: study models, lab tests, percussion, and pulp vitality tests

Review of Assessment

Components of Assessment •Agency Description and Mission Statement •Review of the Literature •Social Determinants of Health

Phase 1

Cultivate partnerships and select and advisory committee

Health Care Literacy Model put it all together

Cultural competence, health literacy, and our role

Fluoride Status Indices

Dean's Fluoride Index (DFI)/Community Fluorosis Index (CFI)•One of the most universally accepted fluorosis index •Simple and easy to use •Used to establish prevalence of fluorosis in the population Dean's Fluorisis Index (DFI)/Community Fluorisis Index (CFI): Criteria •A single score for an individual given based on the 2 most affected teeth •If the 2 teeth are not equally affected, then the less affected tooth is scored •If there is any doubt, the lower score is recorded

Phase 3

Design and organize the needs assessment

Critical Consciousness

Developing the understanding of root causes of problems

Ms. Howell's #1 Test Taking Tip

Do no 2nd Guess Yourself •Always go with your first instinct when you are in doubt •Only change your answer when you have proof your initial answer was incorrect Remember, you have studied and know the information—Trust yourself and be confident! "Forget all the reasons it won't work and believe the one reason that it will."- unknown

Health Care Literacy Model

Endorsed by the office of disease prevention and health promotion

ICP=

Interprofessional Collaborative Practice

Phase 7

Evaluate the Needs Assessment

Making a change

Example: A local dental hygiene association works to ban sugary snacks and beverages from vending machines in schools •Health Education—teaching the effects of a sugary diet •Health Promotion—increasing awareness of availability of sugary foods AND promoting actions to decrease the children's access to them •The act of working to make a behavioral change—MORE than solely educating

IPEC

Interprofessional Educational Collaborative

Dean's Fluorosis Index (DFI)/Community Fluorosis Index (CFI): Scoring

Fluorosis Index = (n ×w )/N ; where, n= number of individuals in each category, w= weighting of each category, N= total # of individuals in the population •Step 1 •Assign each individual in the population a category based on the 2 most affected teeth •Step 2 •Tally the total number of individuals in each category •Step 3 •Multiply the total number of individuals in each category by the category weight •Step 4 •Add ALL categories and divide by total number of individuals in the population

Empowerment

Gaining power over oneself or one's community to produce change

Issue Selection

Identifying concerns as the focus of action

Promotion and Marketing of Program

Important for participation, recognition, and success of the program

What is Health Literacy?

Knowledge and taking knowledge to make decisions about your health.

Type II

Limited exam using mirror, explorer, lighting, posterior BWX, and PAs when needed

Why is health literacy important to oral health status?

Make sure they understand the information that we are providing them

M

Measurable; info can be collected, detected, or obtained

Cumulative

Measures all the evidence of a condition, both past and present

Reversible

Measures conditions that can be reversed or resolved

Irreversible

Measures cumulative conditions that cannot be reversed

Simple

Measures presence or absence of a condition

NBDHE

National Board Dental Hygiene Examination

Phase 3: Design and organize the needs assessment

Needs assessment must be designed to collect data related to the current status of assets, gaps, needs, problems, resources, solutions, and partnerships in community

Janet is a 45 year-old female who is the primary caregiver for her mother. She took her mother to be tested for Dementia because she noticed a change in her behavior. The mother speaks English very well and has integrated in American culture, but was born and raised in the Philippines. During the test, the physician showed the mother a picture of a hippopotamus to identify as part of the testing. The mother was unable to identify the animal because hippos are not commonly seen in the Philippines. Janet tried to explain this to the physician, but he was very dismissive and assumed it was a sign of cognitive impairment. How would a culturally competent provider respond in this scenario?

Physicians should be aware of the patient's culture and not stereotyping this certain individual.

Phase 6

Prioritize Issues and Report Findings

Phase 5

Organize, Review, and Analyze the Data

R

Relevant; to the overall vision and mission

CAUTION: BE AWARE OF

STEREOTYPING

All Virginians Have Access to

Safe, Trusted, Affordable, Fluoridated Water - and they drink it

S

Specific; how, what, who, where, and when

T

Time bound; target date or timeframe when it will be achieved

DFI/CFI Example

Total Fluorosis Score for population= (⅀n ×w )/N ; ⅀ = summation, total criteria scores= (total sum of all criteria scores)/(Total number of those in the population) Total fluorosis Index for Example= 33.5/36 = 0.9, which rounds up to 1 Overall, very mild fluorosis in this example town.

R = RECOMMEND

Treatment while still remembering the patient's cultural parameters

Acceptability

application is not unnecessarily painful, time demanding, or demeaning to participants

Virginia-specific

Virginians choose tap water as their preferred beverage Virginians choose tap water as their preferred beverage

Community Water Fluoridation

Water Equity Taskforce

•L = LISTEN

With sympathy and understanding of the patient's perception of the problem

Clinical Example

You have a patient who has been smoking for over 40 years. You notice a suspicious lesion on the lateral border of the tongue and the patients reports slight difficulty with swallow. What kind of conversation would you have with this patient? Is education alone going to promote a behavioral change? Ask patient if they are ready to stop smoking, how it impacts them

E = EXPLAIN

Your perceptions of the problem and your strategy for treatment

All of the following political tactics EXCEPT one will be beneficial to ensure that the fluoridation referendum will pass. Which is the EXCEPTION? a.Public debate with the antifluoridationists b.Analysis of the referendum of 10 years ago c.Endorsements by community leaders d.Distribution of literature in Spanish and English throughout the community

a. Public debate with the antifluoridationists •Allows them the opportunity to reach more people with their scare tactics •Emotion-based arguments

Validity

accurately measures what is intended

I = INTERVENTION

agreeing on an intervention that may include cultural practices

Attendance

at all field experiences is REQUIRED •Very difficult to duplicate these experiences due to an unexcused absence •All field sites are scheduled in advance with the non-profit organization on a customized date and time schedule •Must abide by the assigned dates and time •Tardiness to a community site will result in a one-point deduction from your final grade •THIS POLICY WILL BE STRICTLY ENFORCED •If you know you will be late or ill, call the rotation site FIRST, and then email course director •An excused absence from any field experience must be made up by an additional community experience approved by the course director Schedule Management will be KEY •Please pay close attention to where you are scheduled to be each Tuesday •Tuesdays are not "free" days •Will be given a folder at the beginning of next semester with all your assigned rotations

Simple

clear criteria, objective, easy to understand, simple to use and calculate, requires minimal equipment

E = EMPATHY

be empathetic

P = PARTNERSHIP

be flexible and work together

•Community snapshot

broad, initial description

C = COLLABORATION

collaborate with patient, family, health, etc.

Sensitivity

can detect small shifts in disease

You practice dental hygiene in a private dental office that serves a relatively higher socioeconomic status (SES) population of an economically and ethnically diverse, multicultural city of 1.5 million people. The city water supply is not fluoridated; consequently, dental caries experience is prevalent in the overall city population. Most families in the city are of Hispanic descent. You recently assisted the public health dental hygienist in conducting a screening on the children in a local Title 1 elementary school to document their oral health status. Fluoridation was defeated 10 years ago because of a strong antifluoridation campaign. Fluoridation will be on the ballot again in 8 months. The natural level of fluoride (F) in the community water is 0.2 mg/L. As a private practice hygienist, what would be the best thing for you to do to help get the fluoride referendum passed? a.Continue educating your patients on the benefits of fluoride b.Start calling community leaders c.Make financial contribution to the cause d.Contact your local dental hygiene society to help with their unified plan of action

d. Contact your local dental hygiene society to help with their unified plan of action •Unified plan of action is the best defense against a strong antifluoridation group •The best and foremost because it can have greatest impact

D

dental caries, including recurrent decay

S = SUPPORT

help patient overcome barriers

Clinical significance

index criteria are clinically meaningful

•R = RAPPORT

make a connection on a social level

M

missing (extracted) teeth due to dental caries

C = CULTURAL COMPETENCE

respect their culture and beliefs

Quantifiability

statistics can be applied to data collected with the index

T = TREATMENT

treatments, home remedies, and other medicines previously tried by the patient

E = EXPLANATIONS

use simple language and check for understanding

Periodontal Indices: Criteria

•0 = negative; no overt inflammation, no loss of function •1 = mild gingivitis; overt area of inflammation in FGM but does not surround the tooth •2 = gingivitis; inflammation surrounds the tooth, but no break in the epithelial attachment •6 = gingivitis with pocket formation; epithelial attachment has broken, pocket formation evident, tooth is firm in socket, no drifting, no loss of masticatory function •8 = advanced destruction; loss of masticatory function, drifting, and depressible

Calculus Index

•0 = no calculus •1 = supra-covering not more than 1/3 of exposed tooth •2 = supra-covering more than 1/3 but less than 2/3, or flecks of sub-around cervical portion of tooth •3 = supra- covering more than 2/3 of exposed tooth or a heavy band of sub-around cervical area

Debris Index

•0 = no debris •1 = soft debris covering not more than 1/3 of the tooth, or the presence of extrinsic stains without debris •2 = soft debris covering more than 1/3 by not more than 2/3 •3 = soft debris covering more than 2/3 of exposed tooth

Plaque Index Criteria

•0 = no plaque •1 = plaque on FMG that is seen after disclosing or with the probe •2 = moderate plaque in pocket, tooth, or FGM and can be seen with the naked eye •3 = abundance of soft matter within the pocket and/or tooth and FGM

Gingival Index (GI) Score

•0 = normal gingiva •1 = mild inflammation, slight color change, no BOP •2 = moderate inflammation, redness, edema, BOP •3 = severe inflammation, redness, ulceration, spontaneous BOP

Agency Description and Mission Statement

•A detailed description of the agency and mission statement •How can you find this information? •Objectives of the facility •What is the purpose or main goals of the facility? •Staffing •How does the agency operate? Who provides care to the patients the agency serves? •Population served/Target population •Who does the agency serve? •Eligibility •What are the eligibility requirements? **Be sure to include references when citing information!

The Advisory Committee

•A group of select individuals to carry out the mission and process •Plans and conducts the needs assessment •Diverse •Business leaders, media, religious, civic, political •Representative of the community (demographics) •Develops the community snapshot •A clear description of the community •Traits and profiles of the health of the community •Identifying the targeted community

DMFT: Interpreting Results

•A high D and a low F= high caries experience and low dental utilization •A high F and low D reflects high caries experience by high dental utilization •A high M= likely emergent care only •DMFT greater than individual's age= high caries experience

Cultural Competence

•Ability of healthcare providers to deliver services that are appropriately sensitive to the health beliefs, practices, and cultural and linguistic needs of diverse patients •Necessary to provide appropriate services to all individuals and communities •Critical to reducing oral health disparities and improving access to high-quality oral health care

Health Professions Accreditors Collaborative (HPAC)

•Accrediting bodies from 23 healthcare professions •Independently create accreditation policies, processes, and/or standards for IPE

CODA—Commission on Dental Accreditation

•Accrediting body for dental health professions (dental school, dental hygiene schools, dental therapy schools) •In 2016, specific requirement focusing on IPE for dental hygiene schools •This has increased more IPE activities for dental hygiene students

Promotion and Marketing of Program techniques

•Advisory committee and key leaders from the community •Liaison groups •Mass media (television/radio) •Banners/billboards •Posters, flyers, invitations, emails—smaller programs

Phase 7: Evaluate the Needs Assessment

•Advisory committee determines if goals of needs assessment were met, problems arose, and improvements for the future •Must incorporate formative and summative evaluation •Formative—evaluation throughout •Opportunity to implement changes to improve assessment results •Summative—evaluation at the end •Record lessons learned for future •Process looks back to phase 2 •Lessons learned to improve the assessment—continuous! •Leading to surveillance

Dental Indices uses

•Aids with data collection—allows for comparisons among population groups that are classified by the same criteria and methods •Assess oral diseases and conditions in oral health surveys •Used to measure variables in clinical trials •Surveillance—continuously assessing the oral health of the population over time

US Water Alliance

•All people have access to clean, safe, affordable water •There is community resilience in the face of a changing climate •The community and economic benefits of water infrastructure investment are maximized

Dental Indices

•An abbreviated measurement of the amount or condition of oral disease or related condition in a population

Got Milk?

•An example of this theory in action •Theory suggests: "social pressure" will cause people to copy the celebrities and drink milk •Seeing celebrities drink milk = Iwill want to drink milk

Program Planning

•An organized response to the community's needs to reduce or eliminate one or more problems identified during the needs assessment •Use data gathered from needs assessment to develop goals and objectives for the oral health program •This step is critical for community oral health programs

Intrapersonal Level: Health Belief Model

•Assesses patient perception of susceptibility and threat •Suggests specific perceptions are necessary to motivate an individual to take preventive action •Increased perception of susceptibility and severity of disease = increased action •Also includes self-efficacy and cues as important factors in promoting action •Perceived susceptibility to condition •Perceived severity of condition •Perceived benefits of preventative action •Perceived barriers of preventative action •Self-efficacy = confidence in one's ability to take action •Cues = strategies to activate readiness

Root Caries

•Root Caries Index (RCI) •Irreversible •Attempts to assess the extent of root caries experience within the context of individuals at risk for the disease •Scored on exposed root surfaces

Importance of Community-Based Dental Indices for Data Surveillance

•Assessing oral health indicators is essential for public health planning •Policies, programs, and practices based on oral health status trends among the population •Surveillance and assessments should evolve as disease patterns and population demographics change •Dental indices are key in monitoring changes over time •This is surveillance—continuous process of assessing a community •Must strengthen these surveillance measures for planning, implementation, and evaluation of dental public health practice

Community Oral Health Assessment considers

•Assets, gaps, needs, problems, resources, solutions, and partnerships •Data used to make plans for initiative to improve community oral health •Collects BASELINE DATA

Cultural Pre Competence

•Awareness of strengths and areas of improvement needed to respond to diverse populations •Diverse workforce, but no clear plan for achieving organizational cultural competence

Audiovisual Materials-CDS, DVD's, PSA's, TV Pros

•Beneficial for audio and visual learners •Can use celebrities •Can be tailored to specific audiences and ages •May help with adoption of new behaviors

Goals

•Broadly based statements of the impact of an intervention •Statement of what changes will occur as a result of the program •HINT: Goals and Broad both have an "OA" in them

Interactive Formats Cons

•Can be expensive •Need human resources for interaction •Need to match format to target audience •Must be culturally and linguistically appropriate

Written Media Pros

•Can include multiple messages in multiple languages •Covers topic more in-depth •Tells a story •Can be tailored to different age groups

Interpreting Results

•Caries Experience •When the score is equal to or greater than 1, individual is considered to have experienced dental caries •Refers to any indication of caries experience •Caries Free •When the score is 0, meaning there is no caries experience, the individual is considered to be caries free

Examples of Oral Health Surveillance Measurements

•Caries Indices •Periodontal Indices •Oral Hygiene Indices •NHANES—National Health and Nutrition Examination Survey •Oral and Pharyngeal Cancer •Craniofacial anomalies •Malocclusion •Dry mouth •Denture use •Orofacial pain and Temporomandibular Disorders •Dental fluorosis •Access to water fluoridation •Access to Oral Healthcare System •Oral Health-Related Quality of Life

Dental Indices

•Caries Indices—coronal and root caries •Simplified Oral Health Index •Plaque Index •Gingivitis Index •Periodontal Index and Periodontal Disease Index Community Periodontal Index Fluoride Status Index

Goals and Objectives

•Clarify the desired outcomes of a community health problem •Specify what you want to come out of the program •Difficult to plan interventions and activities if you do not have defined goals and objectives •Cannot ensure you will achieve the desired outcomes •Unable to measure the programs success without goals and objectives •Needed to justify continuation of the program

Visual Displays Pros

•Combines graphic and written information •Best in public places to highlight key messages •Most useful to bring attention

Question Format: Question

•Communicates a problem or set of circumstances, posed as a question 1.Ex. What type of graph shows a plot of variables to depict their relationships? a.Pie chart b.Histogram c.Scattergram d.Polygon

Communication

•Communication will be VERY important next semester •Must communicate with site coordinators, as well as course director •Remember, if you are unable to attend your site, call/contact site FIRST, then contact course director

Identify Primary Health Issues

•Completed during the needs assessment •Must be done prior to developing goals and objectives •Need to analyze the major oral health conditions that impact the community •Once primary oral health issues have been identified, and the cause, can develop the health priorities

Interprofessional Educational Collaborative (IPEC)

•Consortium of national associations and schools of health professionals •Began in 2009 •6 initial professions—dentistry, nursing, medicine, osteopathic medicine, pharmacy, and public health •Now, over 60 other professions have participated •Formed to promote and encourage efforts that would advance IPC learning experiences •Goal: "to help prepare future health professionals for enhanced team-based care of patients and improve population health outcomes." •Core competencies released in 2011 (updated in 2016) to guide curriculum development across health professions schools

Desired Outcomes

•Continue to cultivate a network of water stakeholders across the state. •Gain shared understanding of water from a variety of perspectives. •Build consensus on next steps to get us closer to our mission: that everyone in Virginia has safe, trusted, fluoridated water that they are drinking.

Cultural Competence Continuum

•Continuum used to grow more culturally competent •Can use steps to challenge growth •Defines characteristics needed to be culturally competent: •Defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structure to work effectively cross-culturally •Capacity to value diversity, self-assess, and adapt to diversity and the cultural contexts of community served •Incorporate these in policymaking, administration, and practice

The ASTDD 7 Steps Assessment Model

•Cultivate partnerships and select an advisory committee •Complete a self-assessment to establish the purpose of the community needs assessment •Design and organize the needs assessment •Collect data •Organize, review, and analyze the data •Prioritize issues and report findings in preparation for program planning, advocacy, and education •Evaluate the needs assessment

Simplified Oral Health Index: Interpretation

•DI and CI (independently) •0 = excellent •0.1-0.6 = good •0.7-1.8 = fair •1.9-3.0 = poor •OHI-S •0 = excellent •0.1-1.2 = good •1.3-3.0 = fair •3.1-6.0 = poor

DMFT

•Decayed, Missing, Filled Teeth •An index used to measure clinically observable coronal caries experience in permanent dentition only (active caries and treatment resulting from caries) •Based on 28 teeth (3rd molar excluded) •Tooth scored as only ONE components •A tooth that meets the requirement for both D and F is considered one D tooth •Teeth missing for reasons other than decay are not scored •Ex. Periodontitis, ortho treatment

Cultural Competence

•Demonstrate an acceptance and respect for cultural differences

Social Determinants of Health:

•Describe the concept of SDOH •Explain each of the 5 SDOH in a separate section •Include responses from the client in each section •Be sure to avoid using any identifying information •Do not say he, she, or the client's name •Strictly refer to your client as "client" or "interviewee"

Community Periodontal Index (CPI)

•Developed WHO •Used to measure periodontal status of a community •Assesses selected markers for periodontitis •Can be performed quickly (1-2 minutes per person) •In U.S, we use a modified form called the PSR (Periodontal Screening and Recording) using the Ramfjord teeth •Ramfjord teeth= 3, 9, 12, 19, 25, and 28 •Must use a WHO specially designed probe •0.5mm ball on the tip

National Board Dental Hygiene Examination (NBDHE)

•Developed and administered by the Joint Commission on National Dental Examinations (JCNDE) of the ADA •Comprehensive, computer-based, pass/fail exam •Total of 9-hours with optional breaks •Current NBDHE consists of (as of 2020): •350 multiple-choice questions •200 discipline-based questions •150 questions based on 12-15 dental hygiene patient cases •Section of 24 questions related to community health/research principles •5 community cases (testlets) with 4-5 questions related to each case

Periodontal Disease Index (PDI)

•Developed by Dr. Ramfjord •Considered sensitive for partial mouth score of periodontal conditions •Teeth frequently used with other periodontal measures for partial mouth scoring •Teeth to score: 3, 9, 12, 19, 25, and 28 •Scoring the same for both, only difference is the teeth scored

Community Collaboration

•Don't want to just tell them what needs to be done •Have to understand what the community believes in important •Want to present the data collected from the needs assessment •Inform those in the community of the existing problems and the consequences from not addressing them •This is why Phase 1 of the needs assessment is so important! •Want to collaborate WITH the community •Form partnerships and collaborate with members of the community

Ethnic

•Emphasizes collaboration •Helpful for patients who practice alternative medicine •E = EXPLANATION •T = TREATMENT •H = HEALERS •N = NEGOTIATE •I = INTERVENTION •C = COLLABORATION

Promotion

•Encouraging a concept to change a behavior •Motivating people to adopt healthy behaviors •Ex. Providing athletic mouthguards to a high school football team

Professionalism

•Essential for the success of each service-learning activity •Will be engaging with community partners, stakeholders, and advocates for oral health •Important to remember you are representing the course director AND the School of Dental Hygiene—you are a reflection of our school •Always arrive prepared for the day •Be respectful of site coordinator and supervising dentists •Address as "Mrs, Ms, Dr, etc."

Cross-cultural communication

•Example: Eye Contact •Important in American society •Avoiding could be interpreted as hiding or being dishonest •Other ethnic group view as disrespectful or rude •A Culturally Insensitive Oral Health Professional •May view avoidance of eye contact as a lack of interest •A Culturally Sensitive Oral Health Professional •Lack of eye contact may be a cultural sign of respect

Participation in an Interprofessional Experience

•Examples of activities that will meet this requirement: •I-HEAR School Physicals Event (from the Summer) •Interprofessional Pop-up Clinic (from Saturday) •PiN Ministry Interprofessional Clinic (scheduled for the Spring)

Audiovisual Materials-CDS, DVD's, PSA's, TV Cons

•Expensive •May not reach target audience •Technological challenges •Discussion or interaction needed to improve potential for behavior change

Community Oral Health Programs

•Extends our role into a community dental hygienist •Providing services to more than 1 individual •Addressing the community as a whole •Able to address the prevention of oral disease and access to care issues for various population groups •Programs should emphasize the Healthy People national health objectives and leading health indicators National Level Programs: •Department of Health and Human Services •Federal grant-making agency •Fund programs at the state or county agencies, nonprofits, educational institutions, and the private sector •Federal budget proposes funds for DHHS •Supports mission of improving American health care and healthcare issues

Health literacy is having the skills to

•Find health information and health services •Process the meaning and usefulness of the information found •Navigate the healthcare system (filling out forms, making appointments) •Share personal information with providers (health history and medication) •Engage in self-care and management of chronic disease •Understand mathematical concepts Apply numeracy skills (reading nutrition labels

Ottawa Charter

•Global health imperative created in 1986 •Mission: enable people and communities to increase control over their health and to improve their health •Established Action Areas: •Build healthy public policy •Create supportive environment of health •Strengthen community action for health •Reorient health services •Develop personal health management skills •Health Promotion Strategies to Achieve These Actions: •Advocate for health •Mediate different societal interests in pursuit of health •Enable people to achieve their full health potential

Individuals with Special Health Care Needs Program

•Goal: "to improve access to dental services for individuals with special health care needs" •Provides oral health education and courses to: •Medical and dental professionals •Health workers •Caseworkers •Educators •Provides education on: •Importance of oral care •Disability etiquette •Hygiene adaptations

Example

•Goal: to improve the use of fluoride mouthrinses •Objective 1: Upon completion of today's six step demonstration, 75% of the adolescent participants will demonstrate the six steps without error (compared with 20% baseline before the program) by rinsing at a sink in the classroom •What is the action verb in this objective? How does this meet the SMART+C characteristics? •Action verb = demonstrate •S = answers the who, how, where, and when •M = defines how many have to demonstrate (75%) •A = there is a margin of error (25% can make errors) •R = aligns with the goal, realistic number of participants •T = defines when it will be measured (same day following demo) •C = only 20% were familiar at baseline, challenge is for 75%

Interactive Formats

•Greatest chance for behavior change •Can incorporate all forms of learning into this format •Engaging •This is your goal for your oral health learning activity •Be aware of your audience!

Head Start Site:

•Groups of 2 will be assigned to a classroom at a Head Start site in Norfolk •Will provide OHI and fluoride varnish with parent's consent •Takes place during Children's Oral Health Month (February) Required Documentation for Head start 1.Emergency Data Form 2.Proof of COVID Vaccination •All forms/documentation must be printed and HAND delivered to me at our first class meeting for next semester •MUST be printed - will deliver packets directly to the site coordinator

Additional Interprofessional Collaboratives

•Health Professions Accreditors Collaborative (HPAC) •Accrediting bodies from 23 healthcare professions •Independently create accreditation policies, processes, and/or standards for IPE •CODA—Commission on Dental Accreditation •Accrediting body for dental health professions (dental school, dental hygiene schools, dental therapy schools) •In 2016, specific requirement focusing on IPE for dental hygiene schools •This has increased more IPE activities for dental hygiene students

LEARN

•Helps build mutual understanding •L = LISTEN •E = EXPLAIN •A = ACKNOWLEDGE •R = RECOMMEND •N = NEGOTIATE •L = LISTEN—With sympathy and understanding of the patient's perception of the problem •E = EXPLAIN—Your perceptions of the problem and your strategy for treatment •A = ACKNOWLEDGE—And discuss the differences and similarities between these perceptions •R = RECOMMEND—Treatment while still remembering the patient's cultural parameters •N = NEGOTIATE—Agreement •Strive to understand the patient's explanatory model •Come to an agreement that achieves improved behavior AND respects the patient's culture

Phase 6: Prioritize Issues and Report Findings Purpose

•Helps decide where to target resources •Assist underfunded and overworked agencies •Assures rational distribution of resources •Raises awareness of community's primary concerns •Alerts public to critical oral health issues •Influenced by availability of resources

Cultural Competence and Dental Hygiene

•Helps us deliver care and education effectively •More likely to respond to oral health disparities in an appropriate manner •Must be able to spread oral health care information and treatment while still recognizing and respecting the populations' cultural differences •In the community setting, cultural competence is essential to meeting the needs of the population

Phase 2: Complete a self-assessment to establish the purpose of the Community Needs Assessment

•Identifying the goals •Defines the purpose of the needs assessment •Determining the "why" •Why is the community oral health assessment needed? •Considered to be a self-reflective step

The Learning Pyramid

•Important to consider when selecting and designing communication formats •Especially important for your learning activities

Questions to Answer Following Interventions

•In order to evaluate success of the intervention/communication to continue, change, or eliminate for the future, must consider: 1.Has the intervention achieved the desired results in relation to program outcomes? Why or why not? 2.What messages or activities produced the best results? 3.Should this intervention be continued in its current form? 4.How can the intervention be improved? 5.Can it be replicated successfully in other settings? 6.Are the resources (people, money, materials) that were used reasonable and cost-effective?

Written Media Cons

•Increases knowledge, but may not change behavior •Graphics needed for low literacy •May not reach target audience

Benefit of IPC for Oral Health

•Increases understanding of the oral-systemic link among different professions •Allows for the collaboration to identify risk, make preventive recommendations, and implement treatments that integrate the oral-systemic link •Examples of IP resources: •Bright Futures Guidelines •National Interprofessional Initiative on Oral Health •Smiles for life •Oral Health Toolkit

Future of Interprofessional Collaborative Practice in Oral Health Care

•Increasing education and clinical experiences with interprofessional practice among diverse populations •Will improve oral health care •I-HEAR at ODU (Interprofessional Health Education and Research •School Physicals Event—example of IPE (interprofessional education) •Students learning the roles of different health professions, while also serving the community •Allows us as hygienists to highlight our role as healthcare providers •Hopefully will lead to an expansion of our role in different medical settings (hospitals, medical clinics) •Importance of these activities—critical role not just in oral health, but also overall health •Highlights our connection to many health professions

Local Level Programs

•Individual county and city health departments •Services can be offered in a variety of options •Local clinics •School-based •Mobile programs •Telehealth/teledentistry—becoming more popular •Non-profit and faith-based organizations

DMFT: Scoring

•Individuals DMFT Score= D+M+F (this will ALWAYS be a whole number) •Population's history of Decay= (Total DMFT (total for all people))/(Total Number of people) = mean DMFT of all groups

Cultural Incapacity

•Ineffectively responding to the needs of the cultural group •Not destructive, but ineffective

Water IS the healthiest drink ... yet

•Inequity is consistent across all spheres •Trust issues are real •Can't shrug off safety concerns How can we make sure Virginia's water is safe, trusted, fluoridated AND that PEOPLE DRINK IT?

Effects of Culture on Health

•Influences health •Influences attitudes toward healthcare providers and facilities •Influences how health information is communicated, healthcare-seeking behaviors, and perceptions regarding the role of family in healthcare

Type III

•Inspection using mouth mirror, explorer, and adequate lighting

Culture

•Integrated pattern of human behavior that includes: •Thoughts •Communications •Languages •Practices •Beliefs •Values •Customs/rituals •Manners of interacting •Roles •Relationships •And expected behaviors •Of a racial, ethnic, religious, or social group, as well as the ability to transmit these to succeeding generations •How we view the world and form our opinions, thoughts, aspirations, and goals •Both inherent and learned •What we live everyday •We have to be able to respond to the wide diversity in our society •Must gain an appreciation for the diverse cultures in our society

Health Promotion Theories

•Intrapersonal Level 1.Stages of Change Theory 2.Health Belief Model •Interpersonal Level 1.Social Learning Theory •Community Level 1.Community Organization Theory

Levels of Influence

•Intrapersonal—self •Interpersonal—others •Institutional—rules/regulations •Community—social networks •Public Policy—laws and policies

Periodontal Indices

•Irreversible indices •Not recommended because they combine reversible disease (gingivitis) and irreversible disease (periodontitis) in the same index

Phase 6: Prioritize Issues and Report Findings (Priority issues)

•Issues that impact oral health of the community are identified in phase 5 •These issues are then prioritized •Which issue must be addressed first?

Models of Cross-cultural communication

•LEARN •RESPECT •ETHNIC

Categories of Outcome Objectives

•Learning •What participants will learn from the program •What the learner should be able to do to show achievement in the program •Behavioral •What actions program participants will take to improve or result the health issue •Changes in health behaviors •Environmental •Emotional, physical, and social surroundings of a community that will change after a program is implemented •Broader changes in the community •Usually long-term

Dmf, def, df

•Lower case= primary dentition • dmf for primary molars • def and df are score on all primary teeth (not counting missing teeth due to potential exfoliation •For mixed dentition, DMF and dmf, def, or df are scored separately—NEVER combined

RCI: Criteria

•M= missing (not counted) •NoR= no recession (excluded) •RN= sound root (recession present, but is sound—no decay) •RF= filled •RD= decayed

Communication with Course Director

•MUST check email daily for announcements from the course director •Please respond to emails in a timely manner; some information may be time-sensitive •DNTH 419 will be run independently •We will only meet one time as a group at the beginning of the Spring semester Inclement Weather Notice: •If ODU is closed: •Due to weather-related events, do not attend the site, BUT notify site via email of the situation •If ODU is not closed, but site is closed: •Do not attend the site •Notify course director that site is closed

Simplified Oral Health Index: Criteria

•Measure 6 teeth (one from each sextant) •1st permanent molars (#3-B, #14-B, #19-L, #30-L) •Max molars= buccal surfaces •Mand. Molars= lingual surfaces •Anterior facial surfaces of #8 and #24 (#8-F, #24-F) •Must score both a debris index and calculus index

Bright Smiles for Babies Fluoride Varnish Program Provides Training to

•Medical professionals •Early childhood professionals (WIC, Head Start) •VDH maternal providers (family planning and maternal nurses) Maternal, Infant, and Adolescent Oral Health Program •Goal: to plan, develop, and implement training and educational programming perinatal (before birth) and infant oral health, as well as adolescent oral health •Provides educational services to dental and non-dental professionals on importance of oral health care for pregnant women and infants •Programs for oral health of adolescents •Updates School-aged Oral Health Curriculum •Includes emerging topics for adolescents •Vaping, HPV exposure

Health Promotion Theories

•Methods to be used when attempting to change values to lead to healthy oral health behaviors •Can help us analyze situations we encounter and apply effective solutions •Must understand oral health problems from multiple perspectives •ECOLOGICAL APPROACH

Intrapersonal Level: Health Belief Model

•Model applied by developing messages that address these perceptions to influence decisions to improve oral health •Focused on INFORMATION

Developing Cultural Competence

•Models that incorporate cultural competence in a multicultural or community setting: 1.Cultural Competence Education Model 2.Cultural Competence Continuum Cultural Competence Education Model: •Focuses on the process of developing knowledge and skills relative to cultural competence •3 areas of intervention: 1.Self-assessment/self-exploration 2.Knowledge 3.Skill •These areas impact attitude, perception, and behavior toward different cultures and becoming more culturally competent

Health Promotion Theories: An Ecological Approach

•Multiple factors that influence health behaviors and health status •Health behaviors are affected by personal, social, and environmental factors •Health Promotion Theories fall under the different levels of influence

Interactive Formats Pros

•Multiple learning pathways to increase understanding, retention, and behavior change •Allows interaction/participation •Can share different perspectives •Can adapt for different audiences

Health Promotion in Dental Hygiene

•Must be aware of the population's knowledge level and aware of the importance of values on health practices and decisions •Health promotion is the goal to improve oral health •Education alone is not enough •Positive values toward oral health—behavioral changes •How can we do this? Samples of sensitivity, fluoridated mouth rinse, tongue scraper

Head Start- Emergency Data Form:

•Must complete form in its entirety •Job position: Intern •Date of Hire: Day you will visit site (will complete in class) •Site Location: Specific Head Start Location (will complete in class) •Site Phone number: Can be left blank •Must provide full address for Emergency contact

Available Resources and Program Constraints

•Must consider available resources •Location •Personnel to assist with logistical operations •Supplies needed •Funding—Donor? Grant? •Must consider possible constraints •Personnel needed to carry out the program—who will conduct screenings? •Negatives responses from participants or caregivers •Time needed •Lack of funding for additional costs

Simplified Oral Health Index: Scoring

•Must determine the Debris Index (DI) and Calculus Index (CI) •DI= (total debris score)/(total number of teeth (6)) •CI= (total calculus score)/(total number of teeth (6)) •OHI-S= DI + CI

Oral Health Literacy

•Necessary component of interventions to improve oral health •Population must understand in order to be willing to participate in improving their oral health •In order to achieve oral health literacy, oral health messages must: •Be developed at the appropriate literacy level •Be developed in the individual's language •Be inclusive of the cultural norms of the specific population

Dean's Fluorisis Index (DFI)/Community Fluorisis Index (CFI): Weighting

•Negative= 0 •Questionable = 0.5 •Very mild = 1 •Mild = 2 •Moderate = 3 •Severe = 4

Dean's Fluorosis Index (DFI)/Community Fluorosis Index (CFI): Categories

•Negative—enamel is normal, surface is smooth, glossy •Questionable—enamel has slight change from normal; a few white flecks to occasional white spots •Very mild—small, paper white areas involve less than 25% of tooth surface; no more than 1-2mm of white opacity at the cusp tips of premolars or second molars •Mild—more extensive white opaque areas in the enamel involving less than 50% of tooth •Moderate—all enamel surfaces of the teeth are affected; attrition; brown stain •Severe—all enamel surfaces affected; hypoplasia, pitting, brown stain widespread, teeth appear corroded

Importance in Community

•Next semester, you will be in the community at various public sites •Must be aware of the population you will serve •Important to avoid stereotyping: not everyone is the same—I AM, BUT I AM NOT •Embrace different cultures •Be aware of the oral health literacy level of the population—remember populations that commonly have low health literacy •Utilize LEARN, RESPECT, and ETHNIC models when educating patients from diverse backgrounds

Simplified Oral Health Index

•OHI-S •Reversible •Measures oral hygiene status •Involves both a debris and calculus index

Social Learning Theory: 4 ways people Learn

•Observational learning = observing other's behavior •Modeling = remembering and imitating observed behavior •Inferences = made from evidence of observed outcomes of behavior •Motivation and judgements = from others, such as experts

Low health literacy is common among:

•Older adults •Minority populations •Less educated (less than high school or GED) •Lower general literacy and numeracy skills •Nonnative English speakers •Low SES •Medically underserved populations

The Disconnect Between Oral and Overall Health Care

•Oral health is still not perceived as important or critical as overall health •Some health professionals still do not understand the link between oral-systemic link •Unaware of our role in promoting overall health •There is a definite disconnect between the 2 •For example, medical insurance does not cover dental care •Must have a separate dental plan •Coverage of treatment is not equal •Why? Isn't the mouth part of the body??

Phase 5: Organize, Review, and Analyze the Data

•Organize data by topic •Synthesize the information and summarize the data •Data critique •Similar to a review of literature •Determine meaning or significance of the data •Demonstrates that a problem actually exists in the community •Determining if a program is really needed •Compare data •Compare current data collected with data from previous years •Hierarchy of comparing data: •Previous years from the same community •Surrounding communities •Surrounding counties •The state •The region •The nation •Current Healthy People data

Phase 1: Cultivate partnerships and select and advisory committee

•Partnerships in the public, private, or non-profit sector •An arrangement between or among agencies, organizations, business, and people that collaborate and combine resources to work toward a goal •Can provide input, data sources, resources, expertise, sponsorship, and political support •How you build support for the oral health program—Financial support •Should be interprofessional •Broad community involvement

Components of the Community Snapshot

•People •Demographics, health status, risk profiles, cultural and ethnic characteristics •Location •Geographic boundaries •Connectors •What connects the people together •Values, interests, motivating factors •Power relationships •Social and political networks, communication patterns, formal/informal lines of authority

Implementation of Health Belief Model

•Perceived Susceptibility—identify patient's risk for the disease or condition •Perceived severity of condition—identify and share with the patient the consequences and risks associated disease or condition •Perceived benefits—make positive outcomes clear •Perceived barriers—reassure and assist patient •Cues to action—promote information and oral health education •Self-efficacy—have patient demonstrate/explain preventative behavior; I.e. perform proper oral hygiene technique

Selecting and Planning Health Interventions

•Plan describes how the objectives will be accomplished •Select interventions based on best practices •Established by scientific evidence •Choose activities that have been tested and shown to be effective in meeting the desired goal •Community involvement and participation needed •Must consider types of resources available and program constraints •Program activities •Procedures carried out to achieve the objectives •Can be preventive, educational, treatment-oriented, or research-oriented •What is implemented to achieve the objectives •Must consider: •Personnel •Location •Equipment •Materials •Resources •Costs

Plaque Index: Scoring and Interpretation

•Plaque Index (per tooth) = (total scores for all surfaces)/(total # of surfaces) •Plaque Index (Total) = (total scores for plaque of all teeth)/(total # of teeth scored) •0 = excellent oral hygiene •0.1-0.9 = good oral hygiene •1.0-1.9 = fair oral hygiene •2.0-3.0 = poor oral hygiene

Head Start- Proof of COVID Vaccination

•Please make a copy of your COVID vaccine card to turn in with paperwork Oral Health Literacy Forums With Lesson Plans: •Two oral health education events at local elementary schools •Groups of 2, will be assigned to an elementary school classroom to provide an oral health education activity—2 separate days •Oral Health Education Learning Activities •Must create 2 lesson plans for this activity using an abbreviated version of the lesson plan created in Prof. Bradshaw's course (DNTH 414) Community Events •Experiences that WILL NOT count toward this requirement: 1.Interprofessional experience 2.Oral health literacy forums 3.SADHA event •Please note: Any EXTRA participation in an interprofessional experience OR Oral health literacy forum WILL count toward this requirement

Professional Attire

•Please wear clean and pressed scrubs for rotations •Remember to bring all materials as outlined for the public health site rotations and necessary materials for oral health literacy forums Arrive EARLY!! If you are not 5 minutes early, you are LATE!

Cultural Destructiveness

•Policies and practices within a system that are destructive to a cultural group

Community Periodontal Index (CPI): Criteria

•Probe upper right central (#8) and lower left central (#24) •Probe 1st and 2nd molars in each sextant, but only record tooth with the worst score •Do not use 3rd molars unless they function in place of 2nd molars Community Periodontal Index (CPI): Criteria •Scoring Criteria •Code 0 = healthy gingiva no bleeding •Cod 1 = bleeding observed after gentle probing •Code 2 = calculus felt during probing but all the black area of probe is visible (3.5-5.5mm from ball tip) •Code 3 = pocket 4-5mm (gingival margin on black area of probe) •Code 4 = greater than 6mm pocket (black area of probe not visible •Code X = excluded segment (fewer than 2 teeth present in sextant)

Levels of Objectives

•Process •Actionable statements •Describe activities, services, and strategies that will be delivered •Usually short-term •Outcome •Specific, intended effects of a program •End result •Focused on a change as a result of the program or activity •Can be short-term, intermediate-term, or long-term •Divided into 3 categories

Community Oral Health Assessment

•Process of identifying the primary health issues of the community •Identifying factors that affect the oral health of the population •Identifies causes of the problem •Determining availability of resources and intervention to improve oral health •Community-oriented and community-directed

Community Level: Community Organization Theory

•Process of involving and activating members of a community or subgroup to: •Identify a common problem •Identify resources •Implement strategies •Evaluate efforts •We as health professionals initiate and motivate community to achieve the desired result •Guide and facility that community organization process •Community learns the skills to guide their own problems

Health Promotion

•Process that informs and motivates people to adopt healthy behavior to enhance their health and prevent disease •Role of behaviors •Looking beyond individual behaviors •Societal and environmental behaviors must be considered •Promoting behavioral changes •Improve oral health by changing behaviors

Bright Smiles for Babies Fluoride Varnish Program

•Provides preventive services, such as fluoride varnish, in non-dental settings •Doctors' offices •Medical clinics •WIC clinics •Goal: "to reduce prevalence of early childhood caries (ECC) in infants and toddlers (6 months-3 years old)"

Goal of Oral Health Education

•Providing facts and knowledge is not solely the goal of the oral health education we provide; 3 step process: 1. Effective dental health education 2. Change in values 3. Healthy Behaviors

Education

•Providing knowledge •Learner gains knowledge about healthy behaviors and lifestyles •Ex. Delivering a group presentation to high school athletes about orofacial injuries from sports

RESPECT

•R = RAPPORT •E = EMPATHY •S = SUPPORT •P = PARTNERSHIP •E = EXPLANATIONS •C = CULTURAL COMPETENCE •T = TRUST

RCI: Scoring

•RCI= (RD+RF)/(Total Surfaces (including RN)) X 100 •Expressed as a percentage of decayed root surfaces and filled root surfaces out of the total at-risk root surfaces •ALL exposed root surfaces are scored (4 surfaces per tooth) •Only cavitated lesions are scored as RD (decayed)

Question Format: Completion

•Requires the correct completion of a concept or data 1.Ex. A public health dental hygienist who meets with the city council members to explain the benefits of fluoridation for the purpose of convincing them to adopt fluoridation for the community is functioning in the role of a.Administrator b.Advocate c.Clinician d.Researcher

Gingivitis Index

•Reversible •Based on severity of inflammation and location •Used often in epidemiological surveys to determine prevalence of gingivitis •Can be used for an area (quadrant or sextant) or whole mouth Gingival Index: Criteria •Score each tooth on its 4 surfaces; use probe to determine bleeding

Categories of Dental Indices

•Reversible •Measures conditions that can be reversed or resolved •Irreversible •Measures cumulative conditions that cannot be reversed •Simple •Measures presence or absence of a condition •Cumulative •Measures all the evidence of a condition, both past and present

Plaque Index

•Reversible •Measures difference in thickness of soft deposits at the gingival margin •Used in conjunction with the GI (gingival index) •Teeth scored: 3, 7, 12, 19, 23, and 28

Review of the Literature:

•Review of current (within last 5 years) peer-reviewed articles about the target population •Articles on the population served •Ex. Oral health disparities, social determinants of health, barriers to accessing dental care, vulnerable populations •See articles from the Journal of Dental Hygiene for examples of literature review

SMART-C Objectives

•S = Specific; how, what, who, where, and when •M = Measurable; info can be collected, detected, or obtained •A = Achievable; objective is possible and able to be attained •R = Relevant; to the overall vision and mission •T = Time bound; target date or timeframe when it will be achieved •C = Challenging; stretches the group to focus on a significant improvement

DMFTS

•Same as DMFT, but applied to the surfaces of teeth •Same criteria, but each surface is scored with a max score of 140 •(5 surfaces X 28 teeth)

Major Areas of Exam

•Scientific Basis for Dental Hygiene Practice •61 questions •Provision of Clinical Dental Hygiene Services •115 questions •Community Health/Research Principles •24 questions •Case-Based Items •150 questions

Periodontal Index (PI)

•Score for all teeth •Complete picture

Gingival Index: Scoring and Interpretation

•Score per tooth= (total score of all surfaces)/(4 (number of surfaces)) •Gingival Index= (sum of scores of all teeth)/(total number of teeth) •0.1-1.0 = mild gingivitis •1.1-2.0 = moderate gingivitis •2.1-3.0 = severe gingivitis

Periodontal Indices: Scoring and Interpretation

•Scoring= PI or PDI= (sum of scores per tooth)/(total number of teeth scored) •Interpretation •0.0-0.2 = clinically normal •0.3-0.9 = simple gingivitis •0.7-1.9 = beginning destructive disease •1.6-5.0 = established destructive disease •3.8-8.0 = terminal disease

Type IV

•Screening with a tongue depressor and available lighting

Community Testlets

•Simulated community situations •Like a case study, but related to community oral health practice •Given a scenario followed by 5-6 questions related to the scenario •Must use concepts based on community practice rather than clinical practice Answering Community Testlet Questions: •Utilizing critical thinking skills •Change thinking from clinical practice to community practice •Correct answer is based on what is best for the community as a whole, not for an individual •Carefully read the community testlet case scenario •Note key words and phrases to guide your thinking

Objectives

•Specific statement that can be measured •Aligns with the overall goal •Clearly communicates the expected outcomes of the program •Must have an action verb •AVOID: understand, value, or learn—too broad, unmeasurable •Must be achievable and challenging •Should be SMART+C

State Level Programs

•State Oral Health Programs (SOHPs) •Exist in every state •Variety of settings •Schools, Head Start, WIC, county and city health departments •Programs are often in partnership with other agencies and organizations •i.e. dental and dental hygiene schools

Assessment Includes

•Statistics on health status and trends •Community health needs •Epidemiologic and other studies of health problems •Determinants of health •CONTINUOUS •Process is ongoing •Also known as—surveillance

Dental Health Theory

•Suggests knowledge alone is not enough to change a health behavior •Values regarding the behavior must be change •Knowledge will not impact oral health until there is a positive behavioral change, leading to a habit •Health behavior becomes automatic

Interpersonal Level: Social Learning Theory

•Suggests learning is based on observing the actions of others and the results of these actions •Supports social pressure as the most powerful factor in influencing social norms •Learning by observing the actions of others, processing consequences, and listening to others

Cultural Proficiency

•Systems and organizations hold culture in high esteem •Foundation that guides all their endeavors

Health Literacy

•The Department of Health and Human Services defines health literacy in 2 categories: 1.Personal Health Literacy •The degree to which individuals have the ability to find, understand, and use information/services to make health-related decisions 2.Organizational Health Literacy •The degree to which organizations equitably enable individuals to have personal health literacy

Phase 4: Collect Data

•The actual IMPLEMENTATION of the oral health assessment •Gathering information to make decisions and set priorities •Primary Vs. Secondary Data •Primary= from the sources (those in the community) through interview and surveys •Secondary= data that has been previously collected •Start with secondary data •If there are gaps in the data, then proceed with primary data collection •Determine what type of primary data needs to be collected

Our Role As oral health care professionals we have to

•Think about the words we use when educating our patients •Simple languages, short sentences, and define technical terms •Use graphics, models, videos, and pictures to supplement instruction •Use the "teach back" method •Provide information in the patient's primary language •Assume EVERYONE has low health literacy

Health Literacy and Oral Health

•Those with a low health literacy are more likely to experience: •Lower oral health status •Reduced oral health knowledge •Greater oral health disparities •Higher risk of diseases and conditions •Less frequent utilization of preventive oral health services •Poorer outcomes and higher hospitalization rates

DMFT: Reporting Results:

•Total DMF= overall caries experience •D/DMF = rate of decayed teeth or treatment needs—treatment needed •M/DMF = rate of missing teeth (mortality) •F/DMF = rate of filled teeth DMF= D+M+F

Adult Oral Health and Chronic Disease Program

•Training and educational programs regarding adult oral health and chronic disease •Focus is to integrate medicine and dentistry regarding chronic diseases and the relationship or oral health—oral-systemic link •Training and education in the following settings: •Senior centers, nursing homes, residential facilities (residents and staff) •Individuals with chronic diseases in medical clinics and hospitals •Free clinics and community health clinics •Private homes •Adults in recovery centers •Non-dental health care providers

Cultural Blindness

•Treating all people the same •Ignoring cultural differences •Lack of workforce diversity •No resources dedicated to cultural knowledge

Interprofessional Collaborative Practice (ICP)

•Two or more professions—learn about, from, and with •Collaboration among dental, medical, social services, mental health services, and other health professionals •WHO declared in 2010, "interprofessional healthcare teams understand how to optimize the skills of their members, share care management, and provide better health services to patients and the community."

Question Format: Double-True False

•Two true/false statements in a question •Must determine the following: •Both statements are true •Both statements are false •The first statement is true and the second statement is false •The first statement is false and the second statement is true Test Taking Tips: 6.Attempt to answer every question •Mark questions you are unsure of to return back to later •Better to make an educated guess than to leave questions unanswered 7.Look for the BEST answer to a multiple-choice question •Several choices will seem correct •There is one that is the BEST 8.Use a process of elimination to answer multiple-choice items 9.Don't overthink a question 10.Stay calm! •Take a few deep breaths •Do not talk to other students right before the test or during breaks—stress and anxiety can be contagious!

Types of Examinations Used in Oral Health Surveys

•Type I •Complete exam using all examination instruments, full set of x-rays, and when needed: study models, lab tests, percussion, and pulp vitality tests •Type II •Limited exam using mirror, explorer, lighting, posterior BWX, and PAs when needed •Type III •Inspection using mouth mirror, explorer, and adequate lighting •Type IV •Screening with a tongue depressor and available lighting

Importance of Exposure to Multiple Cultures

•Understand and appreciate the values, attitudes, and behaviors of others •Avoid stereotypes and biases •Focus on commonalities rather than differences •Allow us to develop and deliver services that are responsive to the individual needs of the patient •Understand the effects of culture on health

Health Communication

•Use of communication strategies to inform and influence decisions to enhance health •Communication shapes beliefs and behaviors about health •Think about commercials on TV (i.e. a public service announcement) •What is an example of a commercial that influences health behaviors and beliefs?

Intrapersonal Level: Stages of Change Theory

•Views change as a process or cycle that occurs over time •Allows us to assess a person's readiness to change a behavior toward a more healthy lifestyle •Assumes that at any point in time, everyone is at a different stage of readiness to make lifestyle changes •In order for behavioral changes to occur, oral health education must address the individual to their current stage of readiness

Public Health Site Rotations

•What to bring to site: 1.N95 mask 2.Face shield 3.Blood pressure cuff/stethoscope 4.Name tag 5.Loupes/Safety glasses 6.Heavy-duty gloves 7.Patient safety-glasses

Public Health Site Rotations

•Will be assigned for 4 Tuesdays (4 hours each) at a public health site •Designed to gain experience in setting similar to private practice and providing care to the underserved •Will be given 1.5 hours per patient •Supervisor at site will review medical history with you and then a final scale check at the end •Most of the comp exam will have already been completed •May have to perio chart •Focusing on prophy, perio maint, or SRP depending on tx. plan

Visual Displays Cons

•Work involved with creating them •Has to be eye-catching •May not reach target population •Not as effective to change behavior

4 Core Competencies of IPEC

•Work with individuals of other professions to maintain a climate of mutual respect and shared values •Use the knowledge of one's own role and those of other professions to appropriate assess and address the health care needs of patients and to promote and advance the health of populations •Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease •Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable