Running head: 4th GRADERS AND ORAL HEALTH

Community Dental Health Project:

Assessment, Diagnosis, Planning, Implementation, and Evaluation Phases

Whitney Copenhaver #33

Angelica Reyes #57

Stacy Yu #60

Community Dental Health IV

Winter Quarter 2019

February 4, 2019
4TH GRADERS AND ORAL HEALTH 2

Assessment

Childhood caries is the most common chronic disease among children (“Dental Caries,”

2016). It is important to address this issue because it can easily be prevented. Our target

population is 4th grade students at Redmond Elementary School in Redmond, WA. We collected

our data using online databases to find relevant articles as well as using what we learned in class

lecture. Our contact person is a friend, Megan Goodwin. She is the teacher of the class we will

be presenting to in the fall.

Community Profile

Socioeconomic status of residents in Redmond, WA is upper middle class, with the

median household income at $107,341 in 2016 (“U.S. Census Bureau Quick Facts,” 2017).

Redmond Elementary has 549 students, with 38.3% Asian, 33.9% Caucasian and 16.2%

Hispanic (“Redmond Elementary School…,” 2018). According to Census, 96.1% of residents in

Redmond have at least a high school education and 66.8% of them have bachelor’s degrees.

42.6% of the people living in Redmond can speak another language other than English (“U.S.

Census Bureau Quick Facts,” 2017).

Needs Assessment

We identified the need of oral health education in Redmond Elementary. Our primary

data identified by our contact person includes the need for education on home care, nutrition, and

the caries process. According to Ms. Goodwin, Redmond Elementary is at about 30% below the

poverty line and an estimated 60-70% of her class has access to dental care. For our secondary

data, we found that 19.3% of students receive free or reduced lunch at Redmond Elementary

(“Redmond Elementary School…,” 2018) and there is an average of 0.7 ppm of water

fluoridation in Redmond (“Water Quality Report,” 2017). The population has easy access to
4TH GRADERS AND ORAL HEALTH 3

dental care because there are multiple dental clinics in the Redmond area (if the family is willing

and can afford it). For those who cannot afford care, there is a Healthpoint Redmond Dental

Clinic as well as public health clinics in Bellevue and Everett (“Free Dental Care,” 2018).

Literature Review

A significant amount of people are uneducated in caries formation or what causes caries

in the first place. Although it is easily preventable, some lack the understanding of how to do so.

Our goal was to improve knowledge of oral health through education and awareness in 4th

graders in Redmond, WA. This can be done by focusing on 3 objectives: caries formation,

nutrition and homecare.

The first objective focuses on caries formation. Dental caries are also known as tooth

decay, which is the destruction of tooth enamel and dentin. According to Hout, 2016, “Plaque, a

sticky film of bacteria, is constantly forming on your teeth. When you eat or drink foods or

beverages containing sugars, the bacteria in plaque produce acids that attack tooth enamel. The

stickiness of the plaque keeps these acids in contact with your teeth, and over time the enamel

can break down.” 23% of children ages 2-5 years and 56% of children ages 6-8 years will

experience dental caries in a primary tooth, with 21% of children between ages 6-11 who will

experience dental caries in a permanent tooth (Claiborne, 2018). Childhood caries affects more

than just the health of the mouth but can also effect the development of growing children.

Studies have shown that “an association between dental caries and all anthropometric outcomes

suggests that higher levels of untreated caries are associated with poorer growth in

schoolchildren” (Alkarimi, Watt, Pikhart, Sheiham, & Tsakos, 2014). The study suggests that

active decay in children’s mouths have an effect on the body’s immune response, which may
4TH GRADERS AND ORAL HEALTH 4

cause “anemia and influence bone remodeling, sleep patterns, and food intake” (Alkarimi et al.,

2014).

“Untreated tooth decay can lead to difficulties eating and sleeping, pain, the need for

invasive restorative treatment, emergency department visits and inpatient hospitalizations, poor

quality of life, systemic health problems, and, in rare cases, death” (Chi, Masterson, Carle,

Mancle & Coldwel 2014). Approximately 50% of children with untreated caries has to do with

low socioeconomic status. Socioeconomic status has a big impact on the types of foods that are

being consumed. With low socioeconomic status, there are more fermentable carbohydrates

being consumed. When fermentable carbohydrates are the main form of food intake, it increases

the potential for caries. “Interventions and policies to ensure food security may help address the

US pediatric caries epidemic” (Chi et al., 2014).

The next objective focuses on the importance of nutrition. Being able to understand the

significance of a healthy diet and eating behaviors is crucial to help improve the oral health in

children as well as prevent caries. Living in a society that has industrialized agriculture has

“impacted food markets and led to an increased availability of more processed, shelf-stable foods

throughout the country” (Mobley, Marshall, Milgrom & Coldwell, 2009). This has made it easier

for people, especially children, to access and carry individually packaged foods that are not

necessarily nutritious and consume them. The media is also to blame because of how they target

the youth, by promoting ads inside schools. According to Mobley et al., “Children and youth

were reported to have received approximately one-third or more of their calories from foods

purchased outside of the home, at restaurants and quick serve restaurants that contain higher fat

content than food consumed at home.”

4TH GRADERS AND ORAL HEALTH 5

Since schools are a main source of food for children’s diets, it would be the ideal place to

focus on a change. School lunch programs have already proven to make an increase in providing

more nutritious foods by including more “made-from-scratch” meals, fruits and vegetables.

Parents can set a great example by establishing healthy eating habits not only at home, but when

packing their kid’s lunches as well. School interventions, like the presentation and activity we

will be conducting in the fall, will help educate a small population of school-aged children on

how dental caries work and how they are easily effected by daily diet. Parents, children and

schools all need to work together to help improve oral health because collaboration is the key to

success.

The final objective that guided us to our project is the importance of proper homecare. In

one of our articles, the authors analyzed the effectiveness of implementing tooth brushing during

the school day on improving children’s oral health. The study was conducted over a two-year

period. This particular intervention aimed to introduce tooth brushing as a "life skill" and

improve the oral health of young children (Woodall, Woodward, Witty & Mcculloch, 2014). The

results showed the children enjoyed participating in the tooth brushing intervention and the

parents reported how it had increased their children’s knowledge of tooth brushing, and helped

them understand the consequences of when they do not brush. According to a pediatric study,

power toothbrushes should actually be the ideal choice for children since there is a significant

increase in plaque removal compared to manual brushing techniques (Davidovich et al., 2017).

Being able to incorporate a tooth brushing intervention for children makes it more possible that

their future habits will be consistent.

Another one of our articles focused on analyzing the different methods of tooth brushing

including: the horizontal scrub, Fones, and modified Bass technique, in a classroom setting.
4TH GRADERS AND ORAL HEALTH 6

There was a total of 180 children in 1st and 2nd grade, ages 6-8 years-old that were randomly

selected and divided into three different groups for each tooth brushing method. The children

were then examined after a 24-hour period and by using a plaque index. The results showed that

the modified Bass method was the most effective technique in plaque removal in the children.

The use of preventive procedures to maintain optimal oral health in children is a major concern

of the dental profession (Patil, Patil, & Kashetty, 2014). This provides evidence that children are

not being exposed to a correct technique of tooth brushing, such as the Bass technique. Since the

caries disease is such a huge dilemma in children, having a program in school for children or

even having presentations such as the one that we are planning for our project would be great

exposure in helping children learn the proper brushing technique, timing, and why it is so

essential.

In conclusion, if all three objectives were met, there would be an increase in knowledge

of oral health. With the new information, prevention of dental caries will be easier to attain.

Diagnosis

Our target population is 4th grade students in Redmond, WA. We selected this group

because we believe that they are in need of oral healthcare education in order to prevent disease.

Since childhood caries is the most chronic disease in children, it was appropriate to choose this

age group. The partners we would work with is the contact person (teacher) as well as the

principle of Redmond Elementary.

Planning

Project Goal and Objectives

Our goal is to improve knowledge of oral health through education and awareness in 4th

graders at Redmond Elementary School. The objectives are: to increase knowledge of home care
4TH GRADERS AND ORAL HEALTH 7

habits in 4th graders in Redmond, WA, to increase knowledge of nutrition in 4th graders in

Redmond, WA, and to increase knowledge of the effects of the oral disease process in Redmond,

WA. We will measure our data using pre-tests and post-tests.

Timeline

Spring Quarter

o Project groups selected

o Project ideas formulated, decided & discussed with instructor

o Contacted Megan Goodwin (teacher at Redmond Elementary)

Summer Quarter 2018

o Turn in planning document, lesson plan, drafts of pre/post tests and instructional

materials created up to this point.

Fall Quarter 2018

o Complete implementation of project, submit ADPI paper

o Perform evaluation of project

Winter Quarter 2019

o Submit final project paper (evaluation section added)

o Present projects
4TH GRADERS AND ORAL HEALTH 8

Lesson Plan

TITLE: 4th Graders and Oral Health

TARGET GROUP: 4th graders
ESTIMATED LENGTH: 1 hour, morning
INSTRUCTIONAL METHOD: presentations & activities
EDUCATIONAL GOAL: To improve knowledge of oral health through education and
awareness in 4th graders in Redmond, WA.
INSTRUCTIONAL OBJECTIVES:
1. Discuss method for cleaning gums and teeth
2. Demonstrate technique for effective brushing and flossing
3. Recommend less sugar consumption
4. Promote nutritious foods
5. Discuss oral disease process
6. Demonstrate disease process with eggs and vinegar

INSTRUCTIONAL MATERIALS
o Eggs & vinegar
o Plastic food
o Poster board
o Teeth models (dentoforms)
o Tooth brushes & floss

LEARNING ACTIVITY:
o Pre & post tests
o Station #1: eggs & vinegar to demonstrate disease process, felt tooth demonstration
o Station #2: placing plastic foods in categories (yes/sometimes)
o Station #3: demonstrate tooth brushing and flossing (homecare)

Instructional Set:
We believe it’s important to educate children on their oral health because childhood caries is
such a prevalent disease and is easily preventable.
Body:
1. Distribute pre-tests on oral health and have participants take to understand current
knowledge (5-10 minutes)
2. Separate into stations, each for 10-15 minutes
3. Distribute post-tests after stations are complete and compare knowledge (5-10 minutes)
4. Any questions

Closure:
We talked about the oral disease process, nutritious foods, homecare habits and how this
contributes to overall oral health. Hopefully the children will apply their knowledge.
4TH GRADERS AND ORAL HEALTH 9

Budget

Items Proposed costs Actual costs

Clear bags $0 $2
Business cards $0 $0
OHI paper $5 $2
Floss $0 $0
Toothbrushes $0 $0
Toothpaste $0 $0
Transportation $30 $15
Paper $5 $0
Poster board $2 $5
Food items (eggs, vinegar) $5 $4
Plastic Foods $0 $0
Dentoforms $0 $0

Summary

The problem we are addressing with our project is the need for oral health education in

4th graders of Redmond Elementary. Childhood caries is the most widespread pediatric disease in

the US, but it is preventable with proper education. For our project, we are hoping to achieve our

goal of increasing knowledge in 4th graders of oral health by demonstrating and presenting

activities for the children to participate in. The next phase in our program planning is going to

Redmond Elementary and implementing these activities.

Implementation

Our objectives for our project are: to increase knowledge of home care habits, nutrition

and the effects of the oral disease process in 4th graders in Redmond, WA. We presented on

November 15, 2018 to Ms. Wienen’s 4th grade class of 24 students at Redmond Elementary in

Redmond, WA. We arrived at the school at 2:40 PM to set up before the students were done with

recess. Our presentation started at 3:00 PM and lasted until 3:30 PM. After introducing

ourselves, we passed out pre-tests for the students to fill out. The teacher divided the class into 3

groups of 8 students. We had 3 stations set up: Stacy was teaching homecare habits, Whitney
4TH GRADERS AND ORAL HEALTH 10

was teaching the effects of the oral disease process and Angelica was teaching nutrition. At

Stacy’s homecare station, she had 8 Colgate plastic mouths, toothbrushes and floss to teach

proper techniques. She also handed out the goodie bags for the kids, which included a

toothbrush, floss, toothpaste, oral health care instructions, and LWTech Dental Clinic business

card. Whitney’s caries station used eggs soaked in vinegar to demonstrate the oral disease

process, as well as a poster board visual. Angelica’s nutrition station included a poster board that

categorized the foods that cause cavities versus the foods that do not. She had the children sort

the foods into appropriate bins after discussing the poster board information. The students rotated

through the three stations, spending about 5 minutes each. Afterwards, Post-Tests were filled out

by each student. The answers were discussed with the entire class, which concluded our

presentation.

The outcomes will be evaluated by a pre-test and post-test. They will be scored and

averaged in order to see the efficacy of the information presented.

Summary

We presented to 4th graders and taught them about homecare techniques, the effects of the

oral disease process and nutrition. The next phase is evaluation.

Evaluation

At this point we have reached the evaluation phase where we will assess the results and

successfulness of our project. For our formative evaluation, we decided what would work best

for our project. The lesson plans that we created and presented, splitting up the 4th grade class

into smaller groups, doing rotations and keeping the rotations within a short time frame were

beneficial to our project. What could have used improvement was having more eggs available to

use as demonstration for Whitney’s station on the oral disease process and for Stacy to focus on
4TH GRADERS AND ORAL HEALTH 11

more one-on-one teaching for her station on home care techniques. For our summative

evaluation, we found that there were successful improvements in the children’s knowledge after

our individual teaching stations. We also managed to spend less on our presentation than what

was predicted, making our project cost-effective. Our goals were to improve the knowledge of

oral health through education and awareness in 4th graders at Redmond Elementary School. The

objectives were: to increase knowledge of home care habits, to increase knowledge of nutrition,

and to increase knowledge of the effects of the oral disease process. Based off our pre and post

test results, both our goals and objectives were met. After calculating our pre and post tests, we

found that the mean score for the pre-test was 68.3% and for the post-test it was 81.75%. When

comparing the two percentages, there is a 13.4% increase in knowledge from the 4th graders after

our lesson plans were presented. Refer to Appendix D for the mean scores and overall scores of

the pre and post test placed in a bar and scatter plot graphs. In addition, we noted an outlier on

our scatter plots graphs of the pre and post tests. One of the students in the class was purposely

choosing answers that were incorrect and he ended up with scores of 13% and 37.5%.

The strengths of our project included having three interactive stations, easy to understand

presentations that were simple, age appropriate, but informative, a short time limit of 5 minutes

for each station, and rewarding the students at the end of the station with a goodie bag. Our

weakness included not having enough eggs available for Whitney’s demonstration. We only

created one bag with eggs to demonstrate the oral disease process and by the time the first group

was finished with the station, Whitney found that the eggs were falling apart from being passed

around by the children. Another weakness involved Stacy’s station where she was demonstrating

to the children on how to brush and floss. In the beginning, she tried to show and explain to the

group all at once, but found that it was difficult for them all to remain focused. She then began to
4TH GRADERS AND ORAL HEALTH 12

teach each child one and one and found that it was much more successful. Overall, we knew

from the beginning that it was going to be difficult to present to a young group of children, but

we believe that we did the best that we could.

We believe that our project was sustainable because not all of the children in the 4th grade

class had exposure or the same amount of exposure to dental care and knowledge. Our

presentation was beneficial for them because they now have the education in three important

aspects of oral health care and will hopefully implement their knowledge into their daily lives. If

we were to attempt the same presentation, we would be more prepared with materials that are

needed. In this case, more eggs for Whitney’s presentation, and we would also teach the children

home care habits one on one rather than the entire group for Stacy’s presentation. Now that we

have completed the evaluation phase of our project, what we decided we would modify for next

time would be our test questions. We could change some of the questions that had more obvious

answers and make them slightly more challenging for the children as we felt they did pretty well

on the tests both times. As we look back on our project, we believe that overall it can definitely

be reproduced again in the future with successful results. Our project was easy to put together,

cost-effective, enjoyable for the audience, and most importantly it met our goals and objectives.
4TH GRADERS AND ORAL HEALTH 13

References

Alkarimi, H. A., Watt, R. G., Pikhart, H., Sheiham, A., & Tsakos, G. (2014, March 01).

Dental Caries and Growth in School-Age Children. Retrieved May 15, 2018,

from http://pediatrics.aappublications.org/content/133/3/e616

Chi, D. L., Masterson, E. E., Carle, A. C., Mancle, L. E., & Coldwel, S. E. (2014, April

9). Socioeconomic Status, Food Security, and Dental Caries in US Children:

Mediation Analyses of Data From the National Health and Nutrition Examination

Survey, 2007–2008. Retrieved May 10, 2018, from

https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2013.301699

Claiborne, D. M. (2018, February). The Role of Fluoride in Caries Prevention. Dimensions of

Dental Hygiene, 16(2), 34-36.

Davidovich, E., Ccahuana-Vasquez, R. A., Timm, H., Grender, J., Cunningham, P., & Zini, A.

(2017). Randomised Clinical Study of Plaque Removal Efficacy of a Power Toothbrush

in a Paediatric Population. International Journal of Paediatric Dentistry, 27(6), 558-567.

doi:10.1111/ipd.12298

Huot, R. A., DDS. (2018). Dental Caries: How They Are Formed and What You Can Do to

Prevent Them. Retrieved May 25, 2018, from https://www.colgate.com/en-us/oral-

health/conditions/cavities/dental-caries-how-they-are-formed-and-what-you-can-do-to

-prevent-them-0813

Mobley, C., Marshall, T. A., Milgrom, P., & Coldwell, S. E. (2009). The Contribution of Dietary

Factors to Dental Caries and Disparities in Caries. Academic Pediatrics, 9(6), 410–414.

http://doi.org/10.1016/j.acap.2009.09.008
4TH GRADERS AND ORAL HEALTH 14

Patil, S., Patil, P., & Kashetty, M. (2014). Effectiveness of different tooth brushing techniques on

the removal of dental plaque in 6-8 year old children of Gulbarga. Journal of

International Society of Preventive and Community Dentistry, 4(2), 113.

doi:10.4103/2231-0762.138305

Redmond Elementary. (n.d.). Retrieved May 28, 2018, from https://www.schooldigger.com/go/

WA/schools/0423000678/school.aspx

Redmond WA Free Dental Care and Dental Clinics And Affordable Or Sliding Scale. (n.d.).

Retrieved May 28, 2018, from http://www.freedentalcare.us/ci/wa-redmond

U.S. Census Bureau QuickFacts: Redmond city, Washington. (n.d.). Retrieved May 28, 2018,

from https://www.census.gov/quickfacts/fact/table/redmondcitywashington/PST045216

Water Quality Report. (n.d.). Retrieved May 28, 2018, from

http://www.redmond.gov/common/pages/UserFile.aspx?fileId=209984.

Water, Sanitation & Environmentally-related Hygiene. (2016, September 22). Retrieved May 26,

2018, from https://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html

Woodall, J., Woodward, J., Witty, K., & Mcculloch, S. (2014). An evaluation of a toothbrushing

programme in schools. Health Education, 114(6), 414-434. doi:10.1108/he-12-2013-0069

4TH GRADERS AND ORAL HEALTH 15

Appendix A: Lesson Plan

TITLE: 4th Graders and Oral Health

TARGET GROUP: 4th graders
ESTIMATED LENGTH: 1 hour, morning
INSTRUCTIONAL METHOD: presentations & activities
EDUCATIONAL GOAL: To improve knowledge of oral health through education and
awareness in 4th graders in Redmond, WA.
INSTRUCTIONAL OBJECTIVES:
7. Discuss method for cleaning gums and teeth
8. Demonstrate technique for effective brushing and flossing
9. Recommend less sugar consumption
10. Promote nutritious foods
11. Discuss oral disease process
12. Demonstrate disease process with eggs and vinegar

INSTRUCTIONAL MATERIALS
o Eggs & vinegar
o Plastic food
o Poster board
o Teeth models (dentoforms)
o Tooth brushes & floss

LEARNING ACTIVITY:
o Pre & post tests
o Station #1: eggs & vinegar to demonstrate disease process, felt tooth demonstration
o Station #2: placing plastic foods in categories (yes/sometimes)
o Station #3: demonstrate tooth brushing and flossing (homecare)

Instructional Set:
We believe it’s important to educate children on their oral health because childhood caries is
such a prevalent disease and is easily preventable.
Body:
5. Distribute pre-tests on oral health and have participants take to understand current
knowledge (5-10 minutes)
6. Separate into stations, each for 10-15 minutes
7. Distribute post-tests after stations are complete and compare knowledge (5-10 minutes)
8. Any questions

Closure:
We talked about the oral disease process, nutritious foods, homecare habits and how this
contributes to overall oral health. Hopefully the children will apply their knowledge.
4TH GRADERS AND ORAL HEALTH 16

4TH GRADERS AND ORAL HEALTH 17

Appendix B & C: Pre-Test/Post-Test

Pre-Test/Post-Test
1. How often should you brush your teeth?
A. Whenever I feel like it
B. Once a week
C. Two times a day
2. How long should you brush your teeth?
A. 2 minutes
B. 10 seconds
C. 3 minutes
3. How often should you change your toothbrush?
A. Once a year
B. When the bristles are too flat
C. Every 3-4 months
4. TRUE OR FALSE: The best way to clean your teeth is to use an “up-and-down” or
“side-to-side” motion.
5. What type of snack is the best for keeping your teeth healthy?
A. A fresh fruit like apples
B. A cold snack like ice cream
C. A chewy snack like a candy bar
6. TRUE OR FALSE: Fruit juices do not cause damage to teeth.
7. What is a cavity?
A. A piece of dirt on your tooth.
B. A hole in your tooth.
C. A bad tooth that needs to be removed.
8. What causes a cavity?
4TH GRADERS AND ORAL HEALTH 18

Appendix D: Evaluation Results

4TH GRADERS AND ORAL HEALTH 19