Dental Health Edu Assessment

DENTAL HEALTH EDUCATION ASSESSMENT IN CORTLAND COUNTY 1

Dental Health Education Assessment in Cortland County

Kristen Basden

State University of New York at Cortland


Introduction

In areas of low income, limited access to healthcare and unequal geographic

distribution of healthcare practices, citizens are often left without care. This results in

untreated patients, which leads to other health complications. Untreated citizens are

also subject to pain or discomfort, days missed of work or school, and long term

consequences. Citizens that do not receive preventative measures, like screenings,

routine check-ups, and vaccinations, can become more ill with complex conditions that

could have been prevented.

The primary causes of poor oral health are a lack of preventative dental care,

lack of fluoride, lack of oral health education, and an unbalanced diet (World Health

Organization, 2012). In addition to a person’s general health being affected by poor oral

health because of limited dental access, the person’s quality of life is also negatively

affected. Problems like being embarrassed, feeling tense, problems speaking,

interrupted meals, and difficulty relaxing are among the aspects of life that are affected

by dental health issues (Crocombe, Mahoney, Spencer & Waller, 2013, p. 192). These

are issues that can interrupt the everyday life, happiness, and comfort of a person, but

are easily preventable with proper oral health education and care.

Not having access to dental care causes problems that begin in childhood and

can follow these individuals throughout their lives. In children, unnecessary oral pain

causes low self-esteem from low self-image or confidence, missed school days and less

involvement in school (Simmer-Beck, et al., 2015, p.1764). When these problems

continue to their adult lives, poor oral health can lead to other health problems such as


diabetes, and the leading cause of death in the U.S., heart disease (Simmer-Beck, et

al., 2015, p. 1763). Bacteria found in oral cavities can reach the heart through the

bloodstream, which leads to a heart infection, then heart disease (Ritter & Southerland,

200, p. 233). Other issues include inability to find a job, as well as even higher dental

bills because of greater damage done to the teeth from not being treated.

Over 50% of third grade children in Cortland County have had an experience with

cavities, and three out of five adults have had a permanent tooth extracted due to gum

disease or tooth decay (Seven Valleys Health Coalition, 2013). The number of

untreated cavities in Cortland County is over 6% higher than in New York State. In

general, the United States lacks mid-level dental providers needed to expand access to

dental care (Simmer-Beck, et al., 2015, p. 1763).15% of the Cortland County population

lives below the poverty line, and the median household income is over six thousand

dollars under the national average (Seven Valleys Health Coalition, 2013).

Socioeconomic factors of Cortland County restrict many people who receive public

health insurance from going to the dentist. There is a barrier between private dentistry

work and public dentistry insurance plans, which often leaves a large gap for people in

communities of low income that do not receive adequate dental care. Most private

dentists do not accept public insurance; in fact, most do not participate in any insurance

programs. Currently, in Cortland, for every 2,783 citizens there is one dentist, whereas

nationally, there is one dentist for every 1,586 citizens (Seven Valleys Health Coalition,

2013). This overcrowds dentist offices, making their accepted insurance options more

exclusive.


Seven Valleys Health Coalition (SVHC) and the Cortland County Health

Department lead the initiative called Cavity Free Cortland (CFC). CFC is divided into

three subcommittees: dental education, fluoride varnish, and fluoridation. Acting as

public advocates and community leaders, the members of CFC support community

water fluoridation (CWF) and are working towards getting fluoride regulated into

Cortland’s water supply. The varnish subcommittee is organizing to get varnish

treatments (a highly concentrated, topical form of fluoride) applied in primary care

offices to ensure the children of Cortland are being reached.

The most cost effective and efficient preventative measure for oral health is

obtaining fluoride via optimally fluoridated water supply, the Fluoride-Varnish Program

and dental education. A fluoridated water supply ensures the population is receiving an

adequate amount of fluoride in their water regardless of socioeconomic status, income

level, education level or dental health access. Adding fluoride to a community water

supply is beneficial for all, being that fluoride prevents tooth decay and cavities (Murthy,

2015).

The dental education subcommittee compiles different ways to reach the citizens

of Cortland County to educate them on oral health. This subcommittee informs people

on a number of topics, including why fluoride is essential to oral health. The education

subcommittee looks for gaps in oral health knowledge and looks to fulfill them through

community outreach. The dental education is aimed towards adults with children, which

indirectly educates the children, and improves oral health. The education subcommittee

also educates about CWF.

Purpose


This project’s purpose was to identify the areas regarding dental health that need

to be implemented in public education, to promote lifestyle changes, and to improve the

overall health of Cortland citizens. This information helped to identify where future oral

health education efforts will be steered. The selection of this project was based on what

is needed in the community to improve health, as well as quality of life here in Cortland.

CFC has identified three subcommittees that were voted on based on highest needs,

which are not only present locally, but statewide and nationally. The goals of this project

are also incorporated into the New York State Prevention Agenda, and Healthy People

2020. By understanding the knowledge level of oral education in the community,

education can be expanded and tailored to what knowledge gaps are identified. This

project helped to continue and extend the efforts of SVHC, and ultimately CFC.

Data collection is being done through a parental survey, built off a tool that CFC

has used and has proven to be effective based on previous data collection (see

Appendix 1). The information obtained helped assess the educational needs of the

community and determine what type of education needs to happen in the future. Based

on prior survey results, results were expected to show that

Some citizens are Without a dentist, some children are being taken to the dentist

more than twice a year (shows dental problems).

Some children are not being taken to the dentist enough (twice a year).

Some children are only being taken to the dentist for emergencies.

The majority of adults with children are in support of CWF in Cortland County.

SVHC has benefitted from this project in many ways. This project aligns with the

mission and goals of Seven Valleys Health Coalition by advancing the health and well-


being of the citizens of Cortland, through coordinated efforts. By improving the health

outcomes for people in the Cortland community, SVHC adds great value to the

community. This project provided information that can be used to move forward with the

work that is already being done, and helping guide where to go next. I benefitted from

this project with improved data collection and analysis skills, giving me an insight on

working with a rural community, becoming more familiar with the needs assessment

process, and the ability to look at specific problem areas and identifying realistic and

feasible solutions. Never having worked in a rural community before, this project

increased my awareness as a health professional of rural living and understanding the

barriers and limitations. Using SVHC’s resources, my knowledge in surveying collection

and data, as well as needs assessment has made me a more efficient health

professional.

Based on the survey that was distributed, the social-ecological model is relevant,

being that the oral health of the people surveyed is intrapersonal, interpersonal, and

also directly related to community and public policy aspects. Socioeconomic limitations,

knowledge and skills are intrapersonal aspects of one's oral health, whereas location

and environment, and available educational programs are aspects of the community

that also affect oral health.

This project is fully evidence based. There have been numerous studies

conducted on dental caries and oral health disparities, and it is proven that community

water fluoridation (CWF) reduces dental caries among socioeconomic groups

(McDonough, et al., 2000, p. xii). Combined evidence from numerous studies shows

that in areas where there is fluoride in the water, caries are over 15% less than in areas


without fluoridated water (McDonough, et al., 2000, p. 21). The survey touched on the

support and opposition of fluoride, which is a very important aspect of CFC, and

Cortland in general. CWF is important to Cortland because lack of access to dental care

is a large problem. CWF would reduce cavities among the population, thus improving

health and quality of life. CWF is important for children because it eliminates

socioeconomic limitations.

Methods

Information was used collecting surveys administered online, through a given

website link, and paper surveys. A website link was used as much as possible because

not only is it easy to reach people, and reduces under or over-reporting. The paper

surveys were used for people who might not have had access to the internet; Head

Start and Early Head Start parents, as well as parents attending Kidsville, a health fair

targeting preschool children in Cortland. They were given a clip board and cover page

explaining anonymity and option to opt-out of questions they did not feel comfortable

asking, and privacy. These were steps to cut back on any bias that could have existed.

The lack of consistency and truthfulness can be the result of stigmas or embarrassment

of the person taking the survey, compelling them to record what they think is the

healthier answer. With the barriers that exist in Cortland County related to oral health,

this could be an issue, therefore, an online survey also gave the citizens the anonymity

they need to cut back any bias that may exist. The sample was residents in or around

Cortland, with children. Qualitative and quantitative information was collected.

Questions included, “How often do you take your child to the dentist?”, “Does your child

brush every day?”, and “Would you be in favor of having Fluoride in your public water


supply?”. In addition to these questions, the questions on my survey measured the

parent’s oral health knowledge and skills, as well as the child’s dental health skills. Data

was collected between March 21st and April 22nd, so there was enough time to

organize and analyze final results. See Appendix A.

Results and Analysis

Graph A.

My child's teeth are important to their overall health

Regular checkups keep my child's teeth healthy

Taking care of my teeth is important to me

0

5

10

15

20

25

30

35

Selected opinions

Strongly disagree Agree Strongly agree

# of

peo

ple

Graph A shows perceptions of oral health importance of the parents in Cortland. The

perception of the parent’s teeth was a little higher than for their children.

Graph B.


< Once a year Once a year Twice a year >Twice a year0

5

10

15

20

25

30

35

Frequency of children's dental visits

Graph B shows the frequencies of which parents surveyed are taking their children to

the dentist. The majority of parents replied they take their child twice a year to receive

dental work, which is the recommended practice. Some parents reported they took their

child to the dentist over twice a year, which indicates dental problems that required

more professional care.

Graph C.

Strongly dis-agree- 62.5%

Disagree- 30%

Agree- 7.5%

I only take my child to the dentist for an emergency visit


Graph C shows the perceptions of parents based on the statement “I only take my child

to the dentist for an emergency visit”. While most disagreed, a few did admit they

agreed with that statement.

Graph D.

Does your child go to the dentist?

Does your child brush every day?

In the past 5 months, has your child had a cavity?

0

5

10

15

20

25

30

35

40

45

Selected questions

YesNo

Graph D shows questions that were selected to compare different aspects of the child’s

oral health. 9.3% of parents said their child doesn’t go to the dentist, and 4.8% of

children don’t brush their teeth daily. Even though a majority of the surveyed parents

take their child to the dentist and brush, there was still over 14% that have had a cavity

in the past 5 months. This shows a need for an intervention.

Graph E.


Graph E shows the distribution of opinion when survey takers were prompted with the

question “Would you be in favor of having fluoride in your public water supply?” 19

people said “yes,” 17 people replied “no,” and 7 respondents skipped the question.

Table A.

Opinions

-My kids are tweens so I don’t help them brush. They do floss, but not regularly

-The dentist won’t see her until she is 3

-We use a well (well water)

-I took my child to Elite Dental in Cortland 1 ½ years ago and was told that he had

cavities that needed to be filled right away but would not show me or take x-rays. He

now sees a dentist from Fayetteville Pediatric Dentistry and has never had a cavity.

Elite Dental attempted to scam me at the cost of a child’s mouth

-Has first dental appointment July 6th

Table A shows the opinions of parents who chose to respond that were prompted with

an open opinion section.

Would you be in favor of having fluoride in your public wa-ter supply?

YesNo


Discussion

Graph A shows most of the parents that took the survey do believe oral health is

important to their child’s overall health, regular checkups help in keeping their child’s

teeth healthy, and taking care of their own teeth is important. These data show that

parents in and around Cortland do think that healthcare is an important health

component for their child and themselves. It can be inferred that this shows the problem

is not in the perceived susceptibility, but perhaps cues to action in completing the

behavior.

Graph B shows the majority of parents take their children to the dentist twice a

year, but some are going more than twice a year, which indicated extra dental work

being done. Therefore, education could be directed towards why taking your child to the

dentist twice a year is important. There needs to be a change of behavior using

interpersonal values.

Graph C shows most parents think children should be taken to the dentist more

frequently than emergencies, but 7.5% of parents said they only take their child for an

emergency visit. This is important because it indicates the need for education on two

things; why children need to be seen by a dentist regularly, and behavioral changes to

improve their child’s oral health. Graphs B and C indicate some parents are not

regularly taking their children to the dentist, which will lead to poor oral health for their

children in the future.

Graph D shows most parents are taking their kids to the dentist and most are

brushing daily. The data shows even though most kids are brushing and seeing a

dentist, there are a higher percentage of children with cavities, than those that reported


not brushing or seeing a dentist. Even though some of the kids are doing what they

should be in regards to oral health, they still have cavities. If the data showed the

number of reported children not seeing a dentist or not bushing matched the number of

children with cavities there could be a conclusion that the cavities might only be

happening to those children, but the data shows it is more than just that group of

children. This is an area where we can see where CWF would make a difference.

Graph E is an opinionated question about supporting or opposing CWF, with a

slight majority in support of CWF. This indicates a need for education because cavities

are showing in children who are brushing and seeing a dentist regularly. There were 19

people in favor of CWF and 17 opposing CWF. Education on CWF, and how CWF will

benefit the community is especially important in keeping children’s teeth strong again

cavities by taking another preventive step. Community education and public policy

(Social Ecological Model) of fluoride can help parents understand that with fluoride in

the water, their children are being protected in an effortless way. By doing this, quality of

life would increase because of the potential for less oral problems in the future. This is

also related to Graph C, for parents who only take their child to the dentist for

emergencies, this would benefit them by having a preventive measure in the water they

drink.

Table A is an open ended response, to which parents could write anything they

wanted while taking this survey. The comment that stands out to me is about the child

who went to Elite Dental and experienced issues. This is important because perhaps

there is a mistrust of dental providers in the community, which can be a barrier for not

wanting to see a dentist. This parent now distrusts the dentists in Cortland, so perhaps


other parents aren’t taking their kids to the dentist, which can be seen in graphs B and

D. This is an opportunity for intervention between the community and providers.

This project indicates that parents who took this survey are concerned about their

child’s teeth, and most are taking their children to the dentist regularly, but some are

only being taken for emergencies, and there is a high rate of cavities, despite regular

dental visits and brushing. An educational need in this community can be inferred to

show need of the importance of taking children to the dentist, how CWF can help their

family’s teeth, and doing something about the possible mistrust between providers and

consumers.

A problem that I experienced while conducting surveys at Kidsville was a lot of

people couldn’t take the survey because they were a mentor to the child, not the parent.

Kidsville also changed locations to a less populated area that may present

transportation barriers for the community, so there was not as much of a turnout as

what was expected based off of previous years. To combat lower attendance, I posted

the survey to SVHC’s Facebook page and I was able to get more input in that way.

Another problem I experienced was my sample population. Surveys went to Head Start,

Kidsville, and online, so the parents that I was able to reach were actively engaging with

their kids, or their kid’s school, or had access to an online survey, therefore I would

have liked a more diverse sample. Input that could have been nice to have is parents of

children who perhaps don’t have online access, and parents (for whatever reason) are

not as involved because this perhaps would have shown a different take on oral health

in the Cortland community.

Recommendations and Reflections


Based on the findings of this project, I think SVHC should continue to educate on

CWF as the most cost effective preventable measure for improving oral health, find

ways to improve the dentist community relationships, and continue to educate on why

children need to see a dentist. All three of these possible initiatives are relatable to the

work Cavity Free Cortland is currently doing. I would also recommend informational

materials and using word of mouth for education in the community, because we are

already aware that that is an efficient way to communicate to parents. I would also

recommend using places where families go (grocery stores, doctor’s offices, etc.) to

promote CWF to get parents informed about what it could do for their children’s oral

health. These educational ideas would promote a behavior change, better oral health

practice, which leads to better overall health, and a higher quality of life.

This was an engaging project for me to complete this semester, especially

because the work is very relevant to the things SVHC and CFC do daily. By gathering

more information for CFC to use after I am done here, they have more ideas about what

to do next and what future initiatives should be. I learned a lot about collecting data from

parents, sometimes it is easy and parents are willing and other times parents are

hesitant. I have never collected data from parents directly before so I now know how to

go about it. Another thing I learned is to find ways to get a diverse sample so the results

aren’t so narrow. I valued the way this project was set up. First was the proposal, which

I thought was very important because this could be a situation that I could find myself in

when I start my career. Starting off with a proposal, getting feedback and moving on

from there is something that could happen in the real world, so I valued the process as

a great, realistic practice. The rewarding part of this project was collecting the results


and knowing they will be used by CFC for future initiatives. The challenging part of this

project was working with some of the parents at Kidsville, because a lot said they didn’t

want to take the survey and brushed me off, when I know that it is important to the

community that things like this are done, so the people trying to help know what is

needed in the community.


Appendix A.

April, 2016

Parents or Guardians,

Seven Valleys Health Coalition (SVHC) is a non-profit agency here in

Cortland, NY, that works to improve the lives of people in the community. As one of

our many goals, we are working to improve oral health, and identify where we

should focus our efforts.

Attached is a voluntary survey about your dental health care perceptions. It

is our hope that you can find the time to take it. It should not take more than 10

minutes to complete. You do not need to put your name on the survey, it is

completely anonymous. The results may be published but will not identify you, or

your child, in any way. You may skip any question you do not feel comfortable

answering.

With your help we will better understand what steps we can take to improve

oral/dental health in Cortland. If you have any questions feel free to contact us at

607-756-4198, or [email protected]. Thank you for your help!

Sincerely,

Jacqueline Leaf, Executive DirectorSeven Valleys Health Coalition


1. What town/ village/ city do you live in? _________________________________________

2. Please check your age range: 20> 20-30 31-40 41-50 51-65 65<

3. Do you have a dentist? Yes No

4. Does your child go to the dentist? Yes No

5. How often do you take your child to the dentist?

Less than once a year Once a year

Twice a year More than twice a year

6. When was your child’s last dental visit? ________________________________________

7. Do you have dental insurance? Yes No

8. Does your child have dental insurance? Yes No

9. Is transportation a problem for taking your child to the dentist?

Yes No

10. Do you have trouble paying for your child’s dental visits?

Yes No

11. In the past 5 months has your child had any dental problems?

Cavities: Yes No

Teeth removed: Yes No

Other (please specify): ______________________________________________________


12. Does your child brush every day? Yes No

13. Do you or your child use dental floss?

You: Yes No

Your child: Yes No

Other (please specify): ______________________________________________________

14. Would you be in favor of having fluoride in your public water supply? Yes No

15. Opinions:

Strongly

disagree

Disagree Agree Strongly

Agree

a. I only take my child to the dentist for an emergency visit.

b. I help my child brush at least once a day.

c. My child’s teeth are important to their overall health.

d. My child is scared to go to the dentist.

e. Regular dental checkups will help keep my child’s teeth healthy.

f. Taking care of my teeth is important to me.

16. Additional comments:

______________________________________________________________________________

______________________________________________________________________________


References

Crocombe, L., Mahoney, G., Spencer, A., & Waller, M. (2013). Will improving access to

dental care improve oral health related quality of life? Australian Dental Journal

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McDonagh, M., Whiting, P., Bradley, M., Cooper, J., Sutton, A., Chestnutt, I. . .

Kleijnen, J. (2000). A systematic review of water fluoridation. NHS Centre for

Reviews and Dissemination: 18. Retrieved from

http://www.nhs.uk/Conditions/Fluoride/Documents/crdreport18.pdf

Murthy, VH. (2015). Community water fluoridation: One of the CDC’s “10 great public

health achievements of the 20th century”. Public Health Reports 130. Retrieved

from http://libproxy.cortland.edu:2106/ehost/pdfviewer/pdfviewer?

vid=5&sid=e4d8da5 5-4de7-497b-9277-8d52069d0987%40sessionmgr4004&hid=4108

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Patients, 19. 233-234. Retrieved from

https://cortland.illiad.oclc.org/illiad/illiad.dll?Action=10&Form=75&Value=193527

Seven Valleys Health Coalition. (2013). Cortland Counts. Retrieved from

http://media.wix.com/ugd/f06d2c_751f91e1796a478ca36fb2a4196efb94.pdf


Simmer-Beck, M., Walker, M., Gadbury-Amyot, C., Liu, Y., Kelly, P., & Branson, B.

(2015). Effectiveness of an alternative dental workforce model on the oral health

of low-income children in a school-based setting. American Journal of Public

Health, 9.1763-1769. Retrieved from

http://libproxy.cortland.edu:2106/ehost/pdfviewer/pdfviewer?vid=3&sid=40466a5

b-e5d1-4af1-b20e-ef21edb92d92%40sessionmgr4002&hid=4205

World Health Organization. (2012). Oral health. Retrieved from

http://www.who.int/mediacentre/factsheets/fs318/en/

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