Hannah Campbell Dental Hygiene Portfolio - Introduction



Dates:We implemented our oral health program on Tuesday, April 2; Saturday, April 6; Tuesday, April 9; and Tuesday, April 16.Program Design:The program was promoted by Stable Spirit in their newsletter as well as through their email list and word of mouth. Session One:The oral health program began on Tuesday, April 2, 2013. For the first session, we spoke with the parents of the children receiving therapy at Stable Spirit. We spoke to three parents. Our original plan was to speak to the volunteers as well. However, due to severe volunteer shortages, we were unable to speak to the volunteers that day. We were also able to speak to the physical therapist and her staff. We did not work directly with the children on this day, either. There was a low turnout for therapy sessions due to illness among the children that day.We did an oral pre-test to test the parents’ dental health knowledge. We discussed oral hygiene and its importance with three parents, the physical therapist, and a therapy intern. We discussed the need for good oral hygiene, especially in children with special needs. We discussed the risk of oral disease in children with special needs. We also discussed the prevalence of childhood caries, the cause of caries and the caries process. We explained the need for daily plaque control. We used our patient education books to show the caries process. The parents also received a handout from the University of Washington on oral hygiene in special needs children.Session Two:Our second session for our oral health program was held on Saturday, April 6, 2013. For this session, we spoke with 25 Girl Scouts and Cub Scouts who were volunteering at the facility for the day, three parents, the physical therapist, and two physical therapy interns. Again, we were unable to speak to the volunteers because of a shortage of hippotherapy volunteers. We worked directly with 25 children.We did an oral pre-test on oral hygiene. We discussed brushing and taught brushing technique. We discussed the need for brushing at least twice a day (morning and night). When speaking to the parents of the children receiving therapy at Stable Spirit, we discussed using a SonicCare with no toothpaste, as recommended by the local pediatric dentist we consulted when planning our program. We also explained the need to replace the child’s toothbrush every three months. We explained the need for desensitizing the child’s mouth. Desensitizing the child’s mouth means getting the child used to having someone working in their mouth, which makes it much easier for the dentist and dental hygienist to work in their mouth at appointments. We explained the use of Social Stories applications or books to help children understand the process of brushing their teeth. We also discussed modifications to the brushing technique, such as using a mouth prop or letting the child chew on something while the parent brushes.We did a pre-test on brushing skills. Only 15 children were willing to try using the toothbrushes. We taught brushing technique using a puppet for the younger children and a typodont for the parents and older children. We taught the rolling method, then tested the children a second time.We used our patient education book to show brushing technique. We also showed the children how plaque accumulates on teeth that are not brushed. The children received an oral health care kit, donated by a local dentist and Crest/Oral B. Each kit contained a child-size toothbrush, toothpaste, an hourglass style timer, and children’s floss holders.Session Three:Our third session for the oral health program was held on Tuesday, April 9, 2013. For this session, we spoke with one parent and their child, the physical therapist, and two physical therapy interns. Again, a volunteer shortage made it difficult to talk to volunteers. The weather was a factor again on this day, as many parents cancelled their child’s therapy session due to bad weather. We taught about gingivitis using our patient education books. We discussed healthy gums verses diseased gums. We talked about why it is important to floss every day and explained that a toothbrush alone cannot clean the areas between your teeth. Flossing is the only way to clean this area. We demonstrated flossing using both regular floss and child floss holders. We also had a floss model using plastic blocks, Play-Doh, and yarn to teach children how to floss using a C-shape.Session Four:Our final session for the oral health program was held on Tuesday, April 16, 2013. For this session, we were only able to speak to one parent for a very brief time and were unable to complete the lesson. Again, there were issues with both a volunteer shortage and bad weather. Many parents cancelled. Others were late due to the weather, which led to multiple sessions going on at once and parents rushing to leave when the sessions were finished.Our lesson plan was on nutrition and its importance to oral health. We planned to discuss the importance of nutrition and the role it plays in oral health. We planned to discuss healthy and unhealthy snacks. We planned to discuss ways that a parent can lower the negative effects of certain foods, such as pairing a protein with a high carbohydrate food.Program Objectives:Increase dental health knowledge by 25%Each session included a short teaching session on dental topics. We did a brief pretest before each session and a posttest after each session. We provided handouts and lists of further resources parents could access. We interacted with them one-on-one and included hands-on skill sessions as well.Provide dental resources to help parents increase their child’s oral healthWe provided a variety of resources for the parents at each session. We provided visual learning tools with our patient education books and handouts. We provided an oral hygiene kit for the children who participated. We provided hands-on activities for both the parents and the children, including brushing and flossing practice on the typodont (for adults) and a puppet (for children.) We told the parents about local dentists who treat children with special needs. We told about a free online resource available through Crest/SonicCare and Autism Speaks.Improve oral hygiene skills by 25%We were only able to see one child repeatedly to work on oral hygiene skills, and we saw significant improvement in him. However, we were able to work with a large group of children on brushing technique. We taught younger children the rolling brushing method and taught older children the Bass method. We were able to work with one child on flossing. We taught how to floss with a C-shape and how to use a child floss holder.Train volunteers to continue oral health program at Stable SpiritOur plan was to work with Stable Spirit volunteers to teach them how to continue the program. However, due to volunteer shortages, were only able to speak to the physical therapist and her two interns. We discussed the program and its importance with them. We explained the importance of good oral hygiene for all children and the higher risks faced by special needs children. Results:Increase dental health knowledge by 25%.We tested a total of three parents the first day, three parents the second day, one parent the third day, and one parent the fourth day. The total scores for the pretest were as follows:Day One: 3, 3, 4Day Two: 3, 4, 4Day Three: 2Day Four: We were unable to give a pretest or posttest on the fourth day.The posttest scores were as follows:Day One: 4, 4, 4Day Two: 4, 4, 4Day Three: 2Day Four: n/aCumulative pretest scores: 22 our of 27 = 81% average scoreCumulative posttest scores: 26 out of 27 = 96% average scoreTotal improvement in oral health knowledge: 15% improvement in oral health knowledgeAlthough we did not reach our goal of 25%, there was a significant increase in oral hygiene knowledge.Provide resources to help parents increase their child’s oral health. We were very successful with this goal. We provided a variety of resources to parents, including handouts, an oral hygiene kit, hands-on activities, practice on practical skills (brushing and flossing), names of local dentists who treat children with special needs, and lists of websites and resources available online.Improve oral hygiene skills by 25%.This was a more difficult goal to attain because of the many cancellations. We were only able to see one child repeatedly. However, his brushing improved by 25% from the first time to the second time we saw him.Train volunteers to continue oral health program at Stable Spirit.We were unable to reach this goal due to circumstances beyond our control. Stable Spirit had a very low volunteer ratio the weeks we were there. All volunteers were needed for therapy sessions, preparing horses for upcoming sessions, and other activities. While there was a high interest from the volunteers, more sessions with the volunteers only would be needed to train them to continue the program.Evaluation:One strength of our program was balancing knowledge with practical skills. We started each session with a brief discussion of an oral health topic. In three of the four sessions, we followed this with a practical skill. Another strength was our involvement of the children who were able to participate. When we taught toothbrushing skills, we had the children practice brushing a puppet’s teeth, then had them brush their own teeth. We also had an activity using laminated teeth. The children drew stains on the teeth with dry erase markers, then practiced brushing the stains off.The main weakness of the oral health program was the issue we had with the facilities having numerous cancelations due to weather conditions, illnesses of the patients, and no transportation for some of the patients. Sometimes parents would arrive late because their child was having a bad day. When this happened, the parents were usually not willing to sit down with us prior to the session or stay late afterward. We also experienced a language barrier with the parents of one patient. We found that the parents who regularly brought their child therapy were also very proactive and knowledgeable when it comes to oral hygiene. They take their children to regular dental appointments and provide good home care. This also led to us seeing many of the same parents multiple times. One possible solution could be calling ahead before a session to see how many volunteers and patients will attend that day.Another weakness was volunteer participation in the oral health program. A possible solution would be setting aside a separate day for volunteer training, or having extra time set aside to train volunteers before or after the therapy sessions.Overall, we feel that our program was strong and well planned. It offers many benefits for the children and parents who participated. It addressed the unique oral health issues of special needs children and how parents can solve the issues. Future Site for Oral Health Program:We feel that Stable Spirit would be a good site for future oral health programs. The target population is in need of increased oral hygiene awareness. The majority of the children receiving therapy at Stable Spirit have some form of autism. While autism itself does not increase the risk of caries in children, many of its symptoms can make oral hygiene more difficult for children. Many of the medications used to treat autism can cause xerostomia, which increases caries risk. Many children also have nutritional weakness. Some children will only eat certain foods. Others are rewarded for good behavior with sweets. It may also be difficult for parents to find a dentist willing to work with their child’s special needs.The staff members and volunteers were very helpful and glad to have us at Stable Spirit. One difficulty we encountered, however, was the low volunteer ratio. On three of the four days we were at the facility, there were not enough volunteers for the therapy sessions. This limited the volunteers from participating in the oral health program as much as they would have liked.The scheduling of the program was difficult. While Stable Spirit welcomed us, the nature of the services offered meant that scheduling changed often. For example, the weather was bad on three of the four days we were there. Due to the outdoor activities involved in therapy, many parents cancelled their sessions due to the weather. Another scheduling issue came from illness. On our first session date, three parents cancelled due to a child’s illness. Learning Value:We learned a tremendous amount about working with special needs children during our oral health program. We learned that special needs are very complex. When evaluating and planning treatment for special needs children, many aspects of their health must be taken into consideration. For example, these children are at higher risk of illness, and there are more complications when they are sick. This can delay their treatment. It may also increase their risk of oral disease. New medications can cause side effects that put them at higher risk, and sickness can create more difficulty in cooperation and in proper oral hygiene. Another example is from behavioral issues. The child’s mood and behavior can affect their cooperation levels. When treating or working with a special needs child, you must look at the “big picture.” Each aspect of their health is affected by many factors, and you must consider all these factors when planning treatment. Overall, we learned that a special needs patient has very complex needs, and any treatment must take a comprehensive approach to care.There was also a learning value for the target population. The parents and caregivers received information on oral hygiene specifically for children with special needs. We taught them ways to overcome the unique challenges special needs children face. They can use this information to improve their children’s oral health, and can also share this information in support groups or other organizations for children with special needs. Collaboration:Our backgrounds helped a lot with our collaboration on the oral health program. Amanda was familiar with Stable Spirit, while Hannah works for a dentist who treats many special needs children. Because of our different backgrounds and perspectives, we were each able to contribute a lot to the planning portion. We brought up many questions during our initial appointment with the director and the physical therapist. We also asked many questions when we visited the local pediatric dentist.We took turns talking to the parents and working with the children. Amanda did a lot of the writing, while Hannah did a lot of the research and also got activities together. Both had ideas for projects and activities for the children. We shared ideas between each other and worked together to come up with a plan for each session. ................
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