Dental Public Health Prevention Plan - Assignment Example

? Dental Public Health Prevention Plan Alexander Heatrice DDS A.T. MPH736.4-Intro to Dental Public Health November 14, Dental Public Health Prevention Plan Problem Statement:- It might appear that improved access to dental care and the inclusion of fluoride in toothpaste, the public water supply, and professional dental products have reduced the issues concerning dental caries in children. However, that is not really the case because dental caries is one of the most common oral health problems in children. In fact the rate of dental caries among 1st to 6th grade students in urban school districts on Oklahoma City is consistently rising. Background:- There is a definite relation between sugar consumption and dental caries. Sugars and other fermentable carbohydrates are hydrolyzed by salivary amylase and provide a perfect environment for cariogenic bacteria to grow and flourish, which results in teeth demineralization (Touger-Decker & Loveren, 2003). Children, between the ages of 6 and 12 years consume soft drinks, fruit juices, cookies and sweet candy, all of which can result in high rates of dental caries. Hashim, Williams & Thomson (2009) found that children who ate snack food items more than three times a day had 33% higher DMFT (decayed, missing and filled teeth) scores than those who ate snacks only once a day. Children who ate snacks more frequently than three times a day had 49% higher DMFT scores than those who ate snacks the least (Hashim et al., 2009). The study also revealed that the mean DMFT score for 6 to 12 year old children was 4.5 and children from poor socio-economic backgrounds and least educated households had higher DMFT score than others (Hashim et al., 2009). Therefore, the eating habits of children, especially the consumption of sweet snack food and drinks, are a major contributor to the occurrence of high rate of dental caries in children. It is known that childhood oral health is a strong predictor of adult oral health (Thomson et al., 2004). Therefore, it is important to alter the determinants of poor oral health in young children. A potential intervention is to promote oral health in schools by offering healthy snacks and drinks in the school cafeteria. In this regard, replacing food items made from sugar and sorbitol with those made from xylitol is a promising option, since xylitol has been found to have powerful anti-cariogenic and tooth protecting properties (Lam, Riedy, Coldwell, Milgrom, & Craig, 2000). Xylitol has been found to significantly reduce Streptococcus mutans levels in saliva and plaque, which is the main cause for tooth decay (Lynch & Milgrom, 2003). In fact, children whose mothers were treated with xylitol were found to have significantly lower levels of S mutans and about 70% reduction in tooth decay than the children whose mothers were treated with chlorhexine or fluoride varnish (Soderling, Isolangas, Pienihakkinen, Tenovuo, & Alanen, 2001). Xylitol, a naturally occurring substance, has also been rated safe by the FDA and World Health Organization and has been endorsed by the national dental associations, health care organizations and healthcare professionals all over the world. Goals:- The goals for this dental public health plan are: 1. Improve the dental health of 6 – 12 year old children in seven schools in the urban school districts of Oklahoma City, Oklahoma. 2. Provide a safe and efficient solution to reduce dental caries among 6 – 12 year old children in seven schools in the urban school districts of Oklahoma City, Oklahoma. Objectives:- The objectives of the dental public health plan are: 1. Decrease the number of decayed tooth among 6-12 year old children in the seven urban school districts of Oklahoma City, OK by 50% by the end of the three year program. 2. Educate 6-12 year old children in the seven urban school districts of Oklahoma City about healthy food habits. Activities:- During the first year, 1333 children from the first to the fourth grade from the selected schools (mentioned later in this section) schools will be selected. An additional 333 children from 1st grade will be selected during the second year and 334 children from 1st grade will be selected during the third year, while the previously selected 1333 children will be retained in the program. A recent study of children from first to the fourth grade revealed that on an average, a child has approximately three dental caries (Dental caries among Oklahoma school children – A Fictitious study). During the first year, the 1333 children will be given xylitol based gummy worms and cookies during their snack break provided by the school cafeteria. During the second year, the intervention will be implemented for children from first to fifth grade and in the third year, the intervention will be implemented for children from the first to the sixth grade. This will ensure that all children enrolled in this program will continue to be monitored till the entire time period of three years. Under the guidance of their teachers, the children will be offered xylitol based snacks during the two snack breaks in school. This project will be implemented during the month of August 2012 and would continue for three years. The rate of dental caries for each child will be reexamined 36 months after the implementation of the project in the schools. This plan will involve contacting and partnering with the following people: 1. Lonia Brown, principal at Earlywine Elementary School 2. Becky Jackson, principal at Fisher Elementary School 3. Ashley Hoggatt, principal at Dennis Elementary School 4. Dan Neugent, principal at Kingsgate Elementary School 5. Phil Cunningham, principal at Columbus Enterprise School 6. Reuben Bellows, principal at Deer Creek Middle School and 7. Josh Bullard, head master at Christian Heritage Academy Partnering with these individuals will help to gain approval and participation in conducting this program in their respective schools to ensure maximum buy in and sustainability. The plan will also involve partnering with Mrs. Baird’s Bakeries Inc. to create xylitol-based gummy worms and cookies to supply to the schools enrolled in this program. Informed consent from the parents of each child participating in the program will be collected. The approval of the principals and teachers will also be sought to ensure their commitment and participation in the project. Timeline:- This project will be implemented for three years. During the first year, 1333 children from grades 1st to 4th will be monitored for dental caries. During the second year, 1666 children from grades 1st to 5th will be monitored for dental caries and during the third year, 2000 children from grades 1st to 6th will be monitored for dental caries. Cultural Competence:- Care will be taken to ensure that children from all racial and ethnic backgrounds are included in this program. Male and female students will also be equally represented in this program. Funding:- The funding for this project will be sought from the National Institute of Health. The grant application will be submitted in December 2011 and the funding will be sought under the NIH Dental Health Grant Program (R01). The grant funding for $590,000 per year for three years will be sought with a possibility of renewal for another two years. If renewal for this project is granted, then the project will continue to be implemented in these schools for an additional two years and further data will be collected to monitor the long term effects of the use of xylitol based snacks in children. Budget Narrative:- Itemized Expenses Narrative Salaries and Wages (includes per diem, lunch and travel) 4 dentists at $800 a day, 8 hrs for each evaluation. 10 school teachers will be paid $50.00 a day for 8hrs 3 times a week. These teachers will be involved in educating the parents and students, and ensuring that the students are abiding by the dental plan while they are in school. Program Materials Posters and handouts for teachers, parents and students. Evaluation sheets videos and oral hygiene items Equipment Laptop computers Sony, $699 x 5 (4 Dentist). Exam packs = $ 4.00 each x 700 = 2,800 Travel This will include cost of travelling to the schools for the purpose of this dental program. Training All dentists will be conducting epid exams and need to be trained and calibrated. Their reliability with each other and with themselves will also need to be checked. For this dental plan, the WHO epid rules will be used. Xylitol based snacks For the first year of the program, 1333 children (1st to 4th grade) get 2 snacks/day for 5 days/week for 37 weeks/school year at $1.00/snack = $493,210/year of xylitol snacks. (Additional funding and donations will be sought to fund the cost of xylitol based snacks for the 2nd and 3rd year of implementation which would cost 616,420 and 800,000 respectively.) Itemized Revenue NIH grant This grant is renewable each year for three years and will cover salaries, wages, program materials and the cost of xylitol based snacks. University Of Oklahoma gift Check for 8,000 (This would meet the cost of supplies) MSBC gift Check 5,000 (This would meet part of the cost of training) OKC Public School Board gift Check for $10,000 (This would meet the cost of travel) Dr. Alvin Wilson Check for $1,000 (This would meet part of the cost of training) Miscellanies donations 1,500 (This would meet part of the cost of training) Source: Fictitious data, for illustration purposes only (Dr. Tucker example) Budget Table:- (Annually) Item Expense US $ Revenue US $ Salary and Wages 90,800   Supplies 6,295   Travel 8,000   Training 15,000   Xylitol based snacks 493,210   Program Materials/Equipment 3,250   NIH grant   590,000 University of Oklahoma gift   8,000 Morning Star Baptist church gift   5,000 Oklahoma school board gift   10,000 Dr. Alvin Wilson gift   1,000 Miscellanies donations   2,555 Total 616,555 616,555 Evaluation:- Baseline data will be collected before the implementation of the program. A dentist will individually examine each child for tooth decay and determine the number of decayed teeth for each child. The mean number of decayed teeth for age groups 6 to 8, 8 to 10 and 10 to 12 will be assessed. Dentists will examine each child, enrolled in this program after 36 months in order to monitor the changes in the number of decayed teeth for each child. References Hashim, R., Williams, S.M., & Thomson, W. M. (2009). Diet and caries experience among preschool children in Ajman, United Arab Emirates. European Journal of Oral Health, 117(6), 734-740. doi: 10.1111/j.1600-0722.2009.00688.x Lam, M., Riedy, C.A., Coldwell, S.E., Milgrom, P., & Craig, R. (2000). Children’s acceptance of xylitol-based foods. Community Dentistry and Oral Epidemiology, 28(2), 97-101. doi: 10.1034/j.1600-0528.2000.028002097.x Lynch, H., &Milgrom, P. (2003). Xylitol and dental caries: An overview for clinicians. Journal of the California Dental Association, 31. Retrieved from http://www.cdafoundation.org/ library/docs/jour0303/March_B_2003_CDA_127DD5.pdf Soderling, E., Isolangas, P., Pienihakkinen, K., Tenovuo, J., &Alanen, P. (2001). Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries Research, 35(3), 173-177. doi: 10.1159/000047452 Thomson, W. M., Poulton, R., Milne, B. J., Caspi, A., Broughton, J. R., & Ayers, K. S. (2004). Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort. Community Dentistry and Oral Epidemiology, 32, 345-353. doi: 10.1111/j.1600-0528.2004.00173.x Touger-Decker, R., & Loveren, C. V. (2003). Sugars and dental caries. American Journal of Clinical Nutrition, 78. Retrieved from http://www.ajcn.org/content/78/4/881S.full.pdf Read More