Shauna Powell

4/19/15

Community Service paper

My group and I chose to go and serve one of the most underserved populations in the United
States, the elderly population. We chose to go to a senior friendship caf here in Richmond, VA.
The friendship caf is where locals around the area get together once or twice a week for
fellowship, working out, and a nice home cooked meal. The friendship caf we chose to go to
was held weekly at Good Shepard Baptist church. The elderly folks of the United States are
defined as 65 years or older and they experience the most difficulty accessing dental care.1
Nearly 23% of adults ages 65-74 have severe gum disease. 2
Our group decided that this friendship caf was in need of oral health education so we decided
to do it in the format of a presentation. Lastly over 30% of older adults suffer from Xerostomia
caused by the medications they have to take daily.2 Thus it contributes to the risk factor of tooth
decay and gum disease.2 The participants in this this group meet at the Good Shepard Baptist
Church every Monday. We decided to go for 2 consecutive Mondays to present new information
to the participants and then a follow up 2 weeks later. At the first visit we went over and the
second we discussed. The participants consisted of 15 senior citizens 65 years or older. Ten of the
participants were females while there were only 5 males. They were given a pre-test before each
presentation and the same test after for a post-test.
Our groups plan was divided into 2 separate visits, two separate lesson plans and two
different pre/post-tests. At our first visit we discussed the changes of the oral cavity as we age
and the different layers of the teeth. We decided to bring a model we could pass around so the
participants could see the various layers of tooth structure. Lastly at this visit we discussed

nutrition and the importance of eating healthy as we age. We asked how many drink water
throughout of the day and many participants stated they werent thirsty. We advised the
participants as we age our thirst needs reduce, and although we are not thirsty it is important to
drink water throughout the day. 3 The theory our group chose to implement was the Health Belief
Model (HBM), because it is a psychological model that attempts to explain and predict health
behaviors. This is the most used theory in health education and health promotion.4 The concept of
this model is modifying ones variable, perceived seriousness of the issue/behavior, and the
perceived susceptibility.

Our groups goal was to promote the following model to our target population:
Perceived Susceptibility- older adults are more susceptible to oral disease due to the anatomical
changes that change with age, medications one is taking, and systemic disease
Perceived Severity- senior citizens believe that the consequences of progressing from gingivitis
to periodontal disease and decay are significant and they try hard to avoid it
Perceived Benefits- senior citizens believe that a daily oral hygiene regimen and routine
preventative care can decrease the risk of periodontal disease, edentulism, and decay
Perceived barriers- senior citizens identify their personal barriers to their daily preventative
health, and explore ways to eliminate/reduce those barriers

Cues to action- senior citizens receive reminder cues for actions in the form of incentives (take
home bags filled with tooth brushes, floss, toothpaste, denture brushes/paste)
Self-efficacy- older adults receive educations and demonstrations on how to properly maintain
optimum oral health

Our main goal was to educate the participants of the basic changes that occur in the oral
cavity as one ages due to systemic disease, medications, and alternative choices due to dexterity
issues. As a group we thought it would be beneficial to review the basic concepts of nutrition and
how it relates to the oral cavity. At the last visit we summed up what we went over at the first
visit prior to the new information. The second visit was mostly all about removable prosthesis
and how to properly care for them. A lesson plan was developed for each visit and it listed
exactly what we wanted the target population to get from the lecture based presentation. The
main objectives of our groups lesson plan is below:
1.
Understand basic dental anatomy changes in aging adults in relation to recurrent caries
2.
Understand the benefit and importance of fluoride
3.
Identify the relationship between systemic diseases and oral health
4.
Identify common dental side effects of medications and how to treat them
5.
Identify healthier snacking food vs. higher cariogenic foods
6.
Identify good oral hygiene habits to implement throughout the day when consuming
foods and beverages
7.
Understand basic at home self-oral hygiene techniques
8.
Identify alternative at home self-oral hygiene methods to aid in plaque removal for
those with limited dexterity, and how to implement these methods
9.
Understand how to properly maintain dental prosthesis including fixed and removable,
and the importance of doing so

Initial Visit
At the first visit we focused on objectives 1-6. In order to evaluate how well we did and to see
what knowledge was gained we gave our target group a pre and post-test. We wanted to test their
base knowledge and see how well they did on the pre-test to base how we should plan for visit
two. The test consisted of seven true and false statements in a larger font so it would be easier to
read. While making the tests we had no idea what our target population would be like. (eye
problems) Our groups idea was to use larger print and more basic dental terminology that way
we could test the participants basic dental knowledge. Pens were passed out to promote the
school, and the tests were started. The test is posted below:
Pre-Test Visit 1: For the following statements, please select either A. True or B. False.
1.
Systemic diseases (ex. Diabetes, heart disease) can place negative impacts on my overall
health.
A.

True

B.

False

Correct answers: 7
2.

My oral health can place negative impacts on my overall systemic health.

A.

True

B.

False

Correct answers: 7
3.

Incorrect answers: 8

Different changes occur in my oral cavity with as my age increases.

A.

True

B.

False

Correct answers: 13
4.

Incorrect answers: 8

Incorrect answers: 2

I understand how to treat xerostomia (dry mouth) and the importance of doing so.

A.

True

B.

False

Correct answers: 5
5.

Incorrect answers: 10

It is important to use fluoride in my toothpaste and/or mouth rinse.

A.

True

B.

False

Correct answers: 12

Incorrect answers: 3

6.
A poor diet can negatively impact my oral health and lead to an increased risk for heart
disease.
A.

True

B.

False

Correct answers: 9

Incorrect answers: 6

7.
Healthful diets low in fat and rich in fruits and vegetables, which contain fiber, may reduce
the risk of some types of cancer.
A.

True

B.

False

Correct answers: 8

Incorrect answers: 7

The most missed question on the pre-test was dealing with xerostomia. After explaining what
dry mouth is; a simple poll of raising ones hand was conducted to see how many of the
participants suffered from xerostomia. It was concluded that the majority of our target population
suffered from xerostomia. We explained the cause of this due to the reduce thirst, daily
medications, and age. Our group spent the majority of the time discussing the importance of
suffering from dry mouth and the increase risk of decay due to the lack of salivation.5 Biotene
samples were given out to those who raised their hand stating they feel as if they suffer from

xerostomia. The importance of using a mouth rinse that was alcohol free was also discussed.
Many of the participants suffering from xerostomia were using alcohol based mouth rinses and
had no idea it was helping progress their case of dry mouth. We discussed further options with
our target population like chewing sugar free gum with xylitol and dry mouth lozenges. Lastly
the importance of fluoride was discussed and the need for it at every 6 months recall.
Our group made sure the relationship between oral health and systemic health go hand and
hand and it was explained in basic medical terminology. We stressed the importance of systemic
health and dental health by linking periodontal disease and systemic disease. The differences
between/the progression from gingivitis to periodontal disease was also explained. Lastly, we
discussed recession and the benefits of using fluoride on those areas to help reduce sensitivity.
We also discussed the higher incidence of recurrent decay as one ages and they importance of
regular dental exams to ensure there is no new decay.
The last section discussed at visit one was nutrition and how to properly read a label. The
majority of the participants stated they never read labels and they didnt understand how to read
one. A nutritional facts sheet was handed out and it broke down each part of a food label and how
to understand what one is reading. Majority of the participants stated they snack and drink
coffee/tea every morning for that wake me up! We explained the importance of drinking it
through a straw, drinking it in one sitting, or swishing with water afterwards to help reduce the
amount of staining on ones teeth. We worked very hard with the participants and tried to keep
them engaged every step of the way. The participants were very engaged and asked numerous
questions that we were sure to answer. The post test was administered and the results were as
followed:
Post-Test Visit 1 : For the following statements, please select either A. True or B. False.

1.
Systemic diseases (ex. Diabetes, heart disease) can place negative impacts on my overall
health.
A.

True

B.

False

Correct answers: 14
2.

My oral health can place negative impacts on my overall systemic health.

A.

True

B.

False

Correct answers: 15
3.

A.

True

B.

False
Incorrect answers: 0

I understand how to treat xerostomia (dry mouth) and the importance of doing so.
A.

True

B.

False

Correct answers: 14
5.

Incorrect answers: 0

Different changes occur in my oral cavity with as my age increases.

Correct answers: 15
4.

Incorrect answers: 1

Incorrect answers: 1

It is important to use fluoride in my toothpaste and/or mouth rinse.

A.

True

B.

False

Correct answers: 15

Incorrect answers: 0

6.
A poor diet can negatively impact my oral health and lead to an increased risk for heart
disease.
A.

True

B.

False

Correct answers: 14

Incorrect answers: 1

7.
Healthful diets low in fat and rich in fruits and vegetables, which contain fiber, may reduce
the risk of some types of cancer.
A.

True

B.

False

Correct answers: 15

Incorrect answers: 0

The post- test demonstrated a huge increase in the amount of correct responses with over more
than half of the participants answering correctly. This shows that the participants were able to
comprehend the material from our lesson and properly answer the questions asked of them via
the post-test.

Second Visit
During the second visit we covered the rest of the objectives by using demonstrations and
hand on activities as opposed to the first lecture based presentation. Our group gave another pre

and post-test, but this time it was only 8 simple questions about basic care for oral prosthesis.
The following questions were asked of the target population:
Pre-Test: Please circle the correct answer to the best of your knowledge:
1. How many times a day should one brush their teeth?
A.
1 time (in the morning)
B.
2 times a day (1 in morning, 1 before bedtime)
C.
0 times a day
Correct answers: 6
Incorrect answers: 9
2. Prior to inserting your denture, you should
A.
Brush your gums and the roof of your mouth with a very soft bristled toothbrush
B.
Rinse mouth out with JUST water
C.
Rinse mouth out with JUST mouthwash
D.
Dont brush or rinse mouth out, just insert denture/partial
Correct answers: 9
Incorrect answers: 6
3. Dry mouth is a normal part of aging
A.
True
B.
False
Correct answers: 5
Incorrect answers: 10
4. Signs of gingivitis:
A.
Red, swollen gums
B.
Bleeding gums
C.
Both A and B
Correct answers: 9
Incorrect answers: 6
5. Prior to going to sleep each night one should:
A.
Remove their dentures
B.
Use a denture brush and denture cleaner
C.
Gently brush all surfaces then rinse using cold water.
D.
Soak them in a denture cleanser solution while they sleep.
E.
All of the above
Correct answers: 6
Incorrect answers: 9
6. One should soak a denture/partial overnight in
A.
Boiling hot water
B.
Warm water
C.
Cold water
Correct answers: 6
Incorrect answers: 9
7. How often should you clean between your teeth with dental floss?
A.
Once a week

B.
Daily
C.
Less than three times a week
D.
Never
Correct answers: 5
Incorrect answers: 10
8. There are alternative methods to brushing and flossing if one is having problems using a
manual toothbrush and string dental floss?
A.True
B. False
Correct answers: 7
Incorrect answers: 8
At the beginning of this visit we handed out patient bags filled with toothbrushes, toothpaste,
and floss for the patients to take home. We went over oral hygiene instructions using a mouth
model we received from Listerene. It is a rather large model of a mouth which it is easier to
demonstrate proper adaptation of floss and a toothbrush. The main purpose of this was to show
how to adequately adapt the toothbrush at a 45 degree angle and flossing in the c-shape flossing
technique. We reminded the participants to not only brush the buccal/facial surface of their teeth
but all surfaces of every tooth. The alternative choices to flossing were also discussed like using
a water flosser. Lastly, we had the patients demonstrate the motion back to us so we could see if
they were doing it properly or not. Other oral hygiene aids were passed around and demonstrated
how to properly use them.
The second topic discussed at this visit was proper care for removable prosthesis. The
majority of the participants raised their hand stating they had some sort of removable either a
partial or denture so we figured this topic was very beneficial to go over. The most important
point we made was to remove the prosthesis at night and give the gingiva time to rest. We went
over how to properly brush and clean the denture or partial. Advised them to cover the sink with
a wash cloth or towel and fill it with water so if the denture is dropped it is not broken. Lastly,
we stressed the importance of not putting the prosthesis is very hot water because it can warp the

denture and it will no longer fit. Even though the participants with complete dentures no longer
had teeth, we stressed the importance of at least a 1 year annual exam is so the gingiva can be
evaluated. Lastly they were advised to rub their gums with a wash cloth or toothbrush to remove
all debris that may be hanging out in their mouth. The patient bags that were handed out were not
only filled with patient necessities there were brochures to advertise the school since many of
them did not have a dental home. The bags also held a card with the information that was
discussed at both visits. The cards that the participants received are below with the post-test from
visit 2.

Post-Test: Please circle the correct answer to the best of your knowledge:
1. How many times a day should one brush their teeth?
A. 1 time (in the morning)
B. 2 times a day (1 in morning, 1 before bedtime)
C. 0 times a day
First Visit: Correct answers: 14
Incorrect answers: 1
2. Prior to inserting your denture, you should
A. Brush your gums and the roof of your mouth with a very soft bristled toothbrush
B. Rinse mouth out with JUST water
C. Rinse mouth out with JUST mouthwash
D. Dont brush or rinse mouth out, just insert denture/partial
Correct answers: 15
Incorrect answers: 0
3. Dry mouth is a normal part of aging
A. True
B. False

Correct answers: 12

Incorrect answers: 3

4. Signs of gingivitis:
A. Red, swollen gums
B. Bleeding gums
C. Both A and B
Correct answers: 14

Incorrect answers: 1

5. Prior to going to sleep each night one should:

A. Remove their dentures
B. Use a denture brush and denture cleaner
C. Gently brush all surfaces then rinse using cold water.
D. Soak them in a denture cleanser solution while they sleep.
E. All of the above
Correct answers: 15
Incorrect answers: 0
6. One should soak a denture/partial overnight in
A. Boiling hot water
B. Warm water
C. Cold water
Correct answers: 14
Incorrect answers: 1
7. How often should you clean between your teeth with dental floss?
A. Once a week
B. Daily
C. Less than three times a week
D. Never
Correct answers: 14
Incorrect answers: 1
8. There are alternative methods to brushing and flossing if one is having problems using a
manual toothbrush and string dental floss?
A. True
B. False
Correct answers: 14
Incorrect answers: 1

Chart Title

Pre-Test

Post-Test

Follow up
Two weeks after the second visit we returned to give the same participants a follow up test to
see if the knowledge was actually retained or not. The follow up test was the same questions
from either the first or second test that was administered. There were not any new questions
asked on the follow up test. The results are as followed:

Comparison of Initial Post Test and Post Test 2 Weeks Later

Post-Test
Post Test 2 Weeks Later

Comparison of Second Post Test and Post Test 2 Weeks Later

Post-Test
Post Test 2 Weeks Later

The data from the 2 week follow up shows that most of the information was answered correctly
right after the presentation. Although the 2 week follow up scores were not as good as the
immediate post-test they were a lot higher than the original pre-tests. The information was
retained and the main goals of our lesson plan was achieved.
Conclusion

While I was not excited for another group project, I feel as if I gained so much knowledge
from doing this project and working with the group I had. I feel as if we all worked well together
and all of the work was completed with everyones help. This was a very successful project and
the participants at the friendship caf were so delighted to have us at each and every visit. The
results were so very worth it to me and I feel as if we have properly educated all 15 participants
in this project. They all had different literacy levels and we were not sure what to expect at first,
but we were able to speak in basic dental terminology to educate the participants. This was a
great site to visit and the coordinator was such a nice women and she helped us set up times and
dates to come without any hesitation. I had a great experience doing this project and I feel so
great knowing the 15 participants now have the basic knowledge to care for their oral hygiene
even as they age.

(A few of the participants of our group.. some had to leave early prior to the picture)

(Our table with all of the pt bags and

models we used
to demonstrate
the
various
brushing
techniques)

Works cited:

1. http://www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_201
2.
3.
4.
5.

3.pdf
http://seniorsoralhealth.org/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884408/
http://www.jblearning.com/samples/0763743836/chapter%204.pdf
http://www.dentalhealth.ie/dentalhealth/causes/dentalcaries.html