A.

General Data
1.

Description of Site
1) The Shorkey Center originated in 1944. The Autism program began
sometime in the 1990s. It only has one location, which is 855 South 8 th
Street in Beaumont, Texas. The goal of the Shorkey Center is to serve
children with disabilities such as speech, Autism, Down syndrome, along
with physical and occupational disabilities. The programs offered at the
Shorkey Center are ABA therapy, physical therapy, aquatic therapy,
occupational therapy, speech therapy, and programs from Autistic
children. This is also an outreach program for parents and children. The
Shorkey Center receives funding from private donations, United Way,
insurance, Angels for Autism, Valero, and Fast Lanes.

2. Description of Client Population and target group

1) Our targeted group chosen to educate about oral health is children with
Autism. Children are generally referred by doctors to the Shorkey Center.
Sometimes, patients will hear about the Shorkey Center and become a
walk-in client. The Shorkey Center has a Board Certified Behavior Analysis
that comes in to observe the patient and writes out a treatment plan. VB
Map testing is also available. As of this time, there are thirty-two autistic
children that attend the Shorkey Center. Two children that are 16 and 17
years of age are on site all day, the other children ages 8-10 come at set
times to participate in specific groups and for one-on-one time with the
program director. There are three Hispanic, seventeen Caucasian, and
ten African Americans. Three out of the thirty two are females. Males are
more prone to having the disability.
3. Description of Staff Population
1) There are twenty-three staff members at the Shorkey Center. Five of
those staff members work with Autistic children. There is the Board
Certified Behavior Analysis, which assesses the patient and writes out
reports and treatment plans for their needs. This person is present one
day a week and they have their Masters degree. Three aids are also
present to help the children with daily skills/activities. The aids are
required to have at least a high school diploma. The final person that
works with the autistic children is the program director. She currently has
her bachelors degree in special education but is working towards a
Masters. She works with children on behavior, social skills, academic
delays, and language, along with meeting with the parents. The parents
are highly involved because this is an educational tool for them to help
incorporate daily skills the children have learned in the program.

4. Description of Services Provided

1) Services provided at the Shorkey Center are preschool, ABA therapy,
physical therapy, aquatic therapy, occupational therapy, speech therapy,
and programs for children with autism. Some daily activities for the
targeted group include swimming, art, cooking, and social groups. The
program director of the autistic group plans daily activities. The daily
routine for the autistic program include the 2 day children arriving at 8
a.m. and leaving at 2:30 p.m. with the outreach children coming for an
hour. The outreach children work on academics for roughly thirty minutes
and then focus on behavioral techniques such as keeping their hands to
themselves for the remaining thirty minutes. Some events the Shorkey
Center has scheduled are a Golf Tournament in April and a Splash and
Dash Fun Run in May. These are planned by the executive director of the
Shorkey Center. There is talk of a motorcycle domino run in December.
Future plans for the Shorkey Center include building a new center on the
land located directly beside their current location. There is also the idea
of a farm that is worked by the attending children at the center to help
teach skills. The vegetables/fruits will be sold to lower income families.
5. Other Pertinent Data
1) Water Fluoridation at the Shorkey Center is .80 mg/L (2).
B. Information Related to Dental Health
1) There is not a dental program implemented with the Shorkey Center,
however, the program director and aids work with the children on
brushing daily. Brushing is usually implemented with the day children in
the early afternoon. The program director stated that parents reward the
children with candy. The biggest challenge faced with tooth brushing is
getting the tooth brush in the childs mouth due to sensory disorders.
Last year, there was a dental program implemented with the preschool
children at the Shorkey Center.
C. Dental Health Status
1) Dental Caries
Autistic children are at the same risk for dental caries as the general
population. (3).
Autistic children are at risk for dental caries when soft, sticky, or sweet
foods are preferred, if oral habits that can cause damage are present, or if
the patient has difficulty brushing and flossing. (3). Sugary or saliva
reducing medications can also increase dental caries risk. (3). 1 in 5
children ages 5-11 have at least one untreated caries. (4).

2) Periodontal Disease
Periodontal disease in autistic children rises the same as in people without
a developmental disability. (3) Autistic children are at the same risk for
periodontal disease as the general population. (3) Some autistic children
can benefit from chlorhexidine rinses. (11)

3) Oral Hygiene
Communication and behavioral problems can bring forth challenges with
oral care. (3). It is important to show-tell-do with autistic individuals.(11)
Also, autistic children have sensory issues and may not allow the
caregiver to demonstrate proper oral hygiene. (11)Poor oral hygiene can
occur due to difficulty for the caregiver and child.(5) Medications and oral
trauma can cause issues with oral hygiene. (11)
4) Malocclusion
Autistic children show a higher percentage in missing teeth, open bites,
diastemas, reverse overjets, spacing, and molar relationship tendencies
than those without autism. (7)
5) Oral Cancer
No research available to support oral cancer in autistic children.
6) Utilization of Dental Services
In 2009, 4,634,387 school aged children (5-17) attended a state dental
program. (6) Nationally, 78% of children with special needs were in need
of dental treatment or a dental examination with in the previous 12
months. (15) This need was second to the need for prescription
medications. (15)

Goals/ Objectives

Goal:
The overall goal is to improve the oral health and knowledge of autistic children at
the Shorkey Center.
Objectives:
1) Have parents incorporate a healthy reward system for children.
2) Increase the dental health knowledge of the parents and staff by 15%.
3) Improve oral hygiene skills of autistic children by 15% by evaluation survey.

Review of Literature

There are many factors that affect the oral health of autistic
children. Some of those factors include: damaging oral habits, medications,
physical behaviors, nutrition, and parent/caregiver's oral health knowledge.
Autism affects one in sixty-eight children and is 4 times more prevalent
in males than females. This is the fastest growing developmental disorder.
Autism is treatable, but the key is early intervention. (8) There are multiple
manifestations related to children with autism. These include: impairment in
social reciprocity, impaired communication skills, atypical behavior, oral
manifestations, and other potential disorders and concerns. (9) Behavior,
nutrition, and oral health knowledge can affect the dental health of autistic
individuals; therefore, it is very important to recognize the oral
manifestations to help with the management of oral health. (9)
Oral manifestations include: bruxism (occurs in 20-25% autistic
children), tongue thrusting (which leads to malocclusion), non-nutritive
chewing, poor oral hygiene (due to difficulty in childs behavior), increase in
caries (due to using sweets as rewards), self-injury (due to picking at gingiva,
biting lips and/or cheeks), and erosion (due to GERD or other intestinal
problems). (9) A mouth guard can be utilized for the self-injurious and
bruxing child if they are able to tolerate it. (11) Fluoride and sealants can
also be used to help prevent cavities if the dentist sees it fit. (11)
Most autistic children are medically healthy and only take few
medications. These medications include: CNS stimulants, antihypertensive,
antidepressants, anticonvulsants, and antipsychotics. (9) This is important to
know because all of these affect the oral cavity. There are multiple side
effects, but the most frequent to note is xerostomia. (9) This will increase the
risk for caries.
Possible behavioral factors for children with autism include: mental
retardation, self-injurious behaviors, seizure disorders, sensorimotor
deficiencies, echolalia, and limited interactive language skills. (10) Mental
retardation could conflict with dental care because the child is not accepting
or understanding of what the dental personnel is doing. Self-injury could be a
problem since the hygienist has sharp instruments near the child. Seizure
disorders would be disruptive to dental treatment. Sensorimotor deficiencies
would make treatment a challenge since children with autism may dislike the
sound of dental equipment, how the dental materials/equipment feels in the
mouth, and having the light in their eyes.(11) This can also cause issues
with everyday oral care. Echolalia could make treatment hard because
autistic children tend to make repetitive sounds which could complicate

treatment. (12) Autistic children like repetitiveness so having the same

hygienist each appointment could help relax the child. Language skills could
also make treatment difficult.
Nutrition is also a factor that can affect the oral health in autistic
children. Researchers found that they are 5 times more likely to have
mealtime temper tantrums, very selective meal choices, and specific
ritualistic eating behaviors. (13) They were also found to have low intake in
calcium and protein. (13) A low intake of calcium relates to dental health in
the manner that calcium helps strengthen the bones and teeth; therefore, a
low intake of calcium affects the teeth of the child. (13) Also, parents tend to
reward their autistic child with sweets which is not nutritious it can also lead
to cavities. (11) Sealants and fluoride treatments should be discussed with
the dentist since autistic patients are at risk for caries. (11)
Parents of autistic children were found to have inadequate oral health
knowledge due to research. (14) In other words, parents of autistic children
need to be educated on the importance of regular dental visits and oral
health of autistic children. (14)

Program Design
1) Activities
a)

Session 1: April 7, 2015 Staff

1. Oral Health Education

Pre test Staff members about oral health
explain the importance of proper oral hygiene
discuss the effects of poor nutrition on the oral cavity
Demonstrate proper brushing technique on typodont
Discuss effects of medications on oral health
Post test staff about oral health
give pamphlets to staff members
b) Session 2: April 7, 2015 Parents
2. Oral Health Education
Pre test parents about oral health
explain the importance of proper oral hygiene
discuss the effects of poor nutrition on the oral cavity
Demonstrate proper brushing technique on typodont
Discuss healthy reward options for children
Discuss effects of medications on oral health
Post test staff about oral health
give pamphlets to parents
c) Session 3: April 16, 2015 ages 8-9
1. Tooth brushing
demonstrate tooth brushing to children with step-by-step
images/instructions
allow children to practice tooth brushing on typodont
have children demonstrate tooth brushing on themselves
Utilize oral hygiene skill survey to check competency
d) Session 4: April 21, 2015 ages 8-9

1. Tooth brushing
demonstrate tooth brushing to children with step-by-step
images/instructions
allow children to practice tooth brushing on typodont
have children demonstrate tooth brushing on themselves
utilize oral hygiene skill survey to check competency

e) Session 5: April 21,2015 Parents

Send evaluation to parents to determine changes in their reward system
methods,
2) Constraints and Alternative Strategies
a) Constraint: Some autistic children have sensory disorders and do not like to
be touched;
therefore, this can be a behavioral issue.
Alternative strategy: If this issue arises we will get the help of a staff
member. If the staff
members are unable to help we will stop the demonstration with that child.
b) Constraint: Parent cooperation: Some parents may not be willing to listen to
the presentation
Alternative: Give pamphlet with information on it for parent to read at
home.
c) Constraint: Staff cooperation: Some staff members may not be interested in
the information
being presented.
Alternative: Give pamphlet to each staff member so the uninterested
individual can have a
reference guide for the future.
d) Constraint: An autistic child becoming self-injurious with tooth brush.
Alternative: Have staff member help child with tooth brushing since the
staff member will be the
one to help the child in the future with brushing.
3) Resources
a) toothbrushes
b) toothpaste
c) Pamphlets (listed in appendix area)
d) Typodont and giant toothbrush for demonstration
e) Step-by-step images of tooth brushing
f) Skill evaluation sheet for each autistic child
g) Permission slips for parents to approve child's participation
h) Program Plan Evaluation
i) Plastic Cups

4) Budget
The estimated cost for the dental health program is listed below:
a) Toothbrushes: Free
Donated by Colgate
b) Toothpaste:
Free
Donated by the LIT Dental Hygiene Clinic
c) Pamphlets :
Free
Printed from a website/ Dr. Alvin Prause
donated paper and ink
d) gloves:
$10.00
e) Plastic Cups
$5.00
Total:
$15.00

5) Timetable
There will be four sessions spanning over a 3 week period. The program will be
implemented as followed:
a) Session 1: April 7, 2015 (Tuesday)
b) Session2: April 7, 2015 (Tuesday)
c) Session 3: April 16, 2015 (Tuesday)
d) Session4: April 21, 2015 (Tuesday)

Evaluation
1. A weekly review for the staff and parents of all the information presented at past
sessions to ensure understanding of information with the use of a pre/post test.
2. A weekly assessment of the autistic childrens ability to use the correct brushing
technique with the use of a skills survey.
3. A weekly consultation with the program director and executive director will be
conducted to seek approval for continuation of the oral health program and to make
changes if necessary.
4. The success of the healthy reward system will be measured with a questionnaire
answered by the parents at the conclusion of the oral health program.

Product Evaluation
1) Parents will be surveyed at the conclusion of the program to evaluate the healthy
rewards program.
2) A pretest/post-test will be administered to parents and staff to assess their
knowledge level of dental health for autistic children.
3) Oral hygiene skills of the autistic children will be evaluated using oral skills
survey.
4) A questionnaire will be given to director upon conclusion to determine the overall
success of the program.

Reference Page
1.) Ferguson, B., Jenkins, G. (2015, February 10). Information About the Shorkey
Center [Personal interview].
2.) Oral Health Data SystemsMy Water's FluorideSafe, effective prevention of
tooth decay for people of all ages: Know if your water is optimally fluoridated.
(2008, February 6). Retrieved February 17, 2015, from
http://apps.nccd.cdc.gov/MWF/PWSDetailV.asp?
PWSID=1230001&State=TX&StartPg=1&EndPg=20&County=Jefferson&PWS
Name=&Filter=0&PWS_ID=&State_ID=TX&SortBy=1&StateName=Texas
3.) Chin, M., Fenton, S., Lyons, R., Miller, C., Perlman, S., & Tesini, D. (2014,
November 3). Practical Oral Care for People With Autism. Retrieved February
24, 2015, from
http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/Practical
OralCarePeopleAutism.htm#9
4.) Children's Oral Health. (2014, November 10). Retrieved February 24, 2015,
from http://www.cdc.gov/oralhealth/children_adults/child.htm
5.) Oral Health Fact Sheet for Medical Professionals Children with Autism
Spectrum Disorder. (2010). Retrieved February 24, 2015, from
http://depts.washington.edu/sodent2/wordpress/wpcontent/media/sp_need_pdfs/Autism-Medical.pdf
6.) Nguyen, V. (2010, April 29). Synopses of State and Territorial Dental Public
Health Programs. Retrieved February 24, 2015, from
http://apps.nccd.cdc.gov/synopses/StateDataV.asp?StateID=TX&Year=2009
7.) Ketanont, S., Leelataweewud, P., Luppanapornlarp, S., & Putongkam, P.
(2010). Periodontal status and orthodontic treatment need of autistic
children. Retrieved March 3, 2015, from
http://www.ncbi.nlm.nih.gov/pubmed/20877735
8.) Autism Fact Sheet. (2015, January). Retrieved March 17, 2015, from
http://nationalautismassociation.org/resources/autism-fact-sheet/
9.) Oral Health Fact Sheet for Dental Professionals Children with Autism
Spectrum Disorder. (2010). Retrieved March 17, 2015, from
http://depts.washington.edu/sodent2/wordpress/wpcontent/media/sp_need_pdfs/Autism-Dental.pdf
10.)
Pediatric Dental Health. (2005, January 10). Retrieved March 17,
2015, from http://dentalresource.org/topic55autistic.html
11.)
Chin, M., Fenton, S., Lyons, R., Miller, C., Perlman, S., & Tesini, D. (2009,
July). Practical Oral care for People with Autism. Retrieved March 17, 2015,
from
http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/Docume
nts/POCAutism.pdf?_ga=1.223079515.1165262067.1424660064

12.)
Stubblefield, H. (2013, September 24). Echolalia. Retrieved March 19,
2015, from http://ask.healthline.com/health/echolalia#Overview1
13.)
Nutrition and Autism. (2013, February 7). Retrieved March 17, 2015,
from https://www.autismspeaks.org/science/science-news/nutrition-andautism
14.)
Anandkrishna, L., Chandra, P., Iyengar, U., Kamath, P., Magoo, J., &
Shetty, A. (2014, September 1). Knowledge, attitude and practice towards
oral health care among parents of autism spectrum disorder children.
Retrieved March 17, 2015, from
http://www.jcri.net/pdf/JCRI_1(4)_07_OA_20141025_V1 final copy.pdf
15.)
Special Needs. (2015). Retrieved March 19, 2015, from
http://dental.washington.edu/oral-medicine/special-needs/
16.)
Step-By-Step toothbrush image: https://www.google.com/search?
q=step+by+step+tooth+brushing&espv=2&biw=1600&bih=799&source=ln
ms&tbm=isch&sa=X&ei=3OYNVcjZD8WoNr_egYAB&ved=0CAYQ_AUoAQ&dpr
=1#imgrc=3fkWEBYXCB3U4M%253A%3BUBm3JgFeZhuBeM%3Bhttp%253A
%252F%252Fwsfamilyofhope.org%252Fuploads%252FBrush_teeth___floss.jpg
%3Bhttp%253A%252F%252Fanjamdairi37.soup.io%252Fpost
%252F490969294%252FBrushing-teeth-in-sequence-pictures%3B614%3B768

Appendix

Tooth Brushing Skill Survey

Name:____________________________ ________
Date:___________________
Steps
1. Identify
Toothbrush
2. Approach Sink
3. Wet tooth
brush
4. Put
toothpaste on
brush
5. Put brush in
mouth
6. Keeps brush in
mouth for 10
seconds
7. Keeps brush in
mouth for 1
minute
8. Keeps brush
in mouth for 2
minutes
9. Brush
inside/outside
anterior teeth
10. Brush
inside/outside

Date

Date

Comments:

posterior teeth
11. Brush
incisal/occlussal
surfaces
12. Rinse with
water and spit
13. put tooth
brush/paste
away
Total:
Scoring Key
0= step was not completed
1= assistance was given
2= need prompt to complete step
3= step was completed independently

Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________

Parent/Caregiver/Staff Pamphlet
Dental health Guidance For Parents and Caregivers of Children with
Autism Spectrum Disorder
http://depts.washington.edu/sodent2/wordpress/wpcontent/media/sp_need_pdfs/Autism-Parent.pdf

Practical Oral Care for People With Autism

http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/Documents/PO
CAutism.pdf?_ga=1.223079515.1165262067.1424660064

Program Plan Evaluation form given to us in class will also be utilized

* Unable to copy and paste pamphlets. They will be present in hard copy.

Pre/Post Test
(for Parents/caregivers and staff)
1) How often should a person brush their teeth?
a) 1 time daily
b) 2-3 times daily
c) once a week
d) 5 times daily
2) How long should a person brush?
a) 30 seconds
b) 5 minutes
c) 2 minutes
d) 1 minute
3) What is plaque?
a) bacteria
b) disease
c) dirt
d) virus
4) What can plaque lead to?
a) cavities
b) gingivitis
c) periodontitis

d) all the above

5) What causes cavities?
a) bacteria
b) unhealthy diet
c) improper oral hygiene
d) all of the above
6) What is a common oral habit for autistic children than can cause
damage
a)grinding/clenching teeth
b) chewing food
c) brushing teeth
d) wearing a mouth guard at night

7) Prescribed medications have the potential to cause:

a) gingivitis
b) dry mouth
c) proper oral care
d) both a and b
8) What food is NOT considered a cariogenic (caused tooth decay) food:
a) Bread
b) Chocolate
c) Cheese
d) Dried fruit
9) What mineral helps strengthen enamel:
a) Calcium
b) Zinc
c) Fluoride
d) Iron
10)
Periodontal disease has two stages: gingivitis and periodontitis.
a) true
b) false
11)
Ginigivitis is:
a) inflammation of the gums
b) bone loss
c) the first stage of periodontal disease
d) both a and c
12)
Periodontitis is:
a) inflammation of the gums
b) bone loss

c) the second stage of periodontal disease

d) both a and c

* X'ed image will not be utilized.

March 23, 2015

Dear Parent/Guardian,

We ask for your permission to allow your child to participate in the dental
hygiene program that will be implemented at the Shorkey Center for Autistic
children. The program will be implemented by two dental hygiene students from
the Lamar Institute of Technology. It will be one day a week for a span of four to five
weeks. The program will include the children, parents and staff of the Shorkey
Center. We plan to educate the children, parent, and staff on proper oral hygiene
such as brushing and flossing. We will give each child step by step instructions on
brushing their teeth. We will educate the parents and staff on proper brushing
techniques, nutrition, and problems that can be caused in the oral cavity and ways
to avoid them. A free toothbrush and toothpaste will be provided for each child that
participates. Our overall goal is to improve the oral health and oral health
knowledge of the children, parents, and staff members of the Shorkey Center. If you
have any questions you are welcome to call us at the numbers listed below.

Thank You,

Katie Ferguson

Telephone: (870) 918-8332

Ashley Mayeux

Telephone: (409) 988-2106

______ YES, I grant ______________________________ permission to participate in the

oral health program that will be implemented at the Shorkey Center by the Lamar
Institute of Technology dental hygiene students.
______ I DO NOT grant _____________________________ permission to participate in the
oral health program that will be implemented at the Shorkey Center by the Lamar
Institute of Technology dental hygiene students.

_____________________________________
_____________________________________
Parent/ Guardian Name Print

Parent/Guardian Signature