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An Exploration of the Oral Health and Education Experiences of Former Drug

Abusers in South Central Texas

Oral Presentation Outline

Patricia Adesanya, DDS

Texas A&M Health Science Center


in partial fulfillment of the requirements for the degree of Masters of Science in
Education for Healthcare Professionals

April 1, 2016

Slide 2: Overview

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas
We will focus on the following in reference to the conducted qualitative study:

Background
Research Question (PICO)
Literature
Purpose and Objectives
Methods
Findings
Discussion
Recommendations
Limitations

Slide 3: Background

The prevalence of dental disease in drug abusers is high when compared to the general
population of the U.S.
Existing interventions within healthcare include:
o Psychological/ behavioral counseling
o Pharmacological education
o Nutritional education
Shetty et al.( 2010)

Slide 4: Research Question


In dental patients with a history of drug abuse, would education about the effects of drugs on oral health
have helped to prevent or reduce drug use?

P: Dental patients with a history of drug abuse


I: Education about the effects drugs have on oral health
C: No education
O: Prevention or reduction of drug use

Slide 5: Literature
Review of the literature presented the following:

Robinson, Acquah, and Gibson (2005)


o Drug users have special dental needs and dental care can contribute to their recovery
o Oral health is a low priority for addicts
o Dental providers can assist addicts to construct a non-addict identity
Brown et al. (2012)
o Oral health education where drug users receive public health services may help addicts to
accept oral hygiene methods to prevent dental disease

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas

o A need for a future study that focuses on patients living in rural areas
Shetty et al. (2010)
o Dental professionals can participate in the collaborative care of methamphetamine
abusers by providing oral health education

Slide 6: Literature Cont.


Review of the literature presented the following:

Shekarchizadeh et al. (2013)


o Barrier in receiving proper dental education amongst addicts
o Lack of oral health care programs
o More emphasis should be placed on education as a preventive intervention
The American Dental Association (2005, 2016)
o Dental professionals need to:
Seize all opportunities to educate the community and patients about the oral risks
associated with illicit drug use
Provide brief interventions that help to prevent the initial use of a substance,
discontinue the use of a substance, or decrease the amount of use
Exercise early prevention techniques

Slide 7: Purpose and Goals

Purpose
o To explore and describe the oral condition of former drug abusers and their experiences
with oral health education

Goals
o To obtain feedback from participants on if oral health education would have helped to
prevent or reduce drug use
o To support the implementation of early oral health education into drug awareness/ health
programs as part of the curricula of secondary schools
o Sociological and behavioral perspective

Slide 8: Questions

Slide 9: Methods

Permission to conduct this research was given by the:


o CEO and Director of Community Health Centers of South Central Texas
o Research committee from Baylor College of Dentistry
o Institutional Review Board (IRB)

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas

Target population
o Adults who abused drugs in the past and live the South Central Texas rural areas
Purposive sampling and inclusion/exclusion criteria
o 7 participants (5 men and 2 women)
Health history to identify former drug users
o Information sheet

Slide 10: Methods Cont.

Semi-structured interviews
o Pre- interview demographic and background form
o Digital audio recorder
o Less than 1 hour
Reimbursement
Confidentiality and Anonymity
o Password protected/ encrypted folder, random code names
Transcription
Thematic Analysis

Slide 11: Results (Demographics)

Gender
Male

Female

2
5

Figure 1: Demographics: Gender (7 total)

Slide 12: Results (Demographics)

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas

Ethnicity
Caucasian/ White

African-American/Black

Hispanic/ Latino

Native American/ American Indian

Asian/ Pacific Islander

Other

100%

Figure 2:
Demographics- Ethnicity

Slide 13: Results (Demographics)

Age of Initial Drug Use


Child

Adolesence

100%

Figure 3: Age of Initial Use of Drugs

Adult

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas
Slide 14: Results (Theme 1)
Table 1:

Sub themes

Theme 1:
Perceptions of
dental condition

*Frequency of
Interviewees

Quotes

Positive

N/A

Fair

Line 76: I guess the condition of them now is fair.

Negative

Line 9: Dont like the appearance of them.

* There were not any participants who were satisfied with the appearance of their teeth.
* 1 out of 7 participants felt the appearance of their teeth was fair with the exception of loosing teeth.
* 4 out of 7 participants had a negative perception of their teeth.

Slide 15: Results (Theme2)


Table 2:

Theme 2: Causes
of oral condition

Sub themes

*Frequency of Interviewees

Quotes

Drugs

Line 10: Drugs did this to my teeth.

Other: Genetics

Line 242: I think it is just genetics.

Other: Oral Hygiene

Line77: Not brushing


Line 10: Stopped taking care of them.

* 6 out of 7 participants felt that drugs contributed to the condition of their teeth.
* Only one participant felt that drugs did not contribute and that it was solely genetics. Also, one participant felt that it was a
combination of drugs and genetics.
* 2 out of 6 participants felt that in addition to drugs, lack of oral hygiene contributed to the condition of their teeth

Slide 16: Results (Theme 3)


Table 3:
Theme 3: Drive
for going to the
dentist

Sub themes

*Frequency of Interviewees

Quotes

Dental pain

Line 141: Uh, started to get tooth aches. I got a lot


of them.

Other: Self
motivation

Line 196: because I am in recovery, when I come


to the dentist I am not coming there to fix the
problem with medication, I am coming there to fix
the problem.

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas

Other: Routine

Line 252: Ive always gone to the dentist. Thats


what you do.

* 4 out of 7 participants came to the dentist because of dental pain.


* 3 out of 7 participants expressed self motivation to care for their teeth as the reason for going to the dentist.
* 1 out of 7 participants mentioned that going to the dentist was routine.

Slide 17 and 18: Results (Theme 4)


Table 4:
Theme 4: Oral
health education

Sub themes

*Frequency of
Interviewees

Knowledge

5-no knowledge

Line 28: No I did not. Not at all.

2- some
knowledge

Line 328: When they went over meth, they showed us pictures
of the mouth.

4- oral health
education would
have helped

Line 164: If the drugs department would of put out pamphlets of


what it does to your teeth and stuff, I wouldnt of done it.

3- oral education
would not have
helped

Line 213: If I would have been a child in todays market and


todays drug scene and I knew all this stuff and I had the tools to
deal with the reasons why I wanted to do drugs. Then most
definitely I would not have done drugs.

7- think its a
good idea

Line 62: I do think its a good idea to talk to younger people


because it really does impact self-esteem. That could be enough
to help change someones mind early on about drugs.

Method for self


intervention

Programs in
secondary
schools

Quotes

Line 121: In so many peoplethey are hiding their mouth, or


they have lost all their teethalready got low self worth from
what you have been doing so its very very important to be
educated beforehand.
Line 46: That information may just help someone else
who is younger, and maybe someone who is more into
their appearance, or trying to find jobs.
Line 64: Just because it wouldnt of helped me, does not
mean it wont help someone else.

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas
Line 227: Notable quote: For me personally, I really
truly wish that I will get all my affairs in order and then
that is exactly what I want to do. Any hand that I can lend
to a child not to go down the same path that I went down is
righteousness.

*5 out of 7 participants said they had no knowledge or received no information on oral health education.
*1 out of 7 participants said that they did receive some form of information from people in general.
*1 out of 7 participants said that they did receive some form of information from inpatient programs.
*4 out of 7 participants said that if they had received oral health education then it would have helped them with the
use of drugs.
*3 out of 7 participants said that if they had received oral health education then it would not have helped them with
the use of drugs.
* All 7 participants felt that it was a good idea to incorporate oral health education into drug awareness programs for
secondary schools.
* 3 participants said it was important to inform people before they start using drugs.
* 2 participants said mentioned that everyone is different so it may impact someone else.

Slide 19: Results (Theme 5)


Table 5:

Theme 5: Other
Methods of
Intervention

Sub themes

*Frequency of Interviewees

Family
Influence

Quotes
Line 112: My parents were both alcoholics, so I was
thought I was just doing what I was supposed to be
doing.
Line 332: A little more parental discipline.

Friends

Line 280: Seeing all my friends die because they didnt


do what they needed to do.

Rehab Program

Line 279: Inpatient treatment all of the probation


meetings all the AA meetings.

* 3 participants mentioned that family influence would have served as a method of intervention.
* 1 participant mentioned that learning from the mistakes of his friends served as a method of intervention.
* 1 participant mentioned that rehab programs served as a method of intervention.

Slide 20: Discussion


Based on the findings of the research oral health education:

Would serve as a good source of intervention for young people and should be implemented into
drug awareness programs for secondary schools
Was not a knowledgeable topic for the majority of participants

Slide 21: Discussion Cont.

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas
Existing Guidelines:

American Dental Association (2005) and the American Academy of Pediatrics (2016) suggest to
provide early prevention techniques and discuss the risks of drug at a young age
Texas Board of Education and the Texas Department of State Health Services (2015) recommend
a list of best practice-based programs for drug abuse prevention and intervention.
o Good Behavior Game
o Im Special
o Prevention through Alternative Learn Style program
The California School board (2010)
o School health programs from pre-school to grade 12
o Programs promote a healthy and safe living style and include information on oral disease
and the risk factors associated with it (including the use of drugs)
Texas schools need this type of program

Slide 22: Discussion Cont.


Recommendations /Implications for the future

Research
o Future study on a larger scale Larger target population
o Increased variety of demographics
o More detailed interview sessions

Clinical Practice and Education


o The implementation of oral health education into secondary schools will be suggested to
school boards.
o Participation of dental schools
Departments of Public Health and Pediatric Dentistry

Slide 23: Limitations

Small sample size


Ethnicity
Transcription process

Slide 24: References


American Academy of Pediatrics. 2015. Teaching health education in school.
Retrieved from: https://www.healthychildren.org/English/agesstages/gradeschool/school/Pages/Teaching-Health-Education-in-School.aspx.
American Dental Association. 2005. Statement on provision of dental treatment for
patients with substance use disorders. Retrieved from: http://www.ada.org/en/about-the-ada/adapositions-policies-and-statements/provision-of-dental-treatment-for-patients-with-substanceabuse.

An Exploration of the Oral Health and Education Experiences of Former Drug


Abusers in South Central Texas
American Dental Association, 2016. Drug use. Retrieved from:
http://www.ada.org/en/member-center/oral-health-topics/drug-use.
Brown,C. et al. 2012. Dental disease prevalence among methamphetamine and
heroin users in an urban setting. The Journal of the American Dental Association. Vol, 143(9).
California School Boards Association Dental Health Foundation. 2010. Integrating
oral health into school health programs and policies. Retrieved from:
https://www.csba.org/~/~/media/904CF0EFAFCD42729DF03AE22F39D7E2.ashx.

Slide 25: References cont.


Robinson, P., Acquah, S., and Gibson, B. 2005. Drug users: Oral health-related
attitudes and behaviours. British Dental Journal. Vol,198 (4), 219-24.
Shekarchizadeh, H. , Khami, M., Mohebbi, S., Ekhtiari, H., and Virtanen, J. 2013.
Oral health of drug abusers: A review of health effects and care. Iranian Journal of Public
Health. Vol, 42(9), 929-940.
Shetty et. al. 2010. The relationship between methamphetamine use and
increased dental disease. The Journal of the American Dental Association. Vol,141(3).
Texas Department of State Health Services. 2015. Public schools best practice- based resources. Retrieved
from: https://www.dshs.state.tx.us/mhsa/Public-Schools-Best-Practice-Based-Resources.aspx.
Texas Education Agency. 2015. Health education. Retrieved from:
http://tea.texas.gov/Curriculum_and_Instructional_Programs/Subject_Areas/Health_and_Physical
_Education/Health_Education/

Slide 26: Acknowledgments


I would like to recognize my research committee for their guidance with this project:
o
o
o
o
o

Dr. Ernie Lacy


Dr. Ann McCann
Dr. Emet Schneiderman
Dr. Charles Berry
Dr. Melissa Kahl-McDonagh