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Rachel Musselwhite

Dimple Panchal
DHYG 1315 Community Dentistry
NEEDS ASSESSMENT
A. GENERAL DATA
1. Description of site
Hope Womens Resource Clinic is located on 3740 Laurel Ave. Beaumont, TX. It
was established in 1997 and supports women and their partners facing unplanned
pregnancies. Their basic goal is to inform, educate and support women with
pregnancy. It is a non-profit organization that provides free pregnancy verification
test, limited ultrasound, earn while you learn programs, abstinence education,
and peer counseling. Donations, fundraisers, churches, private donors and gifts
are what fund this organization. (1)
2. Description of Target Group
Hope Womens Resource Clinic helps women with unplanned pregnancies and
any child within a year old. Clients are admitted regardless of religious affiliation
or socio economic status. Hope does not provide or recommend abortions but try
to directed women against it. They convinced 34 women to change their minds
about abortion in 2015. Hope provides referrals to community programs and
services. It educates clients on abstinence, parenting and spiritual matters. In
2015, 954 new clients were seen in the Hope clinic. 30% were Caucasian, 20%
African and Hispanic, and others were included. (2)
3. Description of Staff Population
The board of directors includes the president, vice president, secretary, treasurer,
nurse, and ultrasound technician. 95% are volunteers. Once a month, the
executive director holds a board meeting. Front desk helps to attends to calls,
manage clients and provide information regarding classes and clinic. The
ultrasound technician provides limited service from the 10th to 18th week of
pregnancy. There is no necessary training required to volunteer. Volunteers
conduct the classes as per their skill in fields. Nurses help with pregnancy tests.
(1)
4. Description of service provided
Hope Womens Resource Clinic provides different services for pregnant women.
Volunteers conduct classes on banking, Spanish bible classes, life skills, infant
CPR, financial recovery by BBVA, nutrition by Southeast Texas food bank,
parenting, breastfeeding tips, safe sleep/SIDS presented by the Garth House and
sewing classes. Classes are conducted twice a week on Tuesdays and Thursdays.
When women come and attend classes and/or bring guests with them to the
classes provided they earn points that they can use in a special on-site boutique
that provides items for the mothers and their babies. In the future this organization
plans to provide STD testing and a mobile ultra sound unit for traveling. (1)

5. Other Pertinent data:


A. Water system name: City of Beaumont water utility department
Water fluoride concentration: 0.70mg/l (3)
B. Information Related to Dental Health
Hope clinic does not provide any services related to dental health. There are
currently no dental supplies available in their clinic; they only distribute flyers
provided by previous oral health programs. The staff is not fully knowledgeable
about the oral heath needs associated with pregnancy or the oral health needs of
an infant younger than one year of age.
C. Dental Health status:
1. Dental Caries:
Some studies show that there is significant difference between pregnant and nonpregnant women with dental caries. Data was collected from 197 women from
whom 94 were pregnant women. The study showed that 74.0% of pregnant
women had caries, meaning that pregnant women were 2.9 times more likely to
develop dental caries. Unaware of the special oral hygiene habits associated with
pregnancy, pregnant women should be trained for proper oral hygiene care. (4)
2. Periodontal Disease:
Approximately 40% of pregnant women have periodontal disease. Most of the
studies mention a relationship between periodontitis and preterm low birth weight
in babies. A possible reason for low birth weights was an unawareness of oral
disease. Studies were conducted on domestic workers, among the participants,
76% were unaware of oral disease and prematurity. Statistical data was analyzed
and 90.4% were unaware of activity and 65.4% never received any information on
oral hygiene. Educating pregnant women in the importance of oral hygiene
should help reduce these numbers and promote overall general wellness. (5)
Some studies have shown that periodontal disease is most prevalent in women
who are either African American, smokers and users of public assistant programs.
A recent trial has not shown any association between periodontal treatment and
pre term low birth weight. More research is needed to prove the association
between periodontitis and adverse pregnancy outcome. (6)
3. Oral Hygiene:
The maintenance of oral health is important for general health during pregnancy.
In some surveys during 2009, 35% of U.S women reported that they did not visit
a dentist last year and 56% women did not visit a dentist during pregnancy. This
could be related to a low socio economic status; women without dental insurance
to cover expenses simply dont make dental appointments. According to post
partum survey data from the Pregnancy Risk Assessment monitoring System in 10
states, 56% of mothers did not have dental care and 60% did not have their teeth

cleaned during pregnancy. Some groups like black non-Hispanic women (24%)
and Hispanic (25%) are less likely to have their teeth clean during pregnancy.
Approximately (59%) of the women did not received counseling about oral health
during pregnancy. Most mothers are unaware of the importance of infant oral
health. For example, mothers should be informed that kissing or sharing a spoon
with babies might transfer bacteria, which can be detrimental to babies oral
health. (6)

4. Utilization Of Dental Services:


Some of the factors associated with utilization of dental services are need, habit and
access to dental care. The studies by The National institute of Health show that during
pregnancy 25% of mothers had periodontal problems. Of 423 mothers involved in the
study, 93% had dental check ups during pregnancy, 80.5% received preventive care and
28% received periodontal treatment. These relatively high check up rates during
pregnancy were related to higher level of education, dental insurance and household
income showing that mothers with more knowledge about oral health and its relation to
pregnancy understand the importance of continued dental visits during pregnancy. (7)

Goal:
To promote the oral health in women during their pregnancy at Hope Womens Resource
Clinic
Objective:
1. To decrease the overall amount of plaque and debris in pregnant women by 15%
2. To provide participants and staff with dental heath resources.
3. To increase the dental health knowledge of pregnant women and mothers with
infants under one by 20%
4. To increase the staffs knowledge about dental health in pregnancy by 20%
Rationale:
Studies from The Center for Disease Controls Pregnancy Risk Assessment
Monitoring System shows only 23%- 43% of pregnant women received dental care
during pregnancy. Therefore it is important to maintain oral health care during, after and
before pregnancy. Training should be provided to staff and healthcare workers to provide
a minimum level of care for people who do not have access to dental care. Oral hygiene
instruction, referrals, nutritional counseling and fluoride treatment should also be

provided to such groups. Data suggests that scaling and root planning in the second
trimester (14-20 weeks) of pregnancy is safe. Therefore to maintain general health it is
important to take preventive measures for oral health. (8)
The most chronic condition in the United States is tooth decay. 20% of children
aged 5-11 years have at least one decayed tooth. Children from low-income families have
a high percentage of tooth decay (25%) over those from high-income families (11%).
Fluoride varnish can prevent 33% of tooth decay in baby teeth. Dental sealants placed in
permanent teeth have shown 81% less decay. It is important for parents to know that
fluoride helps to prevent tooth decay. Knowledge about dental sealants is also important
for parents. Sealants fight chronic dental decay and improve childhood health. (9)
The health care provider as well as dental care provider should not overlook
dental care during pregnancy and follow preventive oral care for overall health of the
mother. It is important for prenatal care professionals to provide education to pregnant
women about oral health to promote overall health and oral health of her children.
Pregnant women should be advised that dental care during pregnancy is beneficial and
can be taken anytime during pregnancy, as there is no risk to the mother or fetus during
pregnancy. Pregnant women should be encouraged to have a dental exam on first prenatal
appointment if they did not have one in previous six months. Patients who receive
Medicaid should be provided with a list of sources for community dental care. (10)
There are different complications associated with pregnancy such as miscarriages,
preterm births, preeclampsia and gestational diabetes. Recent dental care studies indicate
that oral care of pregnant women will decrease transmission of oral bacteria from

mothers to their children. There is no evidence that reflects any miscarriage in the first
trimester due to oral health care or dental care procedures. Preeclampsia is not a
contraindication to dental care. Evidence to date shows that periodontal treatment has no
effect on preterm labor or low preterm birth weight and is safe for mother and fetus.
Effective periodontal treatment during pregnancy shows reduction in periodontal
pathogen and disease. In the United States, studies conducted on pregnant women
between 6-20 weeks pregnant found no association between periodontal disease and
adverse pregnancy outcome. (10)

In 2004, a study done in California showed that only one in five pregnant women
enrolled in Medicaid received any dental services. Nationally, 2% to 5% show evidence
of dental caries in 28% of children. In California 53% of children had experienced dental
caries by the time they reached kindergarten. It is important for pregnant women to
control oral disease, which will help reduce the transmission of oral bacteria from
mothers to their children. DNA fingerprinting studies show cases where 70% of the time
the mother is most common cariogenic donor to their children. Cariogenic bacteria can be
transferred by mother or care giver to child by saliva: sharing spoons, cleaning a pacifier
by mouth and so on. Therefore it is important that pediatricians work with the dental
community to educate pregnant women and encourage them to breast feed and use good
oral hygiene care for them and their children. (10)

Program Design:
A. Activities:

This program is design to educate pregnant women and mothers of infants under
the age of one on the importance of oral hygiene. Each session is aimed in
teaching basic oral hygiene care and pregnancy associated dental care. We will
have a session that will teach mothers of infants on the importance of infant oral
hygiene and how to care for infants when it comes to their oral hygiene.
Session One:
1. We will give a pre test to the pregnant women in our class and to the staff to
see where their level of intelligence is pertaining to oral hygiene in pregnancy.
2. Before we start the session we will inform them that after the session we will
ask questions regarding all the information that they have learned that day to
have a chance to win a price that we will provide. This is to help try and get
them interested and involved in the class.
3. We will discuss the importance of good oral hygiene during pregnancy with
pregnant women and the staff. We will have a PowerPoint that we will present
throughout our session that will include information about what to expect with
ones oral health during pregnancy such as pregnancy gingivitis, pregnancy
tumor, and plaque. Also on how bad oral hygiene can have an affect on a
pregnant womens unborn child
4. We will discuss the needs for dental health programs for pregnant women.
5. We will discuss with them about the resources for oral health programs and
provide them with information on the local LIT dental hygiene clinic. We will
also provide them with toothbrushes, floss, and toothpaste
Session Two: (Review session 1)
1. We will briefly review session one with the class incase there are any new
students and to help refresh the information with the women who are
participating in our session again.
2. After reviewing session one we will demonstrate to the class on proper
brushing and flossing techniques using a typodont. We will have the women
demonstrate also to help make sure that they understand and to help get them
involved.
3. We will show a video to the class to demonstrate oral hygiene care.
4. We will provide anyone new to the class with a toothbrush, floss, and
toothpaste.
Session Three: (Review session 1&2)
1. We will briefly review session 1&2, which is over the importance of oral
hygiene in pregnancy and let them ask any questions that they might have
before moving on to our next lesson.
2. Before we start the session we will inform them that after the session we will
ask questions regarding all the information that they have learned during our
session to have a chance to win a price that we will provide. This is to help try
and get them interested and involved in the class.
3. During this session we will start discussing with mothers on the importance of
infant oral health. We will have a PowerPoint to present that will go along
with all our information that we will go over as well as a video. We will

provide them with information as to when to expect their childs primary teeth
to start erupting, when to start taking their child to see a dentist, and signs to
watch for. We will teach them the effects that thumb sucking and baby bottle
decay can have on their childs oral health.
4. We will discuss with them the prevention technique for infant oral health such
as fluoride toothpaste, fluoride mouth rinse, and sealants as well as how to
clean their childs teeth. We will also provide them with information on dental
emergencies.
5. We will provide them with resources and pamphlet about infant oral health.
Session Four: (Review 1, 2, &3)
1. After reviewing over sessions 1,2, & 3 and letting them ask any questions that
they have we will evaluate brushing and flossing techniques and take plaque
scores.
2. Will provide dental related games to staff and students to get them involved
in the class. The activities will include matching words with definitions in a
given period of time.
3. We will give everyone an opportunity to ask any questions or concerns that
they have and if any would like to go over any information from the previous
session we will do so.
4. A posttest will be given so we will be able to measure the amount of
knowledge that that have obtained throughout our sessions. The post rest will
be the same as pre test to help us with measuring the knowledge gained.
B. Constraints and Alternatives Strategies:
1. Constraint- Patients might be coming to class just for points and uninterested
in leaning the importance of oral health during their pregnancy.
Alternatives- To gain their interest by proper presentation and getting them
involved through activities. Grabbing their attention by rewarding them with
prices that we will provide.
2. Constraints- Due to lack of knowledge that oral health in pregnancy can lead
to adverse pregnancy outcomes and effects on general health
Alternative- Provide them presentation with importance of oral hygiene care
during pregnancy.
3. Constraint- No dental insurance or finances to help with dental visits.
Alternative- Provide resources for dental health insurance and suggest the LIT
dental hygiene clinic for preventive dental care.
4. Constraints- Lack of knowledge that a childs deciduous teeth are just as
important as the childs permanent teeth.
Alternative- Provide the knowledge that the deciduous teeth act as a space
retainer and a guideline for permanent teeth.
C. Resources:
The following resources will be required for implementation of the oral health
program.
1. Video- for mothers of infants.

2. Supplies- games, toothbrushes, floss, typodont, pamphlets, mouth rinse,


gloves, masks, disclosing solution.
3. Visual aids- PowerPoint
D. Budget:
The following is the estimated costs of the oral health program.
1.
2.
3.
4.
5.
6.
7.
8.
9.

Pamphlets $0
Toothbrushes $0 Colgate pharmaceutical and Johnson & Johnson
Floss $0
Mouth rinse $0 Johnson & Johnson
Gloves $5
Mask $3
Disclosing solution $5
Games and prizes $25
Paper napkins & cups $4

Total: $42
E. Timetable:
Session One: Thursday March 31st 2:00pm
Session Two: Tuesday April 5th 2:00pm
Session Three: Tuesday April 12th 2:00pm
Session Four: Tuesday April 19th 2:00pm
Evaluation:
A. Process Evaluation (Formative):
1. To evaluate plaque control techniques for pregnant women in order to achieve
optimum oral health
2. A weekly review for each group for each group of the information that was
presented during the previous session will be conducted to promote optimal
understanding and retention of information.
3. A review the oral health information regarding pregnancy with the staff to
promote overall oral health.
4. The success and individual comprehension of each presentation will be
assessed through a question and answer session after each session is
completed.

B. Product Evaluation (Summative):


1. Pretest and posttest will be administered to the pregnant women to assess and
compare their knowledge in regarding to their oral health care needs.

2. A pretest and posttest will be given to the staff to assess and compare their
level of knowledge in dental health care relating to pregnancy as well as their
comprehensive support and educational roll as health care providers.
3. The success of the overall program will be evaluated by a questionnaire
given to the director upon the conclusion of the program.

Pretest/Posttest
1. Regular dental visits should be avoided during pregnancy
because of adverse effects on pregnancy.
A. True
B. False
2. Nursing bottle rampant caries only affect the front teeth.
A. True
B. False
3. Gingivitis is a gum disease that is not reversible.
A. True
B. False
4. Fluoride is a mineral that is presented in drinking water, which
helps to make teeth strong.
A. True
B. False
5. Dental sealants help to seal the deep grooves of the teeth and
prevent cavities.
A. True
B. False
6. Baby teeth are temporary and therefore not important.
A. True
B. False
7. Rampant caries can occur in adolescent ages.
A. True
B. False
8. After morning sickness you should brush teeth immediately to
avoid sour taste.
A. True
False

References:
1. Jeniffer Nixon, (Director of client services). 2016, Feb 2nd. Hope Womens
Resource Clinic. Personal Interview
2. Hope Womens Resource Clinic. (2012). Services. Retrieved from
http://www.hope-clinic.com
3. Centers for Disease Control and Prevention. (n.d). My Waters Fluoride. Retrieved
from http://nccd.cdc.gov/gisdoh/waterfluor.aspx
4. Rakchanok, N., Amporn, D., Yoshida, Y., & Sakamoto, J. (2010). Dental Caries
and Gingivitis among pregnant and non-pregnant women in Chiang Mai,
Thailand. Nagoya Journal of Medical Science, 72(1-2), 43-50.
5. CATAO, Carmem Dolores de Sa; GOMES Thaissa de Amorim; Rodrigues,
Rachel Queiroz ferreria & SOARES, Renata de Souza Coelho. (2015).
Evaluation of the knowledge of pregnant women about the relationship between
oral diseases and pregnancy complications. Rev. odontl. UNESP [online]. Vol.44,
n.1, pp. 59-65. Retrieved from http://dx.doi.org/10.1590/1807-2577.1078.
6. The American College of Obstetricians and Gynecologists. (2015). Oral health
care during pregnancy and through the lifespan. Number 569. Retrieved from
http://www.acog.org
7. Ami, M., & ElSalhy M. (2014) Factors affecting utilization of dental services
during pregnancy. Dec; 85(12): 1712-21. doi: 10.1902/jop.2014.140235.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25119559
8. Jared, H., & Boggess, K. (2008). Periodontal diseases and adverse pregnancy
outcomes: A review of the evidence and implications for clinical practice.
Retrieved from https://www.adha.org/resourcesdocs/7838_Periodontal_Diseases_and_Adverse_Pregnancy_Outcomes.pdf

9. Center for disease control and prevention. (2013). Sealants for preventing dental
decay in the permanent teeth. Issue 3. Art NO: CD001830. Retrieved from
http://www.communityguide.org/oral/fluoridation.html
10. California Health Care Foundation. (2010). Oral Health During Pregnancy and
Early Childhood: Evidence-Based Guidelines for Health Professionals. Retrieved
from https://bb-lit.blackboard.com/bbcswebdav/pid-492186-dt-content-rid1519309_1/courses/DHYG_1315_6A1_201610/poh_guidelines%5B1%5D.pdf