Do Community Based Oral Health Promotion Experiences in Dental Schools Change Dental Students Attitu

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Do Community- Based Oral Health Promotion
Experiences in Dental Schools Change Dental
Students Attitudes towards Oral Health Care for
the Underserved?

• Jennifer Holtzman DDS, MPH Dental Public Health
  resident
• 10.30.2007

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Extramural experiences in dental school
(Literature Search)

• Positively influence attitudes towards community
  service
• Increase understanding of oral health disparities
• Increase self-efficacy to care for diverse
  populations
• Little evidence that these result in long term
  care for the underserved

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Project Purpose

• To evaluate the impact of USCSD oral health
  promotion programs, Doctors Out to Care and the
  Neighborhood Mobile Dental Van Prevention
  Program, on the freshmen DDS students attitudes
  toward providing care to the underserved.

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Project Design
Purpose to evaluate the impact of extramural
community rotation on attitudes of freshmen
dental students towards oral health care for
underserved populations
Survey 1
Orientation week of DDS Class of 2009 (Sept. 2005)
Students assigned to groups (August 2005)
Did not participate in DOC
Participate in DOC
First group completed DOC (Dec 2005)
Survey 2
Sealant Van rotation
All Students work on the Van rotation 1 (Spring
2006)
All Students work on the Van rotation 2 (Summer,
Fall 2006)
Student reflections
Survey 3
Students complete Survey (October 2006)
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DOC Program Diagram

DOC training sessions 1)Into to
caries,disparitiesReview of OWTI 2)Cultural
issues OHI/disclosing 3) After visit 2,
discussion of problems/successful strategies.
Intro to sealant van

• DOC orientation
• Syllabus
• OWTI
• School rep

• Students (8)
• create curricula
• material and supply needs

Students to meet with assigned teacher to get
feedback/suggestions
Classroom interventions focused on 1)
relationship between oral bacteria and tooth
decay 2) the importance of eating healthy
foods 3) the importance of good oral health
practices 4) the ability to demonstrate proper
tooth brushing behavior
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Neighborhood Mobile Dental Van Prevention Project
Rotation(s)
Case (wk 1)
Sim lab (week 2)
First Clinical Experience (week 3)
Second Clinical Experience (assigned by Academic
Affairs in following trimester)
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• 5th Wheel
• 4 operatories
• Hardwired electricity
• Public water for sinks
• Distilled for operatories
• Sewage into school sewage system
• No xray units

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• Students share patients
• Screening
• Treatment determined by faculty
• Sealants
• Fluoride (APF gel or varnish)
• OHI
• 2 ½ day rotations
• Self-evaluation/reflection
• Competency based

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The Neighborhoods

• 1
• 86 Hispanic/Latino
• 10 Asian
• 32 live at or below FPL
• 40 of children live at or below FPL

• 2
• 50 Hispanic/Latino
• 23 American Black
• 14 Caucasian
• 10 Asian
• 32 live at or below FPL
• 40 of children live at or below FPL

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The Schools

• 1
• 98.9 Hispanic/Latino
• 68 English Learners
• 100 FRL

• 2
• 96.6 Hispanic/Latino
• 64 English Learners
• 100 FRL

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Californias Latino/Hispanic Kindergarten and 3rd
Graders ( white)

• 72 experienced decay (47.6)
• 5.2 urgent needs (2.0)
• 32.9 untreated (19.8)
• 26 caries on 7 or more teeth
• 65 of children FRL (21)
• Poor children more likely to have decay
  experience, untreated decay, and urgent needs
  less likely to access dental treatment, parents
  who speak English

Mommy it hurts to Chew, the Dental Health
Foundation, 2006 From sample of 21,000
Kindergarten and 3rd graders.
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Attitude toward Health Care Crandall SJ, Volk
RJ, Loemker VJAMA 1993 269(19)2519-23

• Originally designed for medical students. Adapted
  for dental students
• 57?40 questions
• 28 questions that were answered on a Likert scale
  
• 1 SD Strongly Disagree
• 2 D Disagree
• 3 U Undecided
• 4 A Agree
• 5 SA Strongly Agree

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• 1. Dentists should be responsible for providing
  medical care to the needy. dr
• Dentists should volunteer their time working in a
  free clinic. dr
• It is not the responsibility of the federal
  government to fund programs that provide dental
  care to the needy.se
• 4. I feel personally responsible for providing
  dental care to the needy.pe
• 5. Individual dentists should not be willing to
  provide care for their patients who cannot pay.
  dr
• 6. Communities should be responsible for
  providing facilities for the care of the needy.
  se
• 7. Dental students should be involved in
  providing dental care for the needy. dr
• 8. Dental care should be provided without charge
  for those who cannot pay ac

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• 9. It is the responsibility of church-related
  organizations to provide some funding for oral
  health care services. se
• 10.To care for needy patients, each dentist
  should allow for 15 of the care he/she provides
  to be true charity. dr
• 11.I would be interested in volunteering
  for programs which provide dental care for the
  needy during my dental school academic tenure. pe
• 12.Not everyone should have access to dental
  care. ac
• 13.All dental students should become involved in
  community health efforts. dr
• 14.State government should be responsible for
  funding programs to meet oral health care needs
  of its residents. se
• 15.I feel I am personally unable to make an
  impact on the problem of meeting the dental needs
  of the underserved. pe

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• 16.Churches should provide facilities for dental
  care of the needy. se
• 17.Access to dental care is a privilege. ac
• 18.I personally want to be involved in providing
  care for the needy during my dental career. pe
• 19.Society is responsible for providing for the
  oral health care of its members. se
• 20.Dental students should not be concerned about
  the problems of the medically needy. dr
• 21.People have a right to unlimited dental care
  regardless of their ability to pay. ac
• 22.All dental students should be involved in
  community activities.dr
• 23.Access to oral health care is a right. ac

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dental student participant demographicsbaseline
plt.001
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dental student participant demographics(contd)
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Attitudes scores of students over study
period Response rate 95.197.288.9
p lt.001 level Analysis is based on
generalized linear models with unbalanced design
statistical significance is similar for testing
independent groups or linear trend for
independent groups with two concerns related to
testing linear trend unbalanced design and
unequal intervals.
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Table of Attitude score by Sociodemographic
characteristics (baseline)
p lt.05 level Analysis is based on generalized
linear models with unbalanced design statistical
significance is similar for testing independent
groups or linear trend for independent groups
with two concerns related to testing linear
trend unbalanced design and unequal intervals.
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Table 4 Univariate Analyses of the Effects of
Sociodemographic Characteristics on Students
Attitudes during the Study Course.
Univariate Analyses of the Effects of
Sociodemographic Characteristics on Students
Attitudes during the Study
p lt.05 level, p lt.01 level, p lt.001
level Analysis is based on mixed models.
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Qualitative Analysis121/129(8 no comments)
Major theme in students reflection
of students that mentioned theme in their piece
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Findings

• Positive powerful experiences
• experience doesnt ultimately result in increased
  sense of social responsibility

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Recommendations

• Dental Education
• Curricula with theoretically based frameworks
  including health behavior, health communication,
  and professional ethics must be integrated in
  community experiential activities throughout the
  dental school program, with formal training in
  dental public health and provider-patient
  communications.
• Community Collaborations
• Collaborate with communities in the development,
  implementation, and evaluation of health
  promotion programs.

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Changes that would be made if to do this project
again

• Create a valid and reliable tool
• Focus groups
• dental students
• the community at large
• the children

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Acknowledgments

• To Drs. Kathy Atchison and Jane Weintraub for the
  conceptualization and development of this project
• To Dr. Hazem Seirawan in generating the
  statistical analysis
• To the administration, faculty and students at
  USC School of Dentistry for their support of the
  DOC and NMDVPP programs