The Lennon Center

U n i v e r s i t y o f M i c h i g a n

H Y G D C E 4 8 5

S p r i n g / S u m m e r

6 / 1 1 / 2 0 1 3

Amber Fredericks

Community Oral Health Program

Amber Fredericks HYGDCE 485 Spring/Summer 2013 Background

The Lennon Pregnancy Center was created in 1984, under the name of Metro Life Choices with

committee members Joe and Marybeth Lennon.1 At first the center was only open one hour a week due

to lack of volunteers.1 In 1996, the center grew its hours of operation to thirty hours and in 1997 the

center changed their name to The Metro Crisis Pregnancy Center.1 In 2003, the Board of Director

decided to once again change the name of the center since the centers name involved crisis, it was

being perceived as an abortion clinic.1 The name soon became changed to The Lennon Center Resources

for Pregnancy and Parenting, attributing to Joe and Marybeth Lennon.1

Demographics

The Lennon Center currently has thirty-five students and growing, enrolled in their Pregnancy,

Childbirth and Newborn Parenting, and Mom and Baby Care classes.1 These students range in age from

fourteen to twenty-six years of age and are from the surrounding area of the Metro Detroit area

including Detroit, Westland, Redford Township, Southfield, Taylor, Dearborn Heights, Belleville,

Dearborn, Livonia and Inkster.1 Of these students, 11 are Caucasian, 20 are African American, 2 are

Hispanic, and three have chosen to not identify their nationality.1 With these surrounding areas being

located within Wayne County, the median household income of Wayne County, Michigan in 2010 was

$42,241 with a poverty rate of 21.4%.2

Pregnancy

In the United States, there are 13.0 births per 1,000 population with 8.1% of births being low

birth weight and 12.0% of births being preterm.3 Pregnancy begins when a fertilized egg implants into

the uterus and can go up to forty-one weeks, including three trimesters.4 Ovulation must occur for a

woman to become pregnant, an egg must be released and sperm must come into contact to produce

Amber Fredericks HYGDCE 485 Spring/Summer 2013 fertilization.5 Pregnancy starts when the fertilized egg attaches to the women’s uterus and begins to

grow, which is implantation.5 Pregnancy is measured using gestational age and starts on the first day of

a woman’s last menstrual period.5

Periodontal disease

Periodontal disease (gum disease) begins as gingivitis, which is the mildest form.6 Gums become

red, swollen and bleed easily.6 Gingivitis is reversible with proper homecare instructions given by a

dentist or dental hygienist.6 Factors that may contribute to gingivitis include, diabetes, smoking, aging,

puberty, pregnancy and certain medications.6 Periodontal disease begins from untreated gingivitis and

with time begins to grow under the gum line.6 Bacteria in plaque produce toxins that irritate the gums,

with time the tissues and bone that support the teeth are broken down and destroyed.6 As the process

continues to destroy and break down, a pocket or space is created between the gum tissue and the

teeth. The main cause of periodontal (gum) disease is plaque; the filmy deposit on the surface of teeth

consisting of a mixture of mucus, bacteria, and food but other factors play a corresponding role

including age, smoking/tobacco use, genetics, stress, medication, clenching or grinding teeth,

cardiovascular disease, diabetes, and rheumatoid arthritis, and obesity.7,8,9,10

Periodontal disease often has no symptoms until advanced stages of disease.10,11 Warning signs

may include red, swollen or tender gums, bleeding while brushing, flossing, or eating hard foods, gum

recession or gums that appear to be pulling away from teeth, causing teeth to appear longer, loose or

separating teeth, and persistent bad breath.9,10,11

Periodontal disease related to pregnancy

Women’s periodontal health can be impacted by a variety of factors. Some women can

experience menstruation gingivitis where women can have bleeding, red and swollen gums occurring

Amber Fredericks HYGDCE 485 Spring/Summer 2013 right before their period and subsides once she starts her period.12 Pregnancy is another risk factor for

periodontal disease. Women with periodontal disease may have a preterm or low birth weight baby by

bacteria flowing through the blood stream.12 Menopause and post-menopause women may experience

gingivitis that makes their gums appear dry or shiny and bleed easily.12

Oral health concerns for children

Tooth pain: Teething can keep both mom and baby up at night from uncomfortable tooth pain

resulting in the use of over the counter topical anesthetics that soothe the gum tissue of a teething

baby.13 Over the counter topical anesthetics for infant and children contain 7.5 % benzocaine.13 When

applied to irritated area the gel can penetrate 2-3mm below the gum line affecting free nerve endings

and remaining numb for a significant amount of time.13 When using topical anesthetics for teething

babies it can pose a risk in developing methemoglobinemia, a blood disorder resulting in an increase of

methemoglobin being generated.13 Most methemoglobinemia is hereditary, resulting in genetic defects

in red blood cells.13 Safe and effective ways of teething without the use of topical anesthetic include

gentle massage of gum tissue with a clean finger. Other things such as a cold washcloth for a baby to

chew on and chilled not frozen food and teething rings may decrease discomfort.13

Caries prevention: Reducing tooth decay and demineralization of enamel is the key to improving

the oral health of children.14 Fluoride is a naturally occurring trace mineral such as calcium and iron, it is

often found in ground water.14 Fluoridated water reduces the need for restorative dentistry, tooth loss

and time away from school.14 If a child is receiving less than 0.6 ppm of fluoride daily their caries risk is

moderate to high.14 When receiving too much fluoride, although safe and effective, it can cause enamel

fluorosis, causing white marks or streaks on the maxillary central and lateral incisors.14 Fluorosis is

usually caused when too much fluoride is ingested by infants and toddlers when using a toothpaste

Amber Fredericks HYGDCE 485 Spring/Summer 2013 containing fluoride. Fluoride toothpaste should not be used until a child can swish and expectorate (spit)

the excess toothpaste completely, usually around the age of 3 years old.

Although some parents may think that a child’s baby teeth aren’t important since they are going

lose them, children lose their baby teeth up to twelve years of age. The baby teeth are lost when the

permanent teeth being to erupt. Maintaining baby teeth is important for the health of the adult teeth,

when a baby tooth is decayed (has a cavity), that is left untreated it can affect the permanent tooth that

will be erupting after the baby tooth. Mother and caregivers can be the source of babies/children

“catching” cavities.15 Bacteria that causes cavities, Streptococcus mutans, can be transmitted from

mother to infant before their teeth erupt by exchanging salvia during kissing and rinsing a pacifier or

bottle nipple in the mother or caregivers mouth.15 The better the mother/caregivers oral health is, the

less chance the child will have problems.15

Conclusion

The main focus is to provide an oral health program for the expecting mothers and baby at The

Lennon Center. The Lennon Center provides pregnancy classes along with mom and baby, both of these

groups would benefit from this information by being educated on how the oral health can be link with

systemic health, including the baby and the safety of child health care. Many women tend to neglect

oral health care when it comes to being pregnant and/or having children. It is important for women to

take care of their oral health and to start healthy oral health habits for their children at a young age.

Mothers have an impact on their babies and children’s oral health starting with pregnancy. It is then

followed through with establishing oral health habits after the child is born and continuing through

childhood years.

Amber Fredericks HYGDCE 485 Spring/Summer 2013

Community Asset Map

Community Assets

Physical Surroundings

Individuals

Elizabeth

Schultz

Katherine

Lennon

Mariann

Bolton

Volunteers

Parents

Bulletin

boards Classroom

Overhead

projector

Baby doll/

Baby set

Handouts

Brochures

MDCH,

NIH

Michigan Department

of Community Health

Michigan Oral Health

Coalition

Wayne

County

Health

Department

Tri-

County

Dental

Health

List of Medicaid offices Local Dental Hygiene

Schools- Wayne County

Community College

District

Local

Dental

School-

University

of

Michigan

Oral-B,

Crest &

Colgate

Amber Fredericks HYGDCE 485 Spring/Summer 2013

Program Plan and Narrative

Community Program Goal

Increase the knowledge on oral health for the mothers and infant/children at The Lennon Center.

Healthy People 2020: Oral Health Objectives

Healthy People 2020 Health Objectives list the following oral health objectives in regards to oral health

in children and adults:16,17

OH-1.1: Reduce the proportion of children aged 3 to 5 years with dental caries experience in

their primary teeth.

OH-2.1: Reduce the proportion of children aged 3 to 5 with untreated dental decay in their

primary teeth.

OH-3: Reduce the proportion of adults with untreated dental decay.

OH-8: Increase the proportion of low-income children and adolescents who received any

preventive dental service during the past year.

Health People 2020: Maternal, Infant and Child Health Objectives.

MICH-8.1: Reduce low birth weight (LBW).

MICH-8.2: Reduce very low birth weight (VLBW).

MICH-9.1: Reduce total preterm births.

Program Plan

Objectives Evaluation Measures/Outcome Indicators

Activities / Strategies

Objective #1 Behavior: By the

end of the program, the members of The Lennon Center

will be able to make nutritional food choices and lower their

caries risk factors for both themselves and their children.

Evaluation Measure:

The members of The Lennon Center will be given a list of different foods

that are healthy and unhealthy. After the program, they will be asked to

organize the list of foods into categories of health and unhealthy food

choices.

Target/Outcome Indicator: The members of The Lennon Center

will demonstrate healthy food choices by listing healthy and sometimes food

on paper by at least 95%.

Discuss healthy eating and

snacking choices for both adults and babies.

Healthy tooth and decayed tooth

with food stickers

Discuss healthy alternatives to

sugary beverages in bottles and sippy cups

Conduct activity demonstrating

amount of sugar in popular drink choices

Objective #2 Behavior: By the Evaluation Measure: Show video form Colgate: “How

Amber Fredericks HYGDCE 485 Spring/Summer 2013 end of the program the mothers will be able to

demonstrate effective brushing

and flossing for adult and

infant/child oral health.

At the end of the program, members of the Lennon Center will be asked to

demonstrate effective brushing and

technique on typodont with adult

toothbrush, child and infant

toothbrushes.

Target/Outcome Indicator: 90% of members will be able to

demonstrate effective brushing on the typodont for adults, children and

infant.

to Brush and Floss”

Typodont will be used as a visual

aid to demonstrate brushing and flossing to members of The

Lennon Center

Use typodont to have members of The Lennon Center practice

and demonstrate effective brushing and flossing.

Brochures on child oral health

will be distributed.

Objective #3 Process: By The

end of the program, the members of The Lennon Center

will attend an oral health educational session.

Evaluation Measure:

The members will use a sign in sheet to verify attendance.

Target/Outcome Indicator: 95% of the members at the Lennon

Center will have attended an oral health sessions.

Brochures will be distributed on

periodontal disease and child oral health.

Print outs on the oral/systemic link will be distributed.

An activity including a drawing of

a person’s body with systematic functions that can be affected by

periodontal disease included, will demonstrate who periodontal disease can affect the body if

untreated.

Program Plan Narrative

Objective 1: Nutrition and Oral Health

With dental decay being one of the most common diseases among children it is important for

parents to make nutritional choices and lower their caries risk factors for both mothers and children.

Discussing healthy eating and snacking choices for both mothers and children can help reduce the caries

risk rate by minimizing food that contain higher amounts of sugar. The activity that will work best to

demonstrate healthy and unhealthy foods and snacking will be the use of having two tooth images; one

being healthy, one being decayed. Stickers containing healthy food and sugary foods will be used to

demonstrate which foods promote cavities and which foods are healthier choices for snacking.

Another risk factor for dental caries is sugary beverages in bottles and sippy cups. Providing

information on reducing sugary beverages in bottles and sippy cups can increase chances of reduced

decay in infants and children. An activity will be conducted showing the amount of sugar in popular

drink choices. This will provide information to the parents on how much sugar their child is drinking with

Amber Fredericks HYGDCE 485 Spring/Summer 2013 every bottle and/or sippy cup. When selecting popular drink choices for children, sugar content in drinks

such as juice, is often overlooked.

Objective 2: Dental Plaque and Oral Health

Dental plaque is the filmy deposit on the surface of teeth containing bacteria and others

substances.7 Dental plaque along is acid and sugar contributes to the caries process. Providing oral

health information on removing dental plaque daily with effective brushing and flossing can decrease

the caries process. Demonstrating the Bass method for adults and Fones for children can teach the

members of The Lennon Center proper brushing techniques. The Bass method is an effective method

for removal of dental plaque adjacent to and directly beneath the gingival margin.18 The Fones method

of brushing is an easy to learn technique for young children.18

The Colgate videos; “How to Brush and Floss” will be helpful as visual aids along with

demonstration and hands on learning with the typodont. Showing the videos before demonstrating

brushing on the typodont will engage in the “show-tell-do”. After demonstration, the members of the

Lennon Center will be able to demonstrate proper brushing and flossing methods.

Objective 3: Oral/Systemic Link

Periodontal disease is a risk factor for preterm and low-birth weight babies.19 Gingival

inflammation changes occur during pregnancy are considered to be an exaggerated response of dental

plaque.19 By having the members of the Lennon Center list any information pertaining to oral health

such as, amount of brushing and flossing performed daily can determine what level of education they

understand about oral health. Providing brochures on periodontal disease and child oral health will be

useful for take home material after the session is over. Having the body picture up with different

systemic links and educating the members of The Lennon Center on how periodontal disease can affect

Amber Fredericks HYGDCE 485 Spring/Summer 2013 systemically will be eye opening. The members of the Lennon Center will be using a sign in sheet at each

oral health education session each time to evaluate attendance.

Amber Fredericks HYGDCE 485 Spring/Summer 2013

References

1. Schultz, Elizabeth (Executive director of The Lennon Center, Dearborn Heights, MI). Conversation with

Amber Fredericks (E-learning degree completion student, University of Michigan, School of Dentistry,

Ann Arbor, MI). 2013 May 21.

2. Michigan demographics [internet]. Cubit; c2013. Get michian demographics; [cited 2013 Jun 17]; [

about 2 screens]. Available from: http://www.michigan-demographics.com/

3. CDC: Centers for disease control and prevention [internet]. Atlanta (GA): National center for health

statistics. Births and natality (data for the U.S.); [updated 2013 Jan 18; cited 2013 May 20]. Available

from: http://www.cdc.gov/nchs/fastats/births.htm

4. Women’s health: empowering women to live healthier lives [internet]. Washington (DC): U.S.

Department of Health and Human Services. Pregnancy; 2010 Sep 27 [cited 2013 May 28]; [about 2

screens]. Available from: http://www.womenshealth.gov/pregnancy/you-are-pregnant/stages-of-

pregnancy.html

5. Planned parenthood [internet]. New York (NY): c2013. How pregnancy happens [cited 2013 May 20];

[about 3 screens]. Available from: http://www.plannedparenthood.org/health-topics/pregnancy/how-

pregnancy-happens-4252.htm

6. AAP: Academy of periodontology [Internet]. Chicago (IL): Types of gum disease. [cited 2013 May 21];

[about 2 screens] Available from: http://www.perio.org/consumer/types-gum-disease.html

7. Wilkins EM. Clinical practice of the dental hygienist. 10th ed. Baltimore: Lippincott Williams & Wilkins;

2009. Chapter 4, Infection control: clinical procedure; p.67-84.

8. AAP: Academy of periodontology [internet] Chicago (IL): Gum disease risk factors. [cited 2013 May

21]; [about 2 screens] Available from: http://www.perio.org/consumer/risk-factors

9. National institute of dental and craniofacial research [internet]. Bethesda (MD); National institute of

dental and craniofacial research; c2012. Periodontal (gum) disease causes, symptoms, and treatments;

2012 Oct 02 [cited 2013 May 21]; [about 2 screens] Available from:

http://www.nidcr.nih.gov/nidcr2.nih.gov/Templates/CommonPage.aspx?NRMODE=Published&NRNODE

GUID=%7bCE246689-D899-4CC7-B68A-

805AD910F4E7%7d&NRORIGINALURL=%2fOralHealth%2fTopics%2fGumDiseases%2fPeriodontalGumDis

ease%2ehtm&NRCACHEHINT=Guest#periodontitis

10. AAP: Academy of periodontology [internet]. Chicago (IL): Gum disease symptoms. [cited 2013 May

21]; [about 2 screens] Available from: http://www.perio.org/consumer/gum-disease-symptoms.htm

Amber Fredericks HYGDCE 485 Spring/Summer 2013 11. CDC: Centers for disease control and prevention [internet]. Atlanta (GA): Periodontal disease; 2011

Dec 15 [cited 2013 May 21]; [about 2 screens] Available from:

http://www.cdc.gov/oralhealth/topics/periodontal_disease.htm

12. AAP: Academy of periodontology [internet]. Chicago (IL): Gum disease and women. [cited 2013 May

21];[about 2 screens] Available from: http://www.perio.org/consumer/women.htm

13. Sleeper L, Strubinger C. Treat teething pain safely. Dimens Dent Hyg.2013;11(2):30-2.

14. Larsen C, Daronch M, Moursi A. Caries prevention in kids: the systemic use of fluoride provides many

benefits in reducing tooth decay. Dimens Dent Hyg. 2012;11(2):34-7.

15. AAPD: American academy of pediatric dentistry [Internet]. Chicago (IL): American Academy of

Pediatric Dentsitry; Fast Facts; 2012. [cited 2013 May 26];[about 4 screens]. Available from:

http://www.aapd.org/assets/1/7/FastFacts.pdf#xml=http://pr-

dtsearch001.americaneagle.com/service/search.asp?cmd=pdfhits&DocId=456&Index=F%3a%5cdtSearc

h%5caapd%2eorg&HitCount=10&hits=272+1ae6+1b15+1baf+1d10+1dbb+2e27+2e3b+3243+340b+&hc=

134&req=bacteria+transfer+from+mom

16. Healthy people [Internet]. Washington (DC): U.S. Department of health and human services; c2013.

Oral health objectives; 2013 Apr 10 [cited 2013 Jun 1]; [about 4 screens]. Available from:

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=32.

17. Healthy people [internet]. Washing (DC): U.S. Department of health and human services; c2013.

Maternal, infant, and child health objectives; 2013 Apr 10 [cited 2013 Jun 10]; [about 5 screens].

Available from:

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26

18. Wilkins EM. Clinical practice of the dental hygienist. 10th ed. Baltimore: Lippincott Williams &

Wilkins; 2009. Chapter 25, Oral infection control: toothbrushes and toothbrushing; p.406-27.

19. Wilkins EM. Clinical practice of the dental hygienist. 10th ed. Baltimore: Lippincott Williams &

Wilkins; 2009. Chapter 45, The pregnant patient; p.766-75.

Amber Fredericks HYGDCE 485 Spring/Summer 2013

Project Timeline: Community I

Activities May 8th-May 14th

May 15th-May 21st

May 22nd-May 28th

May 29th-June 4th

June 5th-June 11th

June 12th-June 18th

June 19th-June 25th

Assessment Submit Memorandum of Understanding

*

Investigate public health resources

*****

Identify Key Individuals

*****

Construct Asset Map

*****

On-site Agency Visit

*****

Research community and develop community profile/needs assessment

***** *****

Develop community plan goal

*****

Planning Develop program plan and narrative

*****

Determine objectives and establish outcome measures

*****

Investigate funding sources

***** ***** *****

Develop project timeline

*****

Amber Fredericks HYGDCE 485 Spring/Summer 2013

Create program budget

*****

Provide program plan to agency for review

******

Secure signed Field Placement Agreement

*****

Collect all surveys used to interpret data

*****

Project Timeline: Prior to Plan Implementation

Activities June 26th-July 2nd

July 3rd-July 9th

July 10th-July 16th

July 17th-July 23rd

July 24th-July 30th

July 31st-Aug 13th

Aug 14th-Aug 20th

Planning

Continue seeking funding

***** ***** ***** ***** *****

Create pre and post tests

*****

Create healthy tooth and decayed tooth with different foods and drinks

*****

Gather popular sugary beverages with sugar amount

*****

Structure *****

Amber Fredericks HYGDCE 485 Spring/Summer 2013

Colgate’s videos for easy presentation

Copy all needed materials

*****

Order items from NIH

*****

Assemble oral health kits

*****

Contact agency to confirm dates

*****

Project Timeline: Community II

Activities Sept 4th-Sept 10th

Sept 11th-Sept 17th

Sept 18th-Sept 24th

Sept 25th-Oct 1st

Oct 2nd- Oct 8th

Oct 9th- Oct 15th

Oct 16th-Oct 22nd

Implementation

Meet members- build rapport

***** *****

Hand-out class flyers

*****

Two 60 minute presentations: Objective 1- Nutrition and Oral Health

*****

Two 60 minute presentations: Objective 2- Dental Plaque and Oral Health

*****

Two 60 minute presentations: Objective 3- Oral/Systemic

*****

Amber Fredericks HYGDCE 485 Spring/Summer 2013

Link

Closing celebration and thanks

*****

Meet with Elizabeth, Mariann and Katherine to share program results

*****

Evaluation Evaluate the lists of healthy food and sometimes food

*****

Evaluate brushing and flossing effectiveness

*****

Evaluate list factors for improving oral health

*****

Evaluate attendance sheets

*****