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Rationale Paper- Dental Care

Anna Patterson, Sean MacLeish, and Brock Williams

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Health is the most important part of anyone’s life, without it there is a lack of quality of life

that allows people to do anything else they desire. Currently, dental health is a rising problem,

especially among low-income and rural families. Within these communities, one of the biggest

problem with oral care is among children. One in five children have some type of tooth decay

and is a chronic problem (Healthy People, 2017). Once tooth material is gone, it cannot be

recovered, and with tooth decay beginning at such young ages, children are setup to experience

decreased quality of life before they can even begin to know the meaning of life. Helping Smiles

is our nonprofit program that will assist children and adults with dental hygiene before they

begin to experience the costs of poor oral care.

Dental hygiene refers to the care of the mouth, teeth, and craniofacial structures and is

needed to maintain the ability and comfort of speech, smiling, tasting, chewing, swallowing, and

emotional expression (Healthy People, 2017). Unfortunately, dental care is becoming an

increasing problem, especially among children as 20% have tooth decay and 33% have some

type of sealant (Healthy People, 2017). Also, oral cancer is being diagnosed in 35,000 Americans

each year. Some individual consequences of poor dental hygiene, besides cancer, are bad breath,

cavities, tooth decay, and disease (Healthy People, 2017). These consequences are due in part to

individual behaviors but are also impacted by the community, such as geographic area and

accessibility, average income, and the cost of insurance and medical procedures (Healthy People,

2017). The goal of Healthy People 2020 is to “prevent and control oral and craniofacial disease,

conditions, and injuries and improve access to dental care” (Healthy People, 2017). Some

influences that are already in place are fluoridation in public water, increasing the awareness of

the problem, and school programs for children (Healthy People, 2017).
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Programs are needed to help resolve the mainstream problem of poor dental care among

low-income and rural families. Helping Smiles will help give knowledge to those families about

how they can receive health benefits with the opportunity to receive dental care from

professionals that can also give them advice on how to take care of their oral health. Our

program will impact the community and individuals and try to alleviate the cost of poor dental

health on them.

Low-income and rural communities need Helping Smiles in their areas because it can

help with educating children on overall health and specifically how poor dental hygiene can

affect them. There are studies that conclude that the more knowledge people have on dental

hygiene, the more they practice oral care and overall healthy habits (Al-Darwish, 2016). If

people are not able to take care of their own health, they may not be educating youth on proper

hygiene, or setting good examples of proper dental hygiene.. One of the community costs of poor

oral hygiene is that children are not getting the education they need and that they will also not

participate in healthy oral care habits. In study done in Qatar, the knowledge on oral health was

below satisfactory, creating an increased number of children that were unaware of proper dental

hygiene practices (Al-Darwish, 2016). Parents in Qatar had the strongest influence on their

children and their oral care habits (Al-Darwish, 2016). Until a program comes and educates

them, children will continue to have poor dental hygiene and an unfortunate pattern of lack of

awareness will continue from generation to generation.

Lack of knowledge in communities affects the dental care of people in low-income and

rural populations, but poor dental hygiene can also lead to negative individual costs that can

further decrease health. As mentioned earlier, one effect of poor dental care are caries or cavities.

Caries are small holes in the teeth that are caused by the buildup of plaque due to not removing
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food particles for substantial periods of time (MedlinePlus, 2017). When cavities continue to

form and plaque is not removed, tooth decay begins (MedlinePlus, 2017). Children and young

adults are prime candidates for caries and tooth decay, where children with cavities experience a

lower oral hygiene related quality of life than those without caries. (Martins, 2017; MedlinePlus,

2017). Helping Smiles can help resolve caries as children and other patients can come to get

professional advice and shop at decreased prices for dental care products.

Another individual cost associated with poor dental hygiene is oral cancer, which

includes squamous cell carcinoma, verrucous carcinoma, minor salivary gland carcinomas,

lymphomas, oropharyngeal tumors, leukoplakia, and erythroplakia (Cancer Center Treatments of

America, 2017). Cancer is an uncontrollable growth of cells that causes damage to the

surrounding tissues, and with oral cancer, some signs and symptoms are sores or eroded areas

that do not go away, unexplained bleeding or numbness, difficulty chewing and swallowing, ear

pain, and teeth changes (WebMD, 2005-17). There was a study done on sixty patients that

wanted to tie the relationship between poor oral hygiene and oral cancer (Oji, 2012). The

conclusion suggests that infrequent tooth brushing is associated with primary oral cancer and

frequent tooth brushing led to a healthy status (Oji, 2012). Creating healthy brushing habits is

important to overall health and these habits need to be created when children are young so that

the habit is formed and continues throughout life. Low income and rural families do not always

have the means to have great habits; however, children are great targets for reiterating the

importance of oral hygiene as caries are “2.4 fold higher in children living 100% below the

federal poverty level” (Biordi, 2015). Helping Smiles will be able to help to educate those

children on the benefits of proper oral hygiene, to try and reduce their risk of cancer in the future.
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A third individual cost of poor oral hygiene is cardiovascular events, especially coronary

artery disease. Individuals with a history of periodontal disease and/or tooth loss were at a higher

risk for peripheral artery disease (Rostami, 2016). This disease is caused by infection and

inflammation which leads to cardiovascular events (Rostami, 2016). Cardiovascular problems

can be caused by periodontitis which is due to inflammation, bacteria growth, and it destroys

connective tissues and the supporting bone and teeth (Rostami, 2016). All of these problems lead

back to poor oral hygiene. Cardiovascular disease account for about 75% of death worldwide,

which is a major concern among low and middle-income families. If families are not able to get

access to important doctor’s appointments when they have a possible cardiac problem, they are

probably not worried about searching for dental hygiene, which in turn could cause the cardiac

problems.

There are many determinants of health that play a role in contributing to poor dental

hygiene among low income and rural communities, whether it comes from a social, individual,

or environmental aspect. Certain determinants however, are placed at higher levels of focus for

intervention. Some major determinants of health surrounding this issue include socioeconomic

status, education, accessibility, and availability.

Having a healthy oral hygiene status contributes to an overall health status for

individuals. Many researchers point out that oral hygiene affects a person’s health related quality

of life (Paula, 2012) and most people know that to have good oral health, the right toothbrush,

toothpaste, and mouthwash are needed along with regular dentist appointments and watching the

type of food and drinks that are consumed. Unfortunately, families of low socioeconomic status

that do not see a great amount of income cannot always pay to have all the proper necessities for

healthy oral hygiene. People that go to the dentist either go annually or biannually and with the
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price of a standard dental cleaning costing about $75 to $200 a visit, a family of four would pay

anywhere from $300 to $1600 a year, depending on how much a visit is and how many times

they go a year (Authority Dental, 2017). People of low socioeconomic status are not going to be

able to afford to pay for dental cleanings, which puts them at a higher risk of developing dental

hygiene problems.

Another determinant of health that contributes to poor dental hygiene is low education

levels. A study was done in London on a group of 65-year old’s that had low education levels

that assessed education level on oral health related quality of life (Tsakos, 2009). The study

found that 30.6% of the individuals had a lower oral health related quality of life with

contributing factors being eating discomfort and appearance (Tsakos, 2009). The London study

shows how education level can affect oral hygiene even when socioeconomic status is not a

factor (Tsakos, 2009). When in school and becoming educated, people learn how to take care of

their health, whether it is talking to educators specifically about oral health or if health class is a

mandatory unit in the classroom. Being educated on dental hygiene, even when it is only the

minimum amount of care, is helpful to dental health as individuals become aware of how poor

dental hygiene can affect their overall health status.

Decreased access to proper dental hygiene needs is a third determinant of health that

leads to poor dental hygiene. Having access to health care is a vital part of maintaining a healthy

life, where accessibility is the ability to have access to appropriate health care, in a timely

manner to achieve the best possible outcome (Rural Health Information Hub, 2017). Ideally,

individuals should be able to access all parts of the health care system, including primary care,

dental care, behavioral health, emergency care, and public health services (Rural Health

Information Hub, 2017). People in rural communities are not always able to have easy access to
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the health care, especially dental care, due to poor finances, lack of transportation, and

confidence to in speaking to a health care physician (Rural Health Information Hub, 2017). For

accessibility, transportation is the largest barrier because people in rural communities are usually

further away in distance to other parts of society and if they do not have a way of traveling to the

nearest dentist or store to buy dental cleaning tools, then they do not receive those services or

products which can lead to decreased oral health.

A final major determinant of health that affects rural and low-income families is

availability to dental hygiene products and services. As of 2015, there is a national shortage of

about 7,300 dentists in the United States of America, where there are 60.9 dentists for every

100,000 people (Munson, 2016). This number translates into there being about 1,642 people per

dentist (Munson, 2016). This is unfortunate, especially to families who live in a rural

community, as they will have a more a difficult time trying to find a dentist that is close enough

to them to visit on an annual or biannual basis. For low income families, this is also tragic

because with an increased demand for dentists, the price for services will also increase, which

means they will have a harder time affording the care. Oral health products are more easily

available to low income and rural families if they can access the products. This is where are

program starts to help those who are rural or low-income families. We will try to decrease the

effects of the determinants of health on dental hygiene.

Dental hygiene is a necessity to a healthy lifestyle. Our program for low income rural

areas will be the implementation of a market combined with a check-up center. “Helping Smiles”

will be a non-profit organization that with the help of volunteers and dentists can give low

income and rural families proper dental care and education on how to have good dental hygiene.

The layout of the building will be like that of a CVS where the market part is the shop where
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toothbrushes, floss, among other dental care items will be available for low and affordable

prices. Where the pharmacy part of the building is, will be the check-up center. A volunteer

dentist could come in once a week or so to help with cleanings, and give information and advice

to the families and volunteers working at “Helping Smiles”. Local college students studying

dentistry or to become a dental assistant could work here and gain experience and skills needed

for their possible career path.

A strong barrier to efficient dental hygiene in everyone is lack of oral care knowledge

and as that knowledge increases among low income, rural families, the dental hygiene will

increase as well. We will teach these families and people about proper dental care through the

volunteer dentists holding seminars as well as educating the workers ahead of time so when they

perform check-ups, they can inform the families as well. Our program and market are like the

Children’s Healthy Smile Project founded out of Pleasanton, California whose main goal is to

“improve Children's oral hygiene and promote a healthy smile by providing oral hygiene

supplies such as toothbrushes, toothpaste, floss and educational materials to children in need”

(Children’s Healthy Smile Project, 2008). This non-profit creates Smile Kits which are

essentially bags that have toothbrushes, toothpaste, and floss in them as well as educational

materials that teach children to have good oral hygiene habits. A more recent program that is

fighting pediatric dental disease, or tooth decay, is America’s Toothfairy from the National

Children’s Oral Health Foundation founded in 2016. America’s Toothfairy strives to increase

access to oral health care and improve oral health literacy. Helping Smiles is similar to our

program because we are making it our goal to educate low income rural families and give them

the tools they need to improve their oral hygiene. Just as America’s Toothfairy works to stock
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dental clinics with proper dental supplies, we want to give these low income rural families the

option to purchase reduced priced efficient dental tools.

This program is practical because we will create an opportunity for these families to

change their oral health for the better and not for extreme costs. Some barriers for Helping

Smiles will be the placement of the building since the target audience is rural families where

people are dispersed. As long as the building is centrally located and near other businesses where

these families shop or eat, it will be accessible. If these families cannot find transportation to

Helping Smiles, we could arrange the basic necessities like tooth floss, toothbrushes, and

informative reading for children and adults alike and put them in small packages that could go

home with kids at school. Finding volunteers to work at Helping Smiles will be another barrier to

the program but increased awareness to the issue in the community will inspire a work ethic that

will drive these low-income populations to end the issue. With proper fundraising and awareness

from the dental hygiene community, we can work to educate people suffering from bad dental

hygiene, especially children. We would also be able to teach these families about how essential

oral health is to overall health.

The lack of dental hygiene in our countries low-income and rural populations is a serious

issue that needs to be addressed. When twenty percent of our children have tooth decay, we

should observe that something needs to be done to change tract of oral health. Helping Smiles

gives these families a chance to improve their oral health dramatically and give our nation’s

youth the correct information and teach proper habits on how to take care of their teeth.
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