Dental Health Edu Assessment

DENTAL HEALTH EDUCATION ASSESSMENT IN CORTLAND COUNTY 1
Dental Health Education Assessment in Cortland County
Kristen Basden
State University of New York at Cortland

Introduction
In areas of low income, limited access to healthcare and unequal geographic
distribution of healthcare practices, citizens are often left without care. This results in
untreated patients, which leads to other health complications. Untreated citizens are
also subject to pain or discomfort, days missed of work or school, and long term
consequences. Citizens that do not receive preventative measures, like screenings,
routine check-ups, and vaccinations, can become more ill with complex conditions that
could have been prevented.
The primary causes of poor oral health are a lack of preventative dental care,
lack of fluoride, lack of oral health education, and an unbalanced diet (World Health
Organization, 2012). In addition to a person’s general health being affected by poor oral
health because of limited dental access, the person’s quality of life is also negatively
affected. Problems like being embarrassed, feeling tense, problems speaking,
interrupted meals, and difficulty relaxing are among the aspects of life that are affected
by dental health issues (Crocombe, Mahoney, Spencer & Waller, 2013, p. 192). These
are issues that can interrupt the everyday life, happiness, and comfort of a person, but
are easily preventable with proper oral health education and care.
Not having access to dental care causes problems that begin in childhood and
can follow these individuals throughout their lives. In children, unnecessary oral pain
causes low self-esteem from low self-image or confidence, missed school days and less
involvement in school (Simmer-Beck, et al., 2015, p.1764). When these problems
continue to their adult lives, poor oral health can lead to other health problems such as

diabetes, and the leading cause of death in the U.S., heart disease (Simmer-Beck, et
al., 2015, p. 1763). Bacteria found in oral cavities can reach the heart through the
bloodstream, which leads to a heart infection, then heart disease (Ritter & Southerland,
200, p. 233). Other issues include inability to find a job, as well as even higher dental
bills because of greater damage done to the teeth from not being treated.
Over 50% of third grade children in Cortland County have had an experience with
cavities, and three out of five adults have had a permanent tooth extracted due to gum
disease or tooth decay (Seven Valleys Health Coalition, 2013). The number of
untreated cavities in Cortland County is over 6% higher than in New York State. In
general, the United States lacks mid-level dental providers needed to expand access to
dental care (Simmer-Beck, et al., 2015, p. 1763).15% of the Cortland County population
lives below the poverty line, and the median household income is over six thousand
dollars under the national average (Seven Valleys Health Coalition, 2013).
Socioeconomic factors of Cortland County restrict many people who receive public
health insurance from going to the dentist. There is a barrier between private dentistry
work and public dentistry insurance plans, which often leaves a large gap for people in
communities of low income that do not receive adequate dental care. Most private
dentists do not accept public insurance; in fact, most do not participate in any insurance
programs. Currently, in Cortland, for every 2,783 citizens there is one dentist, whereas
nationally, there is one dentist for every 1,586 citizens (Seven Valleys Health Coalition,
2013). This overcrowds dentist offices, making their accepted insurance options more
exclusive.

Seven Valleys Health Coalition (SVHC) and the Cortland County Health
Department lead the initiative called Cavity Free Cortland (CFC). CFC is divided into
three subcommittees: dental education, fluoride varnish, and fluoridation. Acting as
public advocates and community leaders, the members of CFC support community
water fluoridation (CWF) and are working towards getting fluoride regulated into
Cortland’s water supply. The varnish subcommittee is organizing to get varnish
treatments (a highly concentrated, topical form of fluoride) applied in primary care
offices to ensure the children of Cortland are being reached.
The most cost effective and efficient preventative measure for oral health is
obtaining fluoride via optimally fluoridated water supply, the Fluoride-Varnish Program
and dental education. A fluoridated water supply ensures the population is receiving an
adequate amount of fluoride in their water regardless of socioeconomic status, income
level, education level or dental health access. Adding fluoride to a community water
supply is beneficial for all, being that fluoride prevents tooth decay and cavities (Murthy,
2015).
The dental education subcommittee compiles different ways to reach the citizens
of Cortland County to educate them on oral health. This subcommittee informs people
on a number of topics, including why fluoride is essential to oral health. The education
subcommittee looks for gaps in oral health knowledge and looks to fulfill them through
community outreach. The dental education is aimed towards adults with children, which
indirectly educates the children, and improves oral health. The education subcommittee
also educates about CWF.
Purpose

This project’s purpose was to identify the areas regarding dental health that need
to be implemented in public education, to promote lifestyle changes, and to improve the
overall health of Cortland citizens. This information helped to identify where future oral
health education efforts will be steered. The selection of this project was based on what
is needed in the community to improve health, as well as quality of life here in Cortland.
CFC has identified three subcommittees that were voted on based on highest needs,
which are not only present locally, but statewide and nationally. The goals of this project
are also incorporated into the New York State Prevention Agenda, and Healthy People
2020. By understanding the knowledge level of oral education in the community,
education can be expanded and tailored to what knowledge gaps are identified. This
project helped to continue and extend the efforts of SVHC, and ultimately CFC.
Data collection is being done through a parental survey, built off a tool that CFC
has used and has proven to be effective based on previous data collection (see
Appendix 1). The information obtained helped assess the educational needs of the
community and determine what type of education needs to happen in the future. Based
on prior survey results, results were expected to show that
 Some citizens are Without a dentist, some children are being taken to the dentist
more than twice a year (shows dental problems).
 Some children are not being taken to the dentist enough (twice a year).
 Some children are only being taken to the dentist for emergencies.
 The majority of adults with children are in support of CWF in Cortland County.
SVHC has benefitted from this project in many ways. This project aligns with the
mission and goals of Seven Valleys Health Coalition by advancing the health and well-

being of the citizens of Cortland, through coordinated efforts. By improving the health
outcomes for people in the Cortland community, SVHC adds great value to the
community. This project provided information that can be used to move forward with the
work that is already being done, and helping guide where to go next. I benefitted from
this project with improved data collection and analysis skills, giving me an insight on
working with a rural community, becoming more familiar with the needs assessment
process, and the ability to look at specific problem areas and identifying realistic and
feasible solutions. Never having worked in a rural community before, this project
increased my awareness as a health professional of rural living and understanding the
barriers and limitations. Using SVHC’s resources, my knowledge in surveying collection
and data, as well as needs assessment has made me a more efficient health
professional.
Based on the survey that was distributed, the social-ecological model is relevant,
being that the oral health of the people surveyed is intrapersonal, interpersonal, and
also directly related to community and public policy aspects. Socioeconomic limitations,
knowledge and skills are intrapersonal aspects of one's oral health, whereas location
and environment, and available educational programs are aspects of the community
that also affect oral health.
This project is fully evidence based. There have been numerous studies
conducted on dental caries and oral health disparities, and it is proven that community
water fluoridation (CWF) reduces dental caries among socioeconomic groups
(McDonough, et al., 2000, p. xii). Combined evidence from numerous studies shows
that in areas where there is fluoride in the water, caries are over 15% less than in areas

without fluoridated water (McDonough, et al., 2000, p. 21). The survey touched on the
support and opposition of fluoride, which is a very important aspect of CFC, and
Cortland in general. CWF is important to Cortland because lack of access to dental care
is a large problem. CWF would reduce cavities among the population, thus improving
health and quality of life. CWF is important for children because it eliminates
socioeconomic limitations.
Methods
Information was used collecting surveys administered online, through a given
website link, and paper surveys. A website link was used as much as possible because
not only is it easy to reach people, and reduces under or over-reporting. The paper
surveys were used for people who might not have had access to the internet; Head
Start and Early Head Start parents, as well as parents attending Kidsville, a health fair
targeting preschool children in Cortland. They were given a clip board and cover page
explaining anonymity and option to opt-out of questions they did not feel comfortable
asking, and privacy. These were steps to cut back on any bias that could have existed.
The lack of consistency and truthfulness can be the result of stigmas or embarrassment
of the person taking the survey, compelling them to record what they think is the
healthier answer. With the barriers that exist in Cortland County related to oral health,
this could be an issue, therefore, an online survey also gave the citizens the anonymity
they need to cut back any bias that may exist. The sample was residents in or around
Cortland, with children. Qualitative and quantitative information was collected.
Questions included, “How often do you take your child to the dentist?”, “Does your child
brush every day?”, and “Would you be in favor of having Fluoride in your public water

supply?”. In addition to these questions, the questions on my survey measured the
parent’s oral health knowledge and skills, as well as the child’s dental health skills. Data
was collected between March 21st and April 22nd, so there was enough time to
organize and analyze final results. See Appendix A.
Results and Analysis
Graph A.
Graph A shows perceptions of oral health importance of the parents in Cortland. The
perception of the parent’s teeth was a little higher than for their children.
Graph B.
0
5
10
15
20
25
30
35
My child's teeth are important to
their overall health
Regular checkups keep my
child's teeth healthy
Taking care of my teeth is
important to me
#ofpeople
Selected opinions
Strongly disagree Agree Strongly agree

Graph B shows the frequencies of which parents surveyed are taking their children to
the dentist. The majority of parents replied they take their child twice a year to receive
dental work, which is the recommended practice. Some parents reported they took their
child to the dentist over twice a year, which indicates dental problems that required
more professional care.
Graph C.
0
5
10
15
20
25
30
35
< Once a year Once a year Twice a year >Twice a year
Frequency of children'sdental visits
Strongly
disagree-
62.5%
Disagree-
30%
Agree- 7.5%
I only take my child to the dentist for an emergency
visit

Graph C shows the perceptions of parents based on the statement “I only take my child
to the dentist for an emergency visit”. While most disagreed, a few did admit they
agreed with that statement.
Graph D.
Graph D shows questions that were selected to compare different aspects of the child’s
oral health. 9.3% of parents said their child doesn’t go to the dentist, and 4.8% of
children don’t brush their teeth daily. Even though a majority of the surveyed parents
take their child to the dentist and brush, there was still over 14% that have had a cavity
in the past 5 months. This shows a need for an intervention.
Graph E.
0
5
10
15
20
25
30
35
40
45
Does your child go to the
dentist?
Does your child brush every
day?
In the past 5 months, has
your child had a cavity?
Selected questions
Yes
No

Wouldyou be in favor of having fluoride inyour public
water supply?
Yes
No
Graph E shows the distribution of opinion when survey takers were prompted with the
question “Would you be in favor of having fluoride in your public water supply?” 19
people said “yes,” 17 people replied “no,” and 7 respondents skipped the question.
Table A.
Opinions
-My kids are tweens so I don’t help them brush. They do floss, but not regularly
-The dentist won’t see her until she is 3
-We use a well (well water)
-I took my child to Elite Dental in Cortland 1 ½ years ago and was told that he had
cavities that needed to be filled right away but would not show me or take x-rays. He
now sees a dentist from Fayetteville Pediatric Dentistry and has never had a cavity.
Elite Dental attempted to scam me at the cost of a child’s mouth
-Has first dental appointment July 6th

Table A shows the opinions of parents who chose to respond that were prompted with
an open opinion section.
Discussion
Graph A shows most of the parents that took the survey do believe oral health is
important to their child’s overall health, regular checkups help in keeping their child’s
teeth healthy, and taking care of their own teeth is important. These data show that
parents in and around Cortland do think that healthcare is an important health
component for their child and themselves. It can be inferred that this shows the problem
is not in the perceived susceptibility, but perhaps cues to action in completing the
behavior.
Graph B shows the majority of parents take their children to the dentist twice a
year, but some are going more than twice a year, which indicated extra dental work
being done. Therefore, education could be directed towards why taking your child to the
dentist twice a year is important. There needs to be a change of behavior using
interpersonal values.
Graph C shows most parents think children should be taken to the dentist more
frequently than emergencies, but 7.5% of parents said they only take their child for an
emergency visit. This is important because it indicates the need for education on two
things; why children need to be seen by a dentist regularly, and behavioral changes to
improve their child’s oral health. Graphs B and C indicate some parents are not
regularly taking their children to the dentist, which will lead to poor oral health for their
children in the future.

Graph D shows most parents are taking their kids to the dentist and most are
brushing daily. The data shows even though most kids are brushing and seeing a
dentist, there are a higher percentage of children with cavities, than those that reported
not brushing or seeing a dentist. Even though some of the kids are doing what they
should be in regards to oral health, they still have cavities. If the data showed the
number of reported children not seeing a dentist or not bushing matched the number of
children with cavities there could be a conclusion that the cavities might only be
happening to those children, but the data shows it is more than just that group of
children. This is an area where we can see where CWF would make a difference.
Graph E is an opinionated question about supporting or opposing CWF, with a
slight majority in support of CWF. This indicates a need for education because cavities
are showing in children who are brushing and seeing a dentist regularly. There were 19
people in favor of CWF and 17 opposing CWF. Education on CWF, and how CWF will
benefit the community is especially important in keeping children’s teeth strong again
cavities by taking another preventive step. Community education and public policy
(Social Ecological Model) of fluoride can help parents understand that with fluoride in
the water, their children are being protected in an effortless way. By doing this, quality of
life would increase because of the potential for less oral problems in the future. This is
also related to Graph C, for parents who only take their child to the dentist for
emergencies, this would benefit them by having a preventive measure in the water they
drink.
Table A is an open ended response, to which parents could write anything they
wanted while taking this survey. The comment that stands out to me is about the child

who went to Elite Dental and experienced issues. This is important because perhaps
there is a mistrust of dental providers in the community, which can be a barrier for not
wanting to see a dentist. This parent now distrusts the dentists in Cortland, so perhaps
other parents aren’t taking their kids to the dentist, which can be seen in graphs B and
D. This is an opportunity for intervention between the community and providers.
This project indicates that parents who took this survey are concerned about their
child’s teeth, and most are taking their children to the dentist regularly, but some are
only being taken for emergencies, and there is a high rate of cavities, despite regular
dental visits and brushing. An educational need in this community can be inferred to
show need of the importance of taking children to the dentist, how CWF can help their
family’s teeth, and doing something about the possible mistrust between providers and
consumers.
A problem that I experienced while conducting surveys at Kidsville was a lot of
people couldn’t take the survey because they were a mentor to the child, not the parent.
Kidsville also changed locations to a less populated area that may present
transportation barriers for the community, so there was not as much of a turnout as
what was expected based off of previous years. To combat lower attendance, I posted
the survey to SVHC’s Facebook page and I was able to get more input in that way.
Another problem I experienced was my sample population. Surveys went to Head Start,
Kidsville, and online, so the parents that I was able to reach were actively engaging with
their kids, or their kid’s school, or had access to an online survey, therefore I would
have liked a more diverse sample. Input that could have been nice to have is parents of
children who perhaps don’t have online access, and parents (for whatever reason) are

not as involved because this perhaps would have shown a different take on oral health
in the Cortland community.
Recommendations and Reflections
Based on the findings of this project, I think SVHC should continue to educate on
CWF as the most cost effective preventable measure for improving oral health, find
ways to improve the dentist community relationships, and continue to educate on why
children need to see a dentist. All three of these possible initiatives are relatable to the
work Cavity Free Cortland is currently doing. I would also recommend informational
materials and using word of mouth for education in the community, because we are
already aware that that is an efficient way to communicate to parents. I would also
recommend using places where families go (grocery stores, doctor’s offices, etc.) to
promote CWF to get parents informed about what it could do for their children’s oral
health. These educational ideas would promote a behavior change, better oral health
practice, which leads to better overall health, and a higher quality of life.
This was an engaging project for me to complete this semester, especially
because the work is very relevant to the things SVHC and CFC do daily. By gathering
more information for CFC to use after I am done here, they have more ideas about what
to do next and what future initiatives should be. I learned a lot about collecting data from
parents, sometimes it is easy and parents are willing and other times parents are
hesitant. I have never collected data from parents directly before so I now know how to
go about it. Another thing I learned is to find ways to get a diverse sample so the results
aren’t so narrow. I valued the way this project was set up. First was the proposal, which
I thought was very important because this could be a situation that I could find myself in

when I start my career. Starting off with a proposal, getting feedback and moving on
from there is something that could happen in the real world, so I valued the process as
a great, realistic practice. The rewarding part of this project was collecting the results
and knowing they will be used by CFC for future initiatives. The challenging part of this
project was working with some of the parents at Kidsville, because a lot said they didn’t
want to take the survey and brushed me off, when I know that it is important to the
community that things like this are done, so the people trying to help know what is
needed in the community.

Appendix A.
April, 2016
Parents or Guardians,
Seven Valleys Health Coalition (SVHC) is a non-profit agency here in
Cortland, NY, that works to improve the lives of people in the community. As one
of our many goals, we are working to improve oral health, and identify where we
should focus our efforts.
Attached is a voluntary survey about your dental health care perceptions. It
is our hope that you can find the time to take it. It should not take more than 10
minutes to complete. You do not need to put your name on the survey, it is
completely anonymous. The results may be published but will not identify you, or
your child, in any way. You may skip any question you do not feel comfortable
answering.
With your help we will better understand what steps we can take to
improve oral/dental health in Cortland. If you have any questions feel free to
contact us at 607-756-4198, or Kristen@sevenvalleyshealth.org. Thank you for your
help!
Sincerely,
Jacqueline Leaf, Executive Director
Seven Valleys Health Coalition

1. What town/village/citydoyoulive in? _________________________________________
2. Please checkyourage range:
 20>  20-30  31-40  41-50  51-65 65<
3. Do youhave a dentist?  Yes No
4. Doesyour childgoto the dentist?  Yes No
5. How oftendoyoutake yourchildto the dentist?
 Lessthan once a year  Once a year
 Twice a year  More than twice a year
6. Whenwas yourchild’slastdental visit?________________________________________
7. Do youhave dental insurance?  Yes No
8. Doesyour childhave dental insurance? Yes No
9. Is transportationaproblemfortakingyourchildto the dentist?
 Yes No
10. Do youhave trouble payingforyour child’sdental visits?
 Yes No
11. In the past 5 monthshas your childhadany dental problems?
Cavities:  Yes  No
Teethremoved:  Yes  No
Other(please specify): ______________________________________________________

12. Doesyour childbrusheveryday?  Yes No
13. Do youor yourchilduse dental floss?
You:  Yes  No
Your child:  Yes  No
Other(please specify): ______________________________________________________
14. Wouldyoube in favorof havingfluoride inyourpublicwatersupply?  Yes  No
15. Opinions:
Strongly
disagree
Disagree Agree Strongly
Agree
a. I onlytake my childtothe
dentistforan emergency
visit.
b. I helpmychildbrushat
leastonce a day.
c. My child’s teethare
importantto theiroverall
health.
d. My childisscaredto go to
the dentist.
e. Regulardental checkups
will helpkeepmychild’s
teethhealthy.
f. Takingcare of myteethis
importantto me.
16. Additional comments:
______________________________________________________________________________
______________________________________________________________________________

References
Crocombe, L., Mahoney, G., Spencer, A., & Waller, M. (2013). Will improving access to
dental care improve oral health related quality of life? Australian Dental Journal
58:2. 292-199.Retrieved from
http://libproxy.cortland.edu:2233/doi/10.1111/adj.12060/full
McDonagh, M., Whiting, P., Bradley, M., Cooper, J., Sutton, A., Chestnutt, I. . .
Kleijnen, J. (2000). A systematic review of water fluoridation. NHS Centre for
Reviews and Dissemination: 18. Retrieved from
http://www.nhs.uk/Conditions/Fluoride/Documents/crdreport18.pdf
Murthy, VH. (2015). Community water fluoridation: One of the CDC’s “10 great public
health achievements of the 20th century”. Public Health Reports 130. Retrieved
from
http://libproxy.cortland.edu:2106/ehost/pdfviewer/pdfviewer?vid=5&sid=e4d8da5
5-4de7-497b-9277-8d52069d0987%40sessionmgr4004&hid=4108
Ritter, A., & Southerland, J. (2007). Heart diseases and oral health. Talking with
Patients, 19. 233-234. Retrieved from
https://cortland.illiad.oclc.org/illiad/illiad.dll?Action=10&Form=75&Value=193527
Seven Valleys Health Coalition. (2013). Cortland Counts. Retrieved from
http://media.wix.com/ugd/f06d2c_751f91e1796a478ca36fb2a4196efb94.pdf

Simmer-Beck, M., Walker, M., Gadbury-Amyot, C., Liu, Y., Kelly, P., & Branson, B.
(2015). Effectiveness of an alternative dental workforce model on the oral health
of low-income children in a school-based setting. American Journal of Public
Health, 9.1763-1769. Retrieved from
http://libproxy.cortland.edu:2106/ehost/pdfviewer/pdfviewer?vid=3&sid=40466a5
b-e5d1-4af1-b20e-ef21edb92d92%40sessionmgr4002&hid=4205
World Health Organization. (2012). Oral health. Retrieved from
http://www.who.int/mediacentre/factsheets/fs318/en/

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