Den 3107 Lecture 6 Oral Health Promotion Sessions PDF

DEN 3107 LECTURE 6 Dr. R. Overton STRUCTURING ORAL HEALTH PROMOTION SESSIONS  Before structuring an OHE session The three domains of learning: ◦ 1. Knowledge related (cognitive)- Receiving new information or explanations and thus increasing knowledge. ◦ e.g. explaining what causes caries ◦...

DEN 3107 LECTURE 6 Dr. R. Overton STRUCTURING ORAL HEALTH PROMOTION SESSIONS  Before structuring an OHE session The three domains of learning: ◦ 1. Knowledge related (cognitive)- Receiving new information or explanations and thus increasing knowledge. ◦ e.g. explaining what causes caries ◦ 2. Attitude related- Forming and changing attitudes, beliefs, values and opinions. ◦ e.g. a nervous patient being persuaded to visit the dentist ◦ 3. Behaviour related- Acquiring and improving new skills. ◦ e.g. toothbrushing  The stages of planning a session are: ◦1. Decide upon the topic ◦2. Obtain background information about the patient/target group ◦3. Write aims and objectives ◦4. Create a lesson plan ◦ 5. Teaching methods and aids ◦6. Plan assessment and evaluation ◦ 7. Rehearse  1. Deciding upon a topic ◦Will be either specific to an individual (related to a problem with their own oral hygiene), or relevant to a larger group ◦When choosing a topic, it is usually best to stick to one area ◦Or you will bombard the patient(s) with too much information all at once.  2. Obtain background information about the patient/group When planning an oral hygiene session, the OHE should take into consideration the following points: ◦ 1. Size of group – if too big, individual attention cannot be given. ◦ 2. Prior knowledge – of the group or individual. ◦ 3. Subject relevance – is the topic meeting their needs? ◦ 4. Timing – too long a session leads to boredom or distraction. ◦ 5. Special needs – (e.g. physical or mental disabilities of patients). ◦ 6. Learning abilities – high intelligence/slow learners. ◦ 7. Minority ethnic groups/language barriers – will you be understood? ◦ 8. Social class – what products learners can afford to buy (if a requirement).  3. Educational Goal/ Aim Is general and non-specific. It should detail what the patient needs to know. Aims should be: ◦ Brief. ◦ Clear. ◦ Simple. ◦ Comprehensive – covering all the material to be taught in a session. ◦ For example, ‘I aim to teach this patient how to brush effectively’.  4. Objectives ◦ Objectives state what the patient will be able to do at the end of a session. Recall objectives are constructed according to: Performance, Condition and Criteria ◦ After stating the intention of the session, the next step is to plan how to achieve it For example, by the end of the session, a patient will be able to: ◦ Select a suitable toothbrush for their needs. ◦ Carry out efficient brushing techniques. 4. Objectives When setting objectives, first consider: ◦ The age, sex, social class, ethnicity, religion, language and culture of the patient(s). ◦ Previous knowledge and attitudes. ◦ Resources available. ◦ Time allocated for the session. ◦ What the patient should realistically be able to achieve after the session. ◦ Words such as know, understand and feel should be avoided because they are not measurable. The OH Educator needs measurable objectives, using words such as explain, describe, state, demonstrate and discuss 4. Lesson plan A plan enables the educator to: ◦ Keep to the topic. ◦ Refer to objectives. ◦ Keep to the teaching method. ◦ Keep to timescales. ◦ Assess how well the patient learned. ◦ Evaluate the lesson. ◦ A lesson plan should comprise a table or a logical list of topics to cover.  5. Teaching methods and aids ◦ There are many methods, and not all patients respond to the same approach. ◦ Recall the learning styles of patients. ◦ Experience will gradually help the OHE plan and vary methods of teaching accordingly. ◦ Resources and motivational aids should be relevant and simple to use/ demonstrate. 6. Plan Assessment and Evaluation ◦ Each teaching session needs to be evaluated. ◦ In the context of oral health education ◦ The term evaluation is used to quantify to what extent the advice given to the patient has produced tangible results. ◦ It can be defined as: ‘making a judgement about the outcome and effectiveness of an oral health education session or Programme’ (Felton, et.al, 2014). Effective evaluation will tell you: ◦ Whether objectives have been achieved. ◦ If your efforts were worthwhile. Types of Evaluations ◦From learning to spot the signs, it is possible to continually process, evaluate and adapt a session. ◦1. Outcome evaluation- What will be the outcome of the session? ◦Will patients increase their knowledge, or change their behaviour or attitude as a result? ◦(Remember! Knowledge, Attitudes, Behaviour.)  Types of Evaluations ◦ 2. Process evaluation - This is concerned with session delivery as it happens. ◦ Is the teaching process going well? ◦ What is the patient telling you? ◦ Usually summarized by a patient’s reactions, or the signals they are giving. Do they look interested and attentive, or are they forgetting and looking out of the window? Observe! ◦ non-verbal feedback: facial expressions and body language Types of Evaluations ◦3. Patient evaluation - Take on feedback at the end of a session and be prepared to modify your teaching in future sessions. ◦4. Peer evaluation- Feedback from colleagues. Ask for comments and suggestions to improve future sessions. Types of Evaluations ◦5. Self-evaluation (reflective practice) ◦Look at your performance after a session. ◦ How well did it go? ◦What did not work and why? ◦How could the session be improved? Evaluation methods ◦How to assess, how well a teaching session worked. ◦There are many methods ◦The method(s)chosen must relate back to your aims and objectives and show whether the goals were achieved.  Evaluation methods ◦1. Question and answer session with patient ◦Have your questions written down in advance, so that you can refer to them in case you need to. ◦Keep them simple, with an emphasis on getting straightforward answers. ◦Questioning will help patients give full, clear, honest answers. ◦2. Patient demonstration of new skill – visual evaluation.  Evaluation methods ◦3. Records of behaviour change – (e.g. plaque scores, indices, documented, decrease in caries rate). ◦ This will be evaluated on return visits, after the patient has (hopefully) carried out your instructions over time. ◦4. Questionnaire – get the patient to fill out a questionnaire after the session.  What is a questionnaire ◦ A questionnaire is a relatively inexpensive and swift mechanism for collecting information or data that can be easily analyzed and interpreted. To produce a successful questionnaire, the OH Educator will need: ◦ A clear idea of an overall goal (aims and objectives). ◦ A good knowledge of the subject. ◦ Background information on the patient/target group (what do they know?). ◦ To decide upon exactly what information needs to be answered (using open and closed questions). Open and closed questions There are two main types of questions in a questionnaire: ◦Open questions – which provide qualitative data. ◦For example, “How do you brush your teeth?’ ◦Closed questions – which provide quantitative data. ◦ For example, ‘Will you now use the method of toothbrushing I suggested?’  Open and closed questions Advantages of open questions: ◦ Respondents can use their own words to reply (e.g. ‘I brush using a back and forth motion’). ◦ Good when used in a pilot study; useful for finding out what people know and do not know, and can help the phrasing of questions in the final questionnaire accordingly. Disadvantages of open questions: ◦ Analysis is more difficult and time-consuming to measure than closed questions. Open and closed questions Advantages of closed questions: ◦Quick to complete – respondents just tick ‘Yes’ or ‘No’. ◦ Easy analysis – questioner counts ‘Yes’ or ‘No’ answers. Open and closed questions Disadvantages of closed questions: ◦ May result in leading questions ◦ Loss of depth – do not capture people’s opinions. ◦ Whether the educator decides to use open or closed questions (or both), care should be taken to avoid questions that are: ◦ Irrelevant – do not tell you what you need to know. ◦ Offensive – make respondents feel small or embarrassed. ◦ Ambiguous – can be interpreted in more than one way.  Open and closed questions ◦ Once the type(s) of questions have been decided upon, the next stage is to design the questionnaire ◦ It is good practice to allow respondents to remain anonymous if they wish ◦ Have a choice of ‘opting out’ of answering any question they may not be comfortable with. ◦ Confidentiality is also an important consideration.  Questionnaire design When designing a questionnaire, take into account the following considerations: ◦ Will a brief pilot (trial) questionnaire with a few respondents be helpful? ◦ Decide how many questions are required (10 or less if possible) ◦ people can get bored if there are too many questions, or may rush and give inaccurate responses if they are pressed for time ◦ Refer back to aims and objectives to clarify the direction. ◦ Write questions in easy-to-understand language. ◦ Give clear instructions on how to answer (e.g. ‘Please tick or circle either Yes or No’). Questionnaire design ◦ If using open questions, leave sufficient space for writing answers. ◦ Plan how and when questionnaires will be handed out. ◦ Think about how they will be collected. ◦ Consider costs (e.g. printing, postage). 7. Rehearse the session ◦It is a very good idea to rehearse the session using friends/family and particularly colleagues. ◦This will help you iron out problems and judge the amount of time needed. ◦Be prepared to take on good constructive criticism and adapt your session accordingly END Reference ◦Felton, A., Chapman, A. and Felton, S. (2014). Basic Guide to Oral Health promotion and Education, 3rd Edition. John Wiley & Sons, Ltd DEN 3107 LECTURE 7 Lecturer: Dr. R. Overton ORAL DISEASE PREVENTION & ORAL HEALTH PROMOTION A. Diet and Oral Diseases  Important messages Give advise on: ◦the reduction of the amount and frequency of foods and drinks high in salt and added sugar ◦How to achieve a good balanced diet and wellbeing through physical exercise  A Healthy Balanced Diet- THE EATWELL GUIDE/PLATE ◦Diet- the type and amount of food and drink we consume ◦The Eatwell Guide shows the proportions of the different types of food groups ◦We need to have a well‐balanced and healthy diet, and reduce the risk of heart disease, stroke, cancer and other conditions. THE EATWELL GUIDE/PLATE Applies to all, EXCEPT: ◦ those with special dietary needs who should seek advice from a dietician ◦ children under 2 years old who have different nutritional needs  A Healthy Balanced Diet HEALTHY BALANCED DIET - THE EATWELL GUIDE/PLATE ◦The recommended daily calorific intake: ◦men- 2500 kcal ◦women- 2000 kcal ◦ Advise patients to aim to balance the different types of food groups right each day, but not necessarily for each meal.  A Healthy Balanced Diet HEALTHY BALANCED DIET - THE EATWELL GUIDE Advise patients: 1. Fruit and vegetables – at least five portions a day ◦A variety of fruit and vegetables is recommended ◦Fresh, frozen, tinned, dried, or juiced. ◦Limit fruit juice and smoothies to 150 ml per day (mealtimes) 2. Meals based on starchy carbohydrates – bread, cereals, pasta, rice, and potatoes ◦Aim for high fibre wholegrain varieties and leave skins on potatoes.  A Healthy Balanced Diet HEALTHY BALANCED DIET - THE EATWELL GUIDE Advise patients: ◦ 3. Dairy/dairy alternatives – an important source of protein and calcium (for bone strength) – choosing lower fat and low sugar options 4. Meat, fish, eggs, beans/pulses– good sources of protein, vitamins, and minerals. ◦ Beans and lentils are good alternatives to meat(lower in fat) ◦ Eat less red meat and processed meat ◦ Aim for two portions of sustainably sourced fish per week (one being an oily fish like salmon or mackerel, high in unsaturated fat).  A Healthy Balanced Diet HEALTHY BALANCED DIET - THE EATWELL GUIDE Advise patients: 5. Oils and spreads ◦Choose unsaturated oils and spreads (like olive and vegetable oil)- can lower bad cholesterol ◦Reduce saturated fats (such as those found in butter and ghee)- can increase bad cholesterol  A Healthy Balanced Diet HEALTHY BALANCED DIET - THE EATWELL GUIDE Advise patients: 6. Less salt and sugar ◦Choose foods low in salt and sugar ◦Adults should eat no more than 6g of salt a day and less for children 7. Reduce snacks – such as cakes, biscuits, chocolate confectionary, pastries, ice cream, and fizzy drinks A Healthy Balanced Diet HEALTHY BALANCED DIET - THE EATWELL GUIDE Advise patients: ◦8. Drink plenty of fluids – 6–8 glasses a day (including water, low‐fat milk, sugar‐free drinks, tea, and coffee) NUTRITION  Nutrition ◦The process by which we absorb and use the food in our diet for energy, growth, and repair of tissue Nutritional Substances: ◦Carbohydrates Vitamins ◦Proteins Minerals ◦Fats Fibre ◦Water  Nutrition 1. Carbohydrates ◦ Should comprise approximately 50% of total daily calorie intake, and provide the biggest source of energy ◦ The glycemic index (GI) is a rating that shows how quickly a food containing carbohydrates affects blood sugar (glucose) levels when that food is eaten on its own. ◦ High‐GI foods (sugar, potatoes, and white rice) are broken down quickly and cause a rapid increase in blood sugar ◦ Low and medium GI foods (fruits, vegetables, wholegrain foods) are broken down more slowly and cause a more gradual rise in blood sugar  Nutrition 2. Proteins ◦Should comprise approximately 10–15% of our daily energy intake ◦Are broken down into amino acids during digestion and absorbed into the body ◦Provide energy, and are bodybuilders, being essential for cell growth and repair  Nutrition ◦ 3. Fats ◦ Approximately 1/3 of total daily energy intake, and are essential to many body processes ◦ Fats keep the body warm, metabolise cholesterol, and act as a reserve source of energy ◦ Advise to eat more of the healthy unsaturated fats and cut down on saturated fats  Nutrition 4. Vitamins ◦A group of complex organic substances that occur in minute amounts in foods ◦Cannot be synthesised by the body and are absorbed unchanged from foodstuffs ◦The absence of certain vitamins in tissues can cause deficiency syndromes  Nutrition- Vitamin classification ◦Vitamins are fat‐soluble or water‐ soluble ◦Fat‐soluble vitamins are found mainly in fatty foods ◦Do not need to be consumed daily because they are stored in the liver and fatty tissues to be used when required ◦A balanced diet should provide the vitamins needed ◦Certain medical conditions and situations (e.g. pregnancy) require prescribed supplements  Nutrition- Vitamins Fat‐soluble vitamins include: ◦ Vitamin A – found in fish oils, eggs, milk, green vegetables, and carrots ◦Protects against infection, influences changes in epithelial cells, and helps eyes see in dim light ◦ Vitamin D – found in dairy products, fish and fish oils, and also synthesized from sunlight ◦Regulates calcium and phosphorus metabolism and helps with the calcification of bones and teeth, protecting against rickets  Nutrition- Vitamins Fat‐soluble vitamins include: ◦Vitamin E – found in nuts, lettuce, egg yolk, wheat germ, cereals, milk, and butter. ◦Function is not fully understood, but believed to be concerned with preventing muscle waste, and aiding fertility ◦ Vitamin K – found in fish, liver, leafy green vegetables, and fruit. ◦Aids in blood clotting  Nutrition- Vitamins Water‐soluble vitamins ◦not stored in the body therefore required more frequently ◦Some are found in vegetables  Nutrition- Vitamins Water‐soluble vitamins include: ◦ Vitamin B complex – (e.g. B6, B12, folic acid) ◦ B vitamins are found in vegetables, starch, seeds, grains and pulses, eggs, fish, and meat ◦Prevents anemia, digestive disorders, skin problems, bleeding gums, and glossitis Nutrition- Vitamins ◦ Vitamin C – found in fruit and vegetables ◦ A deficiency can cause scurvy, bone fractures, skin lesions, bleeding gums, and damage to the periodontal ligament  Nutrition- Minerals 5. Minerals- Include Calcium, Sodium, Potassium, Phosphorus, Magnesium, Iron, Chloride, Iodine, Fluoride. ◦ Absorbed directly from the diet ◦ Found in minute amounts in most foods Minerals are important for: ◦ Building strong bones and teeth ◦ Controlling body fluids ◦ Converting food into energy  Nutrition- Fibre 6. Fibre ◦ Only comes from plant based foods (e.g. fruit, vegetables, seeds, and pulses) ◦ There are two main types: ◦ A. Insoluble fibre ◦ Cannot be digested, so it passes through the gastrointestinal tract, helping other food and waste products move through the tract more easily ◦ Examples: Wholegrain bread and breakfast cereals, brown rice, and wholewheat pasta Nutrition- Fibre 6. Fibre B. Soluble fibre ◦Can be partially digested and may help reduce the amount of cholesterol in the blood ◦Examples: Oats and pulses  Nutrition 7. Water ◦The amount of water an individual requires to prevent dehydration varies depending on a range of factors, including: ◦their size ◦the ambient temperature ◦how active they are ◦ 6–8 glasses of fluid a day is recommended  Food Additives ◦Is a substance not normally consumed as a food by itself, and not normally used as a typical ingredient of food, whether it has nutritive value or not ◦Food additives are normally non‐nutrients but they are used to improve flavour, colouring, shelf‐life, and convenience in cooking. Example: monosodium glutamate  Food labelling ◦Guided daily amount labels (traffic light labels) are used on many pre‐packaged foods ◦The labelling provides nutritional information on the number of calories, fat, saturated fat, sugar, and salt content ◦the percentages given are often only for a portion (by weight) of the food, rather than the whole amount of the food Physical Exercise and General Wellbeing ◦Although its not the OHE’s job to give advice on physical activity, you should be aware of general recommended activity guidelines in relation to whole body health for when working with other professionals in health promotion ◦This helps to reduce the risk of heart disease, stroke, cancer and other conditions, such as type 2 diabetes, which can have oral manifestations. Sugars in the diet Classification of Sugars ◦1. Intrinsic sugars ◦2. Extrinsic Sugars A. Free sugars (previously called non‐milk extrinsic sugars B. Milk sugars  Intrinsic sugars ◦ Found in the cell walls of whole fruits and vegetables ◦ They also include fructose, glucose, and sucrose (which, confusingly also come in free sugar form), but they do not begin to break down in the mouth) ◦ are therefore generally less cariogenic than their free sugar form ◦ Also include processed (dried, stewed, canned, and frozen) fruits, and vegetables ◦ Limit these foods to mealtimes- potential carciogenicity ◦ Intrinsic sugars found within the cell wall of fresh fruit and vegetables are less cariogenic than those found in dried, stewed, or canned fruit and vegetables (do not break down in the mouth) Extrinsic Sugars ◦Found outside the cell of fruits and vegetables  Extrinsic Sugars- A. Free sugars ◦ Include monosaccharides (e.g. glucose and fructose), and disaccharides (e.g. sucrose, maltose Free sugars are : ◦ Added by the manufacturer, cook, or consumer – including processed foods, such as confectionery, soft drinks, biscuits, and cakes ◦ Naturally present in unsweetened fruit and vegetable juices, honey, syrup, purees and pastes, and raw sugar ◦ In drinks (other than from dairy sources), including alcohol. Extrinsic Sugars- B. Milk sugars ◦Milk sugars (lactose and galactose) occur naturally in milk and dairy products, such as yogurt and cheese ◦Less cariogenic than free sugars (are accompanied by other essential nutrients (e.g. calcium), which counteract potential damage to teeth). OHE ADVICE TO PATIENTS ON SUGAR CONSUMPTION 1. Free Sugars WHO recommendations for the reduction of consumption of free sugars: ◦ Clear nutritional labeling ◦ Improving the food environment in public institutions (e.g. schools, hospitals, work) ◦ Increasing awareness/access to safe, clean drinking water  Advice to Patients on Sugar Consumption ◦1.Reduce daily sugar consumption if not done so already. ◦ Pregnant women and parents of young children, in particular, adding sugar to food can contribute to obesity, caries, and behaviour ◦2. Identify hidden sugars (read labels)  Advice to Patients on Sugar Consumption ◦ 3. Reduce frequency of sugar intake ◦ the frequency of sugar intake is far more significant in the development of caries than the amount consumed ◦ Sugary foods are best taken during mealtimes, when salivary flow is good, while bedtime is a particularly bad time to consume sugar as the salivary flow rate slows during sleep. ◦ Remind patients about the amounts of sugars in foods and drinks by giving an information sheet, setting out these amounts (5 grams of sugar is roughly 1 teaspoon) ◦  Advice to Patients on Sugar Consumption ◦4. Reduce unhealthy snacks ◦ Patients should reduce all snacks, particularly those containing sugar (and especially free sugars). ◦ It is important to give the same advice as other health professionals, such as dieticians and health visitors, who are concerned with healthy eating and obesity  Advice to Patients on Sugar Consumption 5. Find healthy alternatives ◦Aim to replace snacks high in sugar and saturated fat with healthier alternatives For example: ◦Unsalted mixed nuts (mindful of nut allergies) and seeds ◦Fresh fruit and chopped vegetables (e.g. carrots and pepper) ◦Rice cakes (plain) ◦Wholegrain and whole meal products  Advice to Patients on Sugar Consumption 6. Sugar‐free medicines ◦ Choose sugar‐free medicines wherever possible ◦ Products not containing fructose, glucose, or sucrose can be called sugar‐ free on labels ◦ Those containing hydrogenated glucose syrup, lycasin, maltitol, sorbitol, or xylitol are also listed as sugar‐free, as considered non‐cariogenic ◦ Artificial sweeteners are also listed as sugar‐free ◦ Patients on long‐term medication not available sugar‐free, should take it at mealtimes Advice to Patients on Sugar Consumption 7. Consider using sugar substitutes ◦The use of artificial sweeteners is increasing as the public becomes more diet conscious, since their low calorific value means that they are virtually non‐cariogenic and non‐ fattening. ◦END Reference ◦ Felton, A., Chapman, A. and Felton, S. (2014). Basic Guide to oral Health promotion and Education, 3rd Edition. John Wiley & Sons, Ltd. ◦ (Please read Chapter 9 and 10)