Global Oral Health Disparities

1 Global Oral Health Disparities Ashley Smith Walden University 2 Abstract 3 Global Oral Health Oral health is an intricate part of health and wellness. Those that live in an environment of lower socioeconomic status are not acquainted with the chronic effects of poor oral health. The Center for Disease Control has a National chronic prevention and health promotion program that focuses on chronic diseases associated with disparities such as oral health. The survey is a resource to provide activities that improve the health of the nation by preventing behaviors attached to chronic diseases. The National Center for Chronic Disease Prevention and Health (2016) provide statistical data related to oral health, which provides a secondary look at the prevalence and parallel of disparity and behavior. The NCCDPH (2016) is a nationally recognized data and statistical resource that identifies and evaluates global health disparities. The arithmetical surveillance for tables, charts, and graphs associated with the Centers for Disease Control and Prevention are secondary data; thus, far it is valid due to the dynamics of the research associated with it. A strategy to overcome limitations with chronic disease surveillance is unidentifiable now. The chronic disease surveillance provides national health observances, statistics, data and governmental resources that play a role in oral health and its research. The Centers for Disease Control and Prevention composed a surveillance system termed the behavioral risk factor; which is a state-based telephone survey that identifies health related risk behaviors. From my findings, I gathered that the data collected from the survey is compiled of primary and secondary data. The BRFS data is primary because it was collected in 50 states, but it can also be considered secondary because the sample sizes may not be equivalent. Regardless, the data is valid and reliable because it has been estimated the largest health survey globally. The CDC’s division of oral health could overcome the limitations of secondary data by 4 having equivalent samples when conducting arithmetic research on global oral health and associated behaviors. Per the Centers for Disease Control and Prevention (2015), Health disparities are defined as differences in the burden of disease, injury, violence or opportunities to achieve optimal health (CDC,2015). Oral health disparities have been a research matter for several years; yet many people remain without adequate resources and health literacy, which will enable underprivileged communities to be cognizant of the importance of oral health. There are various factors related to poor oral health such as socioeconomic status, educational inequalities, and access to healthcare (CDC,2015). Inclusive health can be effected by poor oral health, which corroborates why methodologies and practices should be exposed and available globally. Annotated Bibliography Dowse, R. (2016). The limitations of current health literacy measures for use in developing countries†. Journal of Communication in Healthcare. This is a study interrogating evidence that supports valid health literacy measures for minority groups within the community. The study reflects on the health systems within the community that require health literacy so that oral health measures are appropriately evaluated. One concern of some of the researchers were surrounding those that would be excluded from the research by default due to lack of understanding the measures that are being used. Ganavadiya, R., Chandrashekar, B. R., Goel, P., Hongal, S. G., & Jain, M. (2015).

Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: a proposed model. Annals of medical and health sciences research, 4(3), 293-304. Provided research and statistics surrounding the Indian population and their dental 5 resource availability. Socioeconomic status plays a vital role in those that reside in what they designated as the “slums,” in which are denied dental services, although there is a steady advancement of dentistry in the country of India. Studies in this population have shown that oral diseases are increased within the underserved population, due to lack of resources and health literacy. From the research and statistics, mobile programs are being implemented to cater to the oral needs of the underserved population in India. Benzian, H., Monse, B., Belizario, V., Schratz, A., & Sahin, M. (2014). Advocacy for global oral health Public health in action: effective school health needs renewed advocates for oral health globally. This program has designed educational programs within the school system to incorporate oral health interventions. Per the researchers in this study, the school systems and their decision makers are viewed as underrated, and has not been able to get the adequate attention from the public health community. The perception is that public health promotion within this sector is underestimated. Therefore, educational programs in school systems can help achieve challenges associated with educational needs within school aged children. Marcenes, W., Kassebaum, N. J., Bernabé, E., Flaxman, A., Naghavi, M., Lopez, A., & Murray, C. J. (2013). Global burden of oral conditions in 1990-2010 A systematic analysis. Journal of dental research, 0022034513490168 is a study that estimates disease burdens and injuries from 1990-2010. Globally, reports showed that 3.9 billion people were affected by lack of oral health and tooth loss in the 2010 study. The study showed the untreated caries increased, and the numbers were dependent upon the age and region of the participants, but gender was not included. Primarily, the study showed challenges with being able to respond to diverse oral health challenges in countries that are developing. 6 Metsch, L. R., Pereyra, M., Messinger, S., Jeanty, Y., Parish, C., Valverde, E., … & Tomar, S. (2015). Effects of a brief case management intervention linking people with HIV to oral health care: Project SMILE. American journal of public health, 105(1), 77-84 dissects the link between those infected with HIV and oral health. Studies have shown that those living with HIV experience more oral health problems. Although, individuals living with HIV are longer due to advancements with antiretroviral, oral needs are harder to treat and the needs are still unmet. The study included screening and intervention groups, and the results show that many did not seek oral care every six months as recommended, which resulted in factors associated with lack of oral care within the HIV community. Molarius, A., Engström, S., Flink, H., Simonsson, B., & Tegelberg, Å. (2014).

Socioeconomic differences in self-rated oral health and dental care utilization after the dental care reform in 2008 in Sweden. oral health, 14(1), 1 is aimed at monitoring those in the Swedish community to evaluate self-oral practices amongst Swedish adults. This study used a survey questionnaire that adults 16-84 answered regarding their overall oral health practices. Chi- square statistics were used in observation to analyze factors for poor oral health. Unlike most reports, 90% of residents did visit the dentist regularly. Those whom rates were lower, were those that were a part of the underserved population, statistically which is about 8% of the Swedish community. Concluding, the results reaffirmed that equality with healthcare is something that should be afforded to everyone because, it plays a role in overall health. Ethics within oral health When engaging in emerging delicate subject matters, one must understand that what is deemed as acceptable may not be ethical. Institutional Review Boards (IRB) are a panel of individuals that focus on ethics within research. IRB’s are an intricate part of ethics within 7 research; so much that they are positioned to delegate researchers to modify studies to protect the patients. There is an ethical code of conduct that health educators stand by for the advancement of health promotion. The code of conduct consists of the public, the profession, the employers, the delivery of health education, research and evaluation, and finally a responsibility to the professional preparation (Salazar, Crosby & Diclemente, 2015). There has been an unparalleled amount of advancement in oral health disease prevention and treatment. Oral health disparities are linked with socioeconomically challenged communities; because in recent studies limited to no access to care have been parallel the absence of the availability of resources and education; Nonetheless, poor oral health cannot be determined just by the absence of resources and education (Hobdell, Sinkfordd, Alexander, Alexander, Corbet, Douglas & Schou, 2002, p. 167). However, this still exposes factors such as accessibility, adequacy and education (Hobdell et al, 2002, p. 167). Global Oral Health Disparities

Acting in an ethical custom is the ability to understand the difference between right and wrong in any environment. Ethics are linked to morals which can be taught, but primarily is imparted at birth. Nevertheless, everything that is deemed right may not always be regarded as ethical. Oral health providers should be devoted to providing the standard of care while upholding the code of ethics (Hobdell et al., 2002, p.175). There are several ethical implications associated with oral research; within the healthcare profession certain morals are omitted based upon the needs of the research team. Autonomy is the first ethical determinant, which emphasizes self-governance because persons involved have the right to legally regulate if they want to be a part of the research, along with information 8 remaining confidential if that is their wish to do so. Morally, autonomy is necessary in allowing one to make clear and conscious decisions on their own. With informed consent, the participant must be aware of all aspects of the research in which they are involved. Ethically, informed consent should not have boundaries, because participants should be aware of parts of the study they are partaking in.

Second, non-maleficence is an ethical standard that means “to do no harm.” As a healthcare provider, there is an oath known as the Hippocratic oath, that all providers in should abide by even if they are not formally sworn to. “To do no harm” is one of the primary ethical standards that is held at a high standard because harm should not be done to willing participants, whether deemed legal or right. Core values of ethics apply to all, whether the secretary or the provider, the code of ethics remain the same. When ethics are put into action, it establishes relationships within communities that yield proper care and education, which brings change in behavior and increase in quality of life. The reduction of oral healthcare is a public disparity that has goals within public and private sectors that have been addressed. Oral health is a component of general health that is as pertinent as general health issues (Patrick, Lee, Nucci, Grembowski, Jolles, & Milligrom, 2006). Decreasing oral health disparities within communities is a step towards improving oral health around the globe. Gatekeepers within oral health Gatekeepers are liaisons between organization and individual, that gain access to resources within the organization to achieve goals related to issues within communities that need 9 to be addressed. Gatekeepers control access to resources and control over what happens within the processes. Medical physicians are gatekeepers to specialist and medical resources (Forrest, 2003, Volume 326, p. 692). The relationship between nutrition and oral health include care from the providers that will reduce the patients’ oral health needs and increase overall health. Oral health disparities have many gatekeepers that are utilized to reduce oral disparities. Physicians are a main gatekeeper within healthcare, because they can connect with patients and identify the need of the patient, while acting as a resource to meet those needs (Forrest 2003, Volume 326, p. 692). Global Oral Health Disparities

There are a few advantages to living in the United States, because access to care and resources are limitless, and there is an abundance of resources that most have access to. Physicians are considered gatekeepers to medical resources; the role of the physician and medical referrals has been an issue that has become controversial over time (Forrest, 2003, Volume 326, p. 693). The benefit of having physicians as gatekeepers in oral health, allow a relationship between organizations to develop as well, which establishes trust between patient and physician (Forrest, 2003, Volume 326, p. 693). Gatekeeping in oral health has allowed health maintenance to grow within the United States, which makes oral maintenance more attainable and available to those that are underprivileged and underserved. Gatekeeping has been an experiment with managed care organizations that have not previously been successful (Forrest, 2003, Volume 326, p. 695). However, it has been studied that gatekeeping is one of the main causes for low healthcare expenditures (Forrest, 2003, Volume 326, p. 695).

Patients that see their oral care provider at minimum two times a year are less likely to develop oral diseases; and have been known to have increased health and wellness. 10 The seven areas of responsibility are a framework designed to understand the roles of a health education specialist. The area of responsibility that relates with an oral health needs assessment and implementation is responsibility 1: assesses needs, assets and capacity for health education. This area addresses the oral health needs of the selected community because it allows assessment of the communities’ oral health needs. This area also allows the data collected to be evaluated and examined so that the needs for the disparity are met with the launch of the assessment. Conclusion An oral health intervention is connected to positive social change because it allows one to have a positive quality of life. Oral health is associated with overall wellness and health, poor oral health can result in poor quality, such as good oral health results in overall health. Individual point of views play a role in the change that takes place within the community, because education of oral disparities, will allow behavior change which will result in a better quality of life. There have been several substantiated measures that has been taken to increase the oral health needs of our nation. Global Oral Health Disparities

There will continue to be an ongoing study, to initiate programs and plans that will decrease health disparities and increase overall health. 11 References Dowse, R. (2016). The limitations of current health literacy measures for use in developing countries†. Journal of Communication in Healthcare. Ganavadiya, R., Chandrashekar, B. R., Goel, P., Hongal, S. G., & Jain, M. (2015). Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: a proposed model. Annals of medical and health sciences research, 4(3), 293-304. Benzian, H., Monse, B., Belizario, V., Schratz, A., & Sahin, M. (2014). Advocacy for global oral health Public health in action: effective school health needs renewed. Marcenes, W., Kassebaum, N. J., Bernabé, E., Flaxman, A., Naghavi, M., Lopez, A., & Murray, C. J. (2013). Global burden of oral conditions in 1990-2010 A systematic analysis. Journal of dental research, 0022034513490168. Metsch, L. R., Pereyra, M., Messinger, S., Jeanty, Y., Parish, C., Valverde, E., … & Tomar, S. (2015). Effects of a brief case management intervention linking people with HIV to oral health care: Project SMILE. American journal of public health, 105(1), 77-84. Molarius, A., Engström, S., Flink, H., Simonsson, B., & Tegelberg, Å. (2014). Socioeconomic differences in self-rated oral health and dental care utilization after the dental care reform in 2008 in Sweden. BMC oral health, 14(1), 1. Bryant, S. R., MacEntee, M. I., & Browne, A. (1995).

Ethical issues encountered by dentists in the care of institutionalized elders. Special Care in Dentistry, 15(2), 79-82. Mathur, S., & Chopra, R. (2013). Ethical Issues in Modern Day Dental Practice. Online Journal of Health Ethics, 8(2). http://dx.doi.org/10.18785/ojhe.0802.03 Patrick, D. L., Lee, R., Nucci, M., Grembowski, D., Jolles, C., & Milgrom, P. (2006). Reducing oral health disparities: a focus on social and cultural determinants. BMC Oral Health, 6(1), 1. Forrest, C. B. (2003). Global Oral Health Disparities

Primary care gatekeeping and referrals: effective filter or failed experiment? Bmj, 326(7391), 692-695. Capstone Project: Final Submission For this Project: • Review the Capstone Project Instructions listed in the Week 2 Learning Resources. • Make any necessary revisions to the five sections of your Capstone Project that you have previously submitted. Review these sections iteratively to ensure that your final submission reflects a well-thought-out, cohesive representation of your Community Health Intervention. The Project: Submit the revised assignments as a single paper, divided into sections as shown here. The Capstone Project is submitted as a single document that includes: • A 14- to 21-page paper using APA format (page count does not include title page or references) Components • Title Page • Table of Contents • Introduction (2–3 pages) • o Describe the health problem you identified. o Provide a brief outline of the need for the Community Health Intervention you have proposed. o Provide a brief description of the Community Health Intervention you have proposed. Part 1 (Week 2): Literature Review (3–4 pages) o Develop a Literature Review that synthesizes and evaluates relevant literature and provides a well-supported rationale for your Community Health Intervention. Include the following: ▪ A synthesis and evaluation of relevant literature that provides a concise yet wellsupported rationale for the Health Education Intervention developed in HLTH 6245: Applied Research in Public Health. ▪ Eight to twelve recent (within the last 5 years) primary peer-reviewed research articles that support the topic of your paper. ▪ Beyond the minimum primary research articles that directly relate to your identified topic, you may add additional, high-quality secondary literature (reviews or meta- analyses), and you may use websites if from a scholarly and relevant source (e.g., CDC, NIH). ▪ • • Part 2 (Week 4): SMART Objectives (1–2 pages) o For each goal from HLTH 6245, develop at least one SMART process objective, one SMART impact objective, and one SMART outcome objective. o Clarify to which goal each objective is aligned. Part 3 (Week 6): Budget, Personnel, and Funding (2–3 pages) o Complete the Budget and Funding Worksheet ▪ o Be sure to include brief job descriptions and qualifications needed for the personnel identified. Part 4 (Week 8): Curriculum (2–3 pages) o Global Oral Health Disparities

• For each funding source identified on the Worksheet, include a 2- to 3-sentence description of the source and a 2- to 3-sentence rationale that explains why you selected it as a potential funding source for your project. Complete the Personnel Worksheet ▪ • Your sources must follow APA formatting. Complete the Curriculum Worksheet. Include the following: ▪ Goal(s) ▪ Objective(s) ▪ Audience ▪ Materials needed (for learners, teacher(s), classroom or meeting space) ▪ Duration/time ▪ Procedure/content/curriculum (Note: A brief description of planned curriculum and procedure is adequate.) ▪ Description of one strategy you will utilize to recruit participants to the program ▪ Description of one way you will market the program Part 5 (Week 9): Evaluation Instrument (2–3 pages) • … Global Oral Health Disparities