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Assessing an Oral Health Curriculum for Students in Low-Income Communities

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               Children in affluent areas are much more likely to have regular dental visits throughout their childhood. This means those children are getting continuous oral health education at the dental office, even if they are not receiving it in their public or private education. Students in low-income areas are much less likely to have access to care. These students fall even farther behind when they are not receiving any education about oral health from the public school system.

               The purpose of this research project is to assess an oral health educational curriculum that was provided to various grade levels of federally identified Title I schools that are in low-income communities. Their current knowledge was assessed with a pre-test, then they were provided with an oral health presentation that addressed the topics that were presented in that test. Days later they received the same test again after the presentation to evaluate if they retained the information they were taught.

               All grade levels assessed showed improvement from the pre-test to the post-test. Fourth grade students showed the largest growth with an overall improvement of 50%. Sixth graders had a growth of 27%. High school 9th graders improved 26% and 12th graders grew by 34%. Including oral health curriculums in these low income schools can increase students overall awareness of oral health practices and encourage them to modify lifestyle habits that can effect their oral health.

               Participants were chosen for this research study based on their enrollment in federally identified Title I schools in low-income communities. Grades selected were based on gaining participants from elementary, middle, and high schools. Grades chosen were 4th, 6th, 9th, and 12th grade, all at different schools in the same area with similar demographics. A total of 102 participants were ultimately used for this research study.             

               The individual oral health curriculums were compiled using various resources that gauged what would be the most pertinent oral health concepts that students should know at that age. Separate power point presentations were made for the two age groups: upper primary/middle grades, and secondary grades. Teachers administered the oral health curriculum without the researcher present. They were given overall instructions on how to assess and submit data, as well as a script for each slide of the presentation to make sure they were all relaying the same information. The script helps assure consistency throughout different classrooms. Below is an example of a presentation slide with script information included.

               The presentations included important oral health practices and information that is pertinent to these age groups. Topics of important relevance include sugar content of various beverages, proper brushing and flossing timing and techniques, periodontal health, and proper steps for an avulsed tooth. Lower grades also focused on age specific topics like the importance of care for primary dentition, while older students were more engaged with the impacts of tobacco on oral health. Each topic had multiple visual aids to engage students including graphs, diagrams, and clinical pictures.

               Students in a randomly chosen class were given a pre-test of 10 questions based on their grade level. These questions align with the presentations previously discussed. They were not identified in any manner, other than their gender and grade level. Once they completed the pre-test, the teacher gave the oral health presentation. Once this was completed, they gave the same test 3-5 days later assessing what information they retained. 

               Fourth graders showed the most growth from the pre-test to the post-test with a 50% increase. Males scores on average 7% higher. Sixth graders showed the least amount of change between the two tests with a 27% increase. They also had the lowest mastery with a 66% average. Male students scored on average 6% better than female students in this grade level.

               Ninth graders had an average of 70%. This was the only grade level in which female students averaged higher than their male counterparts(by 2%). Twelfth graders averaged a 69%. Male students had a higher overall average and more growth between pre and post tests.

               The most commonly missed question regardless of grade level focused on the sugar content of common beverages. The question asked students to rank tea, Gatorade, soda, and juice in order of sugar content. The overall average throughout all four grades was 51%.

              The overall improvement by each grade level assessed in this research study suggests that additional curriculum about oral health is beneficial for students in low income communities. All students regardless of age averaged less than a 50% understanding of common oral health practices on the pre-test..

               As discussed earlier, the most commonly missed questions amongst all the student participants dealt with assessing sugar content of various beverages. The figure below was used in the educational material. It ranks different beverages by the amount of sugar contained in them. The most commonly misplaced beverage item by students on the assessment was juice. 

               According to an article based on parental and child assessment of sugar containing beverages, the misconception on sugar content of juice is based on the fact that it is seen as a more natural alternative. Therefore, parents chose this over other alternatives like skim milk or tea. Suggestions on healthier and low-sugar alternatives should be explained to students as well as their parents. This may help correct this misconception on what beverages are best for oral health. 

               Another factor of educating students on oral health should be to include modalities of learning that are best suited for both male and female students. In this research assessment, male students on average scored higher on the post-test, also with more growth over time,  than their female counterparts. The sixth grade females were the only ones to score higher, and this was only by 2%.

               To conclude, this oral health curriculum has shown success in various grades of federally identified Title I schools in low-income communities. Programs incorporating basic oral health practices should be integrated into these community schools to help bridge the gap on oral health education. Additional teaching modalities can be incorporated to appeal to the learning styles of both male and female students. 


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