>> ANGELA WEAVER: Hello and welcome to the first webinar in a two part series called Mouth Matters: Disability and Oral Health.
I want to welcome you all and thank you for joining us.
This webinar is sponsored by the University Center for 
Excellence and Developmental Disabilities or the UCEDD.
I want to give a special thanks to our partners the Oregon Self-Advocacy Coalition, the Northwest ADA Center and Oregon Public Health Association and its Disabilities and Oral Health Sections.
I want to set the stage why we are here today.
I'm sure we all agree all individuals deserve the opportunity to receive dental care.
However not all individuals can readily access the care they need.
Historically one such group is people with intellectual or developmental disabilities.
And in the U.S. there are approximately 6.5 million people who have been diagnosed with an intellectual disability.
Despite some progress over the years a significant disparity still exists in oral healthcare between individuals with intellectual or developmental disabilities and the popular generation.
Barriers of finances, lacks of appropriately trained dental leaders, limited accessibility of dental clinics, lack of Medicare and Medicaid funding and the patients themselves combine to create significant challenges to providing dental care.
And I want to be clear with this last part of the statement that it is not intended to blame the individual but it is intended to, rather, stress the inaccessibility of the system as a whole.
So today we are going to hear from a wonderful lineup of speakers who are going to share their expertise and experiences so we can all learn about strategies and programs to decrease the magnitude of these obstacles and help eliminate the oral health disparity.
I'm going to start with a little house keeping information, we are recording this webinar and the recorded webinar will be available on the OSAC websites and a link will be available on OSAC's website and Facebook page.
So we, unfortunately are not able to stream live on OSAC's Facebook page which we were hoping to do but it will be available there.
We have closed captioning available and it will also be available on the recorded version.
And to access the captioning you can click on the closed captioning button on the bottom of your zoom bar there or for another option is to click in the chat box and if you scroll all the way to the top you can see a link that you can click on that and that opens another page so you can watch the captioning at that time as well.
I want to remind everyone to please keep your camera and microphone off during the webinar and if you have any questions for any of the presenters please go ahead and write them in the chat box and then we will answer all the questions at the end of the webinar.
And we are also going to have plenty of time at the end of the webinar for people to ask questions and at that time we will have you turn on your microphone and ask each presenter your questions.
And lastly before you leave we have a poll that has three questions that we would really appreciate you answering at the end of the webinar.
Like I mentioned we have a great panelist and I want to thank them, we appreciate their time.
Each presenter will introduce themselves before their presentation and at the end of the webinar we have the presenters bio and you can read them and no they are available on the website.
Presenting along with me today we have Kathy Hunt, we have Lori Aus, we have Kiersi Coleman and Michael Richardson and they will introduce themselves.
I will start by sharing with you some Oregon specific data from the 2018 behavioral risk factor surveillance survey, what we call BRFSS, it's a telephone street call, all the answers come directly from the people being surveyed and the data is representative of people with all types of disable, this data is not specific for people with cognitive disabilities.
And looking at the slide here, if we just focus on the dark blue half of the pie charts and compare those, what we see within an one year time period fewer adults with disabilities or 59% visited a dentist or dental clinic compared to 71% of adults without disabilities.
So what this data shows us is people with disabilities are not accessing or benefiting from the same yearly dental care as people without disabilities.
In this chart we are going to look at the number of people who reported having had one or more teeth removed.
This is important data because having teeth removed is an indication of poor oral health so the more teeth a person has removed most often what that means is unfortunately they have poor oral health and/or limited access to oral health care.
In this chart the orange bars represent adults with disabilities and the blue bars represent people without disabilities.
This chart shows us that adult Oregonians without disability have had one or more teeth removed or total of 60% when you look at the two orange bars with the circles around them and add them together.
We compare this to 33% of adults without disabilities which is about half the number of people with disabilities who have had one or more of their teeth remove.
What is more striking if you look all the way to the right the difference in the number of people who have had six or more teeth removed.
What we are looking at is 30% of people with disabilities versus 9% of people without disabilities which is three times more people with disabilities have had six of their teeth removed or more of their teeth removed.
So this chart shows Special Olympics Special Smiles Program, this is not BRFSS data and is specific for people with disabilities.
Around 140,000 athletes were screened come the special smiles program and when they conducted their examinations what they found was that a large percent of the Olympians in the U.S. were unknowing of their oral health.
47% had signs of gingivitis, 25% had untreated tooth decays.
9% received an urgent dental referral and 12% had mouth pain.
It's important when we are looking at this data to realize more than one athlete -- I mean an athlete may have chosen one or more of these indicators.
Then one fact that came from the same report I'm talking about that is not on the slide but it does tie nicely into the slide we just previously viewed is that 30% of the Special Olympic athletes were missing one or more teeth.
So that's the data I'm going to share with you and now I'm going to turn the presentation over to Kathy Hunt.
>> KATHY HUNT: Hello, every one, my name is Kathy Hunt and I live in the state of Kansas and I currently serve as the Dental Program Director for Oral Health Kansas which is our state's oral health coalition.
I'm a registered dental hygienist by profession and have worked in both private practice and public health for over 40 years.
Next slide.
So as you just heard the oral health status of people with disabilities is a serious concern and you will be hearing later on about how improving oral health is very important for good overall health and well being.
So, we asked ourselves why aren't we hearing more about it?
Why aren't we talking more about oral health?
Well, for much of my public health career I've had the opportunity to work with head start programs across our state and one of the most consistent themes I heard from our health educators and other support staff was their reluctance to discuss the topic of oral health.
They acknowledge spending little time talking with families about oral health concerns.
The reasons that they gave for their hesitance was varied.
I wanted to share some of the reasons with you today.
Next slide.
So we use our mouths to eat, to smile, to speak and many more things.
Poor oral health can have an impact on all of these.
We all have teeth but we all have different experiences with our teeth that can color our view and affect our conversations.
Some of those experiences play be positive while others may not be so good and this can influence the tone and the willingness on the part of support staff as well as families to have important oral health conversations.
The health of our mouth and teeth is personal and can cause anxiety for some just as it might when talking about overall health.
Next slide.
So understanding some of the specific underlying reasons oral health isn't discuss can hip us bring the topic into focus.
The first reason in talking about oral health is that it's importance to overall health may not be understood.
As you will be hearing from others in the webinar, people with disabilities have a much higher risk of having dental problems and it can have devastating consequences to their overall health.
Also if daily oral hygiene and visits to the dentist were not an integral part of life to the families and caregivers, it may not be seen as important.
It's comment on for people with disabilities to have many other health and behavioral considerations, it can be difficult in terms of time, money and energy for oral health to get the attention that it needs.
Obtaining good oral health can have a host of challenges especially for people with disabilities.
Sometimes they are not able to cooperate with daily hygiene needed to prevent future problems.
And, as you herder earlier, finding a dental office that can provide needed support for the specific disabilities can be extremely difficult.
So these can both leave caregivers frustrated and fielding like there are no solutions.
Negative dental experiences also can last a lifetime, fear and anxiety about dental visits can result in ignoring and everything to do with oral health.
It may also be something has not been detected.
If a person with disability is very young or nonverbal people around them may not realize they are experiencing a dental problem.
Some signs of dental problem such his irritability, inability to focus, withdrawal, fatigue, depression or refusal to eat can easily be attribute to other causes, that's why it's important to have the oral health conversations.
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So some of the same reasons can be why support staff avoid the topic of oral health.
They bring into their role their family habits and culture.
As an educator this is something I heard a lot with our health educators here in Kansas, as an educator when you do not have the adequate knowledge on a topic it's difficult to have meaningful conversations.
Then there's the uncomfortable situation of not knowing what to ask or what resources are available or how to get the families the help they need.
Finally dental offices and caregivers may not feel confident how to support people with disabilities in their effort to improve their oral health.
So how might we address these factors?
Improving oral health starts with getting comfortable talking about it.
I'd like to offer some strategies that you might consider.
The first is to recognize any gaps in knowledge and find ways to learn more.
For support staff they can seek out professional development opportunities to learn basics on oral health as well as what local resources are available for professional dental services.
Also look for opportunities for people with disabilities to engage in activities that will help them make decisions about adopting healthy habits.
And I will have more information about one such opportunity later on in the webinar.
Another strategy is to start thoughtful conversations by asking open ended questions that can trigger interest in the topic of oral health.
This discussion can help uncover the values that families and people with disabilities can embrace, what is most important to them?
It might be healthy food, maintaining overall health, positive relationships or reducing healthcare costs connect with their values and not your own and connect that to the importance of a healthy mouth.
For people with disabilities, activities that lead to good oral health can be really challenging so celebrate successes, show appreciation for the positive things that are currently happening.
And then discover any specific challenges families may have in accomplishing those self-care activities and finding needed dental services and have some options that you are ready to offer.
One of the most important strategies is successful collaboration, everyone brings their own areas of expertise into the conversation.
Make sure you ask permission before offering advice and help with problem solving.
I can tell you as a personal aside a lot of us as dental hygienists really need to work on, ask permission before offering advice.
And then brainstorm together to arrive at realistic solutions to removing barriers to good oral health.
These could include changes in eating habits, daily home care or accessing professional dental services.
If you listen to the information in this webinar today, I challenge you to identify concrete action steps you can take to shine a light on oral health of adults with disabilities and how to play a role improving not only oral health but overall health and well being.
Thank you.
>> ANGELA WEAVER: Thank you, Kathy.
And now we are going to hear from Lori and Kiersi.
>> LORI AUS:  Hello, my name is Lori Aus.
I live in Westland, Oregon, and I have my own equipment I can go to a facility and set up, go bed to bed or wheelchair to wheelchair and that's mostly what I'm doing these days is bringing access of care to those who lack access and to the most vulnerable.
Okay.
>> ANGELA WEAVER: Do you want to introduce yourself, Kiersi?
>> KIERSI COLEMAN: My name is Kiersi Coleman, I'm a disabilities rights advocate and self-advocate, I live independently and I'm here to talk about my dental health and dental experiences.
>> ANGELA WEAVER: Great, thank you.
Okay.
>> LORI AUS:  All right, like Kathy was saying, oral health seems to be called a silent epidemic, that is what the Surgeon General referred to it as, but it's silent because it is out of sight and out of mind, people don't know it's there and those with disabilities and special needs that are not able to communicate issues, this becomes very relevant study.
Dental care and oral health care has been referred to as the number 1 unmet healthcare need.
Next slide?
So why do we need teeth?
Kathy mentioned this.
The obvious is biting and chewing.
The next -- go ahead and put them all up there.
Digestion starts in the mouth and it's so important that we have teeth to chew, to mix enzymes into the food.
If we are not able to do that there is weight loss or obesity.
Speech is a very real issue and everyone from every age understands this, that -- how do you say the letter "S" or "F" or "TH" -- you need teeth to be able to speak and understood.
Also the appearance and that is something that is very important and to avoid a decline in health.
So now we are going to talk about that, how teeth impact our health.
I love this slide because it shows all this debris just flying out of the pocket, but a lot of people don't understand that teeth are sitting in bone covered by tissue and this tissue can be impacted by that level of bacteria or the level of infection.
This increases the inflammatory responses and that is important to understand how each one of these diseases that we will talk about will be impacted.
There is about 700 different species that are inside our periodontal pockets and there are literally billions of bacteria.
Not all of them are bad but this is what makes this oral health so important.
Diabetes is the first one and that is kind of more studies have been done on the links between oral health and diabetes than any other.
It's a bi-directional, as the infection increases the glucose levels spike.
As the glucose level spikes, the infection spikes, so it's a circular issue.
Cardiovascular diseases, high blood pressure, stroke.
When some people have massive strokes they will biopsy what is causing the stroke and they are finding periodontal bacteria and microbes in that atheroma so it traveled from the cell walls around the teeth and travels every where.
Respiratory diseases.
There is a picture down on the right of pneumonia and what it looks like in a x-ray.
The same, the bacteria found in the mouth are found in the lungs.
We can inspire and aspirate the bacteria that is in our mouth.
Arthritis is an inflammatory disease that can be impacted by the level of infection, same with GI disorder and Alzheimer's is considered a disease from that.
These are a few of the diseases that can be impacted by oral health.
Next slide.
So what is the culprit, you see this little pink guy, there's a big word for it, this is one of the main bacteria that causes problems and it's found in plaque.
Plaque is the soft sticky stuff, if you don't remove it, it becomes calculus.
The calculus holds all different kinds of little holes and this bacteria can run through it and both of these provide a reservoir for all of the bacteria.
So when this bacteria hits that diseased pocket wall, that is how it can enter your bloodstream and travel throughout the rest of your body.
For an illustration on how big or how vast this infection can be, if you take the space and distance around each one of your teeth and plot that all out on a single surface, the space of the infection would be about the size of the palm of your hand and most people don't think, because it's that silent epidemic that is happening, you don't feel it happening but if you had an infection that was this big and say it was on your arm, or better yet, on your face, you would be seeking help immediately.
But because we can't see this it's outs of sight, out of mind, it gets ignored.
Plus it's very difficult to get rid of this infection because it comes back, so regular care is essential.
Common oral implications for the intellectual or developmentally disability are tooth malformations or missing teeth, tongue thrust where the tongue will push the teeth forward.
Inflamed gums, this is a concern for those on antiseizure medications and this can hide a lot more of that bacteria under those gums when the gums are inflamed and larger.
Dry mouth again is a problem that can be drug induced.
Trouble closing lips, because of the malocclusion many have a large tongue, sometimes the tongue can be fissured and hold a lot of bacteria.
Next slide.
A narrow and vaulted palate.
Low self-cleansing mechanisms.
So if there is food that becomes pouched, it's very difficult for some that are disabled to remove that food.
And you add to that decreased motor skills.
They are going to need special help and we need special help for it.
High gag reflex is very, very common in a lot of everybody and this is a consideration that we as practitioners need to be aware of.
Also some trouble chewing and swallowing and this can be a risk.
Next slide.
Common physical implications, seizure activity and this can make dental office visits more stressful and lead to anxiety when there is high anxiety already.
Heart defects, many can be corrected with surgery.
Hypothyroidism, and this can bring on a low blood pressure and decreased cardiac output and can impact the respiratory rate.
And acid reflux is also common and can -- the acid can, of course, impact oral health as well in teeth.
Okay.
And next slide.
Now we will hear from Kiersi and she is going to tell her story.
>> KIERSI COLEMAN: Hi, my name is Kiersi again, I have cerebral palsy, I'm an advocate in Portland, I live on my own with limited care hours and caregivers that come in.
So I'm going to talk to you a little bit about my dental experiences, in particular a story that stood out to me.
So I'm about 26 and a little bit older than the age that is usually required when talking about wisdom teeth, getting your wisdom teeth out.
It became very difficult for me to eat because my wisdom teeth needed to come out and my teeth were beginning to become impacted.
I remember this very clearly, I was at a restaurant and eating one of my favorite thing, steak and fries, I was havings a lard time because I was biting down trying to eat the steak and fries and when I would bite down I would bite the inside of my cheek which would impact my startle reflex which Lori touched on.
So I knew I had to go to the dentist.
And like Lori said and some other people have touched on, I was avoiding going to the dentist because it was so difficult for me to figure out how to get there.
So I looked at my insurance card and there was a certain dental office on the insurance card.
I, excuse me, I knew that I could only use that dental office because I have Oregon Health Plan.
And I also know there's a protocol I go through for every appointment.
So usually what I do, when I call for any appointment I say can you do wheelchair transfers?
And wheelchair transfers just means helping the person transfer from wheelchair to bed or wheelchair to dental exam chair.
Liability is a big issue and I couldn't take a caregiver with me because at that time the caregivers weren't able to leave and also, so, I didn't take any caregivers out in public with me because I don't have those hours and also my parents live in a different state than I do.
So they said no problem, we have people trained to help you.
I also said:  I have a wheelchair, power wheelchair, I don't know if everyone can see it, but I use a power wheelchair to get around.
Now, if you have ever been to a dental office, which I'm sure everyone has, you know that they are pretty narrow and small and hard to navigate, especially with the 300 pound chair.
Now, I'm a pretty small person so I have like a kid sized wheelchair but even then it's hard to navigate.
So what ended up happening is my dental office that I was assigned by OHP was in Beaverton and I live in Portland.
I use public transportation to get around.
I had to navigate taking three buses to get there and when I arrived they said:  We can't help you get into the exam chair from the wheelchair.
So that was a really hard time for me and I remember being turned away.
So I said:  Can't we work things out?
I'm a little bit ambulatory?
And they said no, we are worried about liability.
So that was a really hard thing for me.
I also let them know about my gag reflex and my startle reflex, so I'm pretty open with people and I know my disability very well.
So, eventually I got online and I asked my friends, other people with disabilities what office do you use?
And they gave me the name of an office.
Then I asked for a referral from the original dentist's office to give to the new dental office that was accessible, but notice how the work is mostly me reaching out to people, it's not the original dental office -- it's not anyone else, it's me doing the work.
And I think I spent about three hours with the insurance trying to switch my insurance to allow the accessible dental office.
So, eventually I did get into that dental office and I did get my wisdom teeth removed.
My parents did have to come down because I had to be put under because of the startle reflex and the gag reflex that is associated with cerebral palsy for some folks, not everyone.
Everyone can speak to their own experience, but I felt like I couldn't just use the laughing gas.
And, so, eventually my problems were resolved and now I am much better but now I know the protocol of going to the dentist even for an oral procedure but even for cleanings and I'm very hesitant to do so but at least I went through that experience and I'm glad do share my experience with you today.
>> LORI AUS:  Thank you so much, Kiersi.
And I know we as dental practitioners have so much to learn from people like you so that we can serve better, but I just, I have one question and wanted to know how has this impacted your confidence in seeking continued care in dental offices?
>> KIERSI COLEMAN: So it's not just dental office, but especially dental offices.
I always come prepared with exactly what I need but, yes, I'm very hesitant to go to the doctor -- I mean go to the dentist and the doctors and healthcare professionals for things without being prepared unless there's a real need.
Now, that can be a problem because I think that with your insurance you are entitled to annual cleaning, I don't usually go to annual cleanings, I try to, but it can be very hard and I'm also a college student and I work with different places and I think the other people in this presentation touched on other health concerns and I have had some other health concerns not to mention like my mental health, so it's really taking time to prioritize your oral health as well and sometimes that looks like it is overlooked.
>> LORI AUS:  Thank you so much for sharing so eloquently.
Next slide?
So I want to finish my part by saying that to have best practices in oral health care can improve your ability to speak, smile, food tastes better, chew and swallow, but there is another advantage.
You are going to be more kissable, we all will be more kissable with optimum oral health care.
Thank you very much.
>> ANGELA WEAVER: So, thank you so much Lori and Kiersi.
Now we are going to move to Michael.
>> Michael Richardson:  Thank you for sharing your story.
I'm the director of the Northwest ADA center.
Just to clarify when I say ADA we will be talking about the Americans with Disability Act.
We are part of the ADA national network -- we don't enforce the ADA or provide legal advice, we will provide information and resources to people can make informed choices of their responsibilities under the ADA.
So we cover -- my region is region 10, we cover Washington, Oregon, Idaho and Alaska but don't be afraid to reach out to your regional center if you are in states other than the four I mentioned.
So today I will be talking about accessibility and accommodations under the Americans with Disability Act which applies to all people with disabilities across the country and this also includes local state laws and federal laws that prevent discrimination and make sure people have accessibility provided by various entities.
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So what is the Americans with Disability Act or the ADA for short?
The Daddies a federal law that protects people with disabilities from discrimination.
The purpose of the law is to make sure that people with disabilities have the same rights and opportunities as everyone else.
Whether you are going to a government agency, accessing a hotel or restaurant, movie theater, people with disabilities like myself that have hearing loss, we have a right to accommodations and accessibility and having rights to services and goods just like anybody else.
And this, of course, includes the healthcare sector and, so, healthcare providers such as dentists are required to provide equal access and reasonable accommodations.
So knowing your ADA rights and what accommodations are available insures you get the best care possible.
So this is important about for individuals who want to pursue oral health care services is to know what your rights are and be prepared to verify that you have access to oral health care services, so we have heard of the unfortunate situation of taking three buses, a hour ride to be denied services.
In that situation that healthcare provider, oral health care provider did discriminate on basis of disability for services.
We will talk about it.
Next slide, please.
Here we talk about physical access, many may be using mobility devices such as wheelchair or scooters, for example.
They cannot access a building because they have a curb or step.
It's a need to be aware and call ahead to make sure it will be accessible and more specifically wheelchair accessible from the parking lot all the way to the exam room.
On the right we have an individual in a piece of new equipment that is slowly making it's away around dental clinics, it's a device while being able to stay in the wheelchair and tilt.
You won't find it every where but it is being utilized more and more in the larger dental clinics.
Even if they don't have such device dental healthcare providers must proceed access one way or another so it means they must have staff trained in transfer possibly, maybe think about having a lift in which a device that helps safely transfer individual from wheelchair to the exam chair for dental services.
You simply can't say I'm sorry, we can't help you.
Now, if they have a policy, as Kiersi was saying, they had a policy saying we don't do transfers for safety reasons.
Now, the ADA calls for modification for policies and procedure so a dental clinic should be thinking how can we make our services available to people with disabilities.
Like we have an appointment in two weeks, a call ahead to someone to come out and help with the transfer, there's are many opportunities to think how we can modify the policies and procedures to not discriminate against people with disabilities.
Next slide, please.
There's also the communication access requirement so people like myself with hearing loss who may be defender may have vision limitations or may have communication limitations in general, dental clinics and oral health care providers should be thinking about communication access and people with disabilities should be requesting any potential services or accommodations to ensure that communication is clear and as effective as its is to others, so, in the bottom left image we have somebody using a sign language interpreter in a dental clinic so you have a right to request an ASL interpreter if you are deaf and use ASL, the dental center must provide it and pay for it.
The middle picture shows pen and paper, it may be okay for people [garbled] you can ask for large print or have the receptionist read it, or electronic so people can take them home and listen to the documents with voice output software.
That's a small example of what potential communication access can be available.
Next slide, please.
So to be a good self-advocate it will be important to know how to request accommodations prior to making your appointment.
So when making an appointment especially let the provider know before your appointments to give them time to prepare, going back to the example a dental clinic play need to hire or request a transfer team to come to the appointment, give them enough time to make those conditions or be prepared.
You can also get your request over phone, thrust a written letter, there is no formal way for requesting accommodations.
Once you request the dental center must work as quickly as possible.
You can even give examples of things or ways that have worked or haven't worked before, so our philosophy is people with disabilities are often their own best experts so be prepared to say this is what I need in order to have access to the dental services you will receive.
In Kiersi's example, asking specific questions, is there wheelchair accessible parking.
>> can I get into front door?
Can I get in the clinic or can you transfer me?
Sometimes a provider may offer a different accommodation that what you asked for so if it won't work don't be afraid to speak up and say I'm sorry, that won't be useful, this is what I need and this is what I request.
And this is also important to remember that many healthcare providers aren't aware of disability issues or accommodation issues and it may be an issue of you or your support person having to help educate the provider on what is going to be needed for your accommodations and having access in receiving dental care services.
Next slide, please.
So the big question is what happens if it don't get my accommodation?
Unfortunately I know many people in the community sort of give up and say that's the way it was.
Unfortunately they denied my service or I couldn't get a cleaning because they didn't have an accessible way for me to get out of my chair but don't be afraid to speak up.
If you think you are being unfairly you do have rights under the ADA.
Some general recommendations is start with the manager of a clinic if there is one or person in charge of access and accommodations if there is one.
Sometimes in very large dental clinics you might have someone in charge of access or a small one you might figure out hut the head dentist is or person in charge and talk about what would happen and hopefully they could make a fix and talk about the next appointment and changes they can make.
If that doesn't come to a nice conclusion, you have rights to file complaints with the ADA as well and there are many people in organizations you can contacts such as your local disability rights office.
For example, in Oregon there is the Oregon Disabilities Rights, we have the Washington state disabilities organization, you can file complaints with to get resolution or mediation to make sure your rights won't be discriminated against again and ensure the entity will make fixes to ensure future people with disabilities will have access to services.
Ultimately if you have a question about other resource, how to file a complaint or who to go to, contact me, contact your regional ADA center for services.
Thank you.
Next slide.
>> ANGELA WEAVER: Thank you, Michael.
All right.
Kathy.
>> KATHY HUNT: Sorry, I was on mute.
I want to wrap up the presentation parts of our webinar by sharing an opportunity with you.
As I mentioned at the beginning of the presentation in addition to addressing the importance of oral health, the disparity and barriers to improve oral health it's also important for adults with disabilities to feel confidents how to keep their mouth and teeth healthy.
Three years ago our Oral Health Kansas worked with the centers on disabilities and health at the University of Kansas to create a learning event geared toward that goal.
So it's called feeling good about your smile.
This is the next slide.
It's called feeling good about your smile and it's a highly interactive event designed for adults with IDD.
It's a workshop that is designed to be fun, engaging and it gives consumers and their support staff the opportunity to practice concepts that will improve their oral health and reduce the risk of future disease that can impact not only their oral health but as you have heard their overall health, especially with chronic conditions such as diabetes, obesity and heart disease.
The next slide.
So, the workshop is designed to take a hour with an additional 15 minutes on either side for pre and post testing that helps us improve your experience.
So to address the differences in how people learn, we use a combination of simple, colorful slides and lively discussion to cover topics such as why it's important to have a healthy mouth, what causes cavities and what can you do to prevent oral disease.
And throughout the workshop they also have the opportunity to participate in several hands-on activities that reinforce those concepts.
Although our audience is adults with disabilities, we highly encourage support staff to participate and this is not only provides any needed help with the activities they are doing but the support staff also learned those concepts and the language that we use that can help reinforce that message later on.
So our goal is to give participants the knowledge and confidence to adopt healthy behaviors and as part of the project we also created a training kit to be used by organizations so that the workshop can be replicated in the future.
There is a variety of materials in the training kit, everything you need to put on a feeling good workshop, some are reusable from one presentation to another while others are disposable or sent home with the workshop participants.
Next slide.
So I wanted to give you a little peek at what we do.
I apologize, I have a dog Whining behind me.
The first is a science experiment where they simulate what happens in the mouth when foods that cause cavities are eaten.
When they see the bubbling reaction it underscores a visual can be worth more than a thousand words.
This is far and away the most popular activity we use in any of our presentations.
We've even created a kit specifically for that presentation that is used by many school nurses in our state.  The second is selecting healthy foods to be eaten every day and those saved for special days.
Next, they apply a liquid solution to their teeth and that shows where the germs and food are hiding on their teeth.
This is followed by practice in putting the correct amount of tooth paste on the tooth brush.
Did you all know that adults don't need to use more than a pea sized amount of tooth paste.
More is a waste and makes a mess in the sink but it can cause excessive foaming and can trigger the gag reflex and Kiersi was commenting on that.
And finally once they are successful with applying the tooth paste to the tooth brush we take a step by step approach having them brush their teeth and then admire their beautiful clean smiles.
It's a lot of fun.
Go to the next slide.
So participants in the feeling good about your smile event leave not only with that new knowledge and confidence we talked about but get to take home their new tooth brush, tube of tooth paste and what you are seeing on this slide is a story board with steps for tooth brushing so everyone gets a mirror cling to take home and we encourage them to mount it on their bathroom mirror or wherever they brush their teeth to serve as a reminder over all the important steps for brushing.
Next slide.
So 14 of these learning sessions have been offered in Kansas so far.
As you can imagine our progress was slowed with the mitigation steps for the COVID-19 out break but we hope to be able to resume them.
The evaluations we did showed 87% of participants improved one item between the pre and post tests and as you can see we have received some very nice compliments.
As the requests for feeling good about your smiles events have expanded we are recruiting hygienists to lead additional sessions and last summer we were able to provide sessions and trainings in Arkansas and if this model interests you we would love to bring it to Oregon.
And you will have an opportunity at the end of the webinar to let us know if your organization would be interested in hosting one of these.
We will plan to work with the Oregon office on disability and health and they will help us get those sessions scheduled and we will identify hygienists and others who are interested in being involved so Oregon can have a continued source of feeling good about your smile learning event.
Thank you and I hope to see you all soon.
>> ANGELA WEAVER: Great, thank you so much, Kathy.
Thank you so much all our presenters.
I just want to say that Kathy is correct, that both OODS and the UCEDD are planning to bring the program to Oregon, we don't know when it would be implemented because of COVID-19 but like Kathy said, if you are interested, take a moment in the chat and write your name and either an email or phone number because we will be looking at where to bring this in Oregon, we hope to move around and go to different regions and train the dental hygienists and also be working with people with intellectual and developmental disabilities and their care providers, so if you could let us know that would be great.
So now we will open up our time for questions, so, on the slide you also see all the presenters' emails if you want to jot any of those down, if you think you may have additional questions later.
Now we can start with any questions that may have been provided in the chat and you can unmute your microphone and ask a question that way.
>> ANGIE:  This is Angie, we had one question earlier in the chat, Ann was wondering what year the Special Olympics data was.
>> ANGELA WEAVER: That was from 2007 through 2019.
That's when they had about 140,000 athletes between that time frame and that is what was represented in that data.
>> Angie.
.
Thank you.
>> My question is in light of the liability risk for dental providers with transferring a patient from the wheelchair to the dental chair, I was curious are there any protections like if we are transferring in a dental clinic or traveling hygienist, if there was nobody there to make the transfer could a hygienist or dentist do it or do we have to have a particular certification, how does that work for liabilities risks.
>> MICHAEL RICHARDSON: This is Mike.
I'm not fully versed in the OSHA requirements or training requirements.
My point is if you have a small clinic and you have established a policy [audio garbled] maybe you have an affiliate practice in which they do have transfer abilities or you may have connection to another clinic that has a lift or transfer device of some kind so try to utilize resources to think about ways to provide access.
I have heard about people being examined in their chairs but that's not ideal just because of the neck issue and pain that can go with that.
There are -- one thing I was going to mention in next week -- I think it's next week's session geared toward the healthcare provider is there are available tax credits to offset some of the costs associated should you want to install a lift or transfer device and get training on that.
As far as staff training I'm sure you can connect with your local healthcare facilities to get resources on where to get some staff training on transferring, things like that.
As far as insurance, things on protection for employees, it's not my area of expertise so I hope that helps a little bit.
>> Yes, a little.
I was curious about the two person transfer if we are willing and ready to help but we don't want to get in trouble for helping if something were to happen to the patient more so than just our own protection for our back or whatever.
>> MICHAEL RICHARDSON: Yes, probably something to check with your own facility's insurance and policy and checking in with the individual themselves, some individuals can't be transferred because of the [audio garbled] communicating with the incoming patient or patient you have been working with to find out what will work best.
So obviously I don't have a black and white clear answer for your situation but it's a matter of how [audio garbled].
>> Thank you.
>> KIERSI COLEMAN: This is Kiersi, I would like to say something possibly.
>> ANGELA WEAVER:  Go ahead.
>> KIERSI COLEMAN: My hope is I hear this all the time from everybody in the healthcare field, I hear it from gynecologists, from doctors, my hope is that medical training will become more available to help people do transfers and feel confident in doing transfers if needed because I'm often asked to bring my boyfriend, to bring people that aren't available, but I do find in certain clinics that there is medical students and people available if you just have to keep asking and I wish that the training and, like, know your rights training for people in businesses was available for people in businesses so they would feel more confident in doing trainings.
>> MICHAEL RICHARDSON: This is Michael, I will add to what she said, just think about COVID right now and ADA requirements.
I just had my first dental cleaning for months last week and I'm only allowed in the office by myself, one person at a time.
Now, there are patients who do have family members that help with transfers, be prepared to modify that policy in your office to allow that patient and their care provider or family member into the office to help with facilitating that transfer to receive dental care services.
Know the things on the air waves with COVID-19 and everybody must wear a mask or only one person at a time, think how you can modify those policies to again enable access and inclusion.
Thank you.
>> ANGELA WEAVER: Thank you, Michael.
That's a good point.
Are there any other questions?
While we're waiting if there are any other questions I want to share some other research I didn't put in my data at the beginning that I found pretty amazing is that currently in the U.S. there is only about 10% of the dentists that advertise or feel comfortable to serve people with disabilities, so only 10% of all dental providers which I thought was very interesting statistic.
So, if we -- please feel free at any time to ask a question, I will move through our slides and we will do a poll in a minute.
I will show you what is available from our presenters.
We have resources that you can access and we will also have these on the website separate from the PowerPoint so you will be access them as well where the webinar will be housed so feel free to look at any of these.
The Special Olympics resources at the top are fabulous, there are a lot of PDFs, pamphlets, booklets, a few videos I think you might find beneficial as well.
And then, like I said too, we have all the presenters' long version of their bios in the webinar and that will be available online too.
And we will have all those.
>> KIERSI COLEMAN: I just wanted to add one more thing.
So when I called the insurance it was a special kind of consideration that you apply, that you tell that you need, that you have special healthcare dental needs I think it was, and that kind of shifts you from, like, using just the insurance that is provided for you and helps you get a referral, but I also had to tell them that I was having trouble eating, so, for other people with disabilities who may be watching or other folks, that is something that you might have to mention if you are having trouble receiving care.
>> ANGELA WEAVER: Great, thank you, Kiersi.
So if there are no other questions we will administer our poll now.
And I'm just going to make a black background for our poll, so, the first is to let us know who is joining us, you can identify yourself, self-advocate, family member, personal care provider, dental health professional, dental student, post second dare student, disabilities service provider, state or county public health employee.
And then you can scroll down to the second one.
Pen are already doing it.
Thank you.
While you are doing that too just as a reminder we do have part 2 of this webinar series next Wednesday on June 10th, it's a little bitter earlier, I think it's -- it's a little bit earlier, I think it's 11:00, that's primarily for dental professionals and dental students, anyone is welcome, it will have a little similar information shared today and then some different information.
So if you want more information we would love to have you join us next week.
I can stop sharing there.
So thank you all for filling out the poll, looks like everyone was able to complete that.
Yeah, any last comments from any presenters or from anyone who is joining us?
>> MICHAEL RICHARDSON: Thank you.
>> ANGELA WEAVER: Michael, did you want to say something?
>> MICHAEL RICHARDSON: No, thank you.
>> Angie:  We have someone asking about are there CEU units provided for today's webinar and next week's webinar?
>> ANGELA WEAVER: That's a great question.
Yes for next week's webinar.
This one we can give certificates for attendance if that is helpful but the CEUs are attached to the webinar next week.
Do this.
>> MICHAEL RICHARDSON: I want to give a shout out for those behind the scenes.
>> ANGELA WEAVER: Thank you, Mel and Angie, we appreciate it.
>> MICHAEL RICHARDSON: And, of course, our captioning provider.
>> ANGELA WEAVER: Yes, thank you, Linda.
Quite the team effort and I really appreciate everyone's effort and time for sure.
Well, if that's it, we will wrap up and maybe we will see some of you next week.
Thank you, everyone.
Bye!
>> KIERSI COLEMAN: Bye, thanks.