Oral Health Across the Life Span. MMS Women s Health Conference. Hugh Silk, MD, MPH Professor Nov 6, Family Medicine and Community Health

Transcription

1 Oral Health Across the Life Span MMS Women s Health Conference Hugh Silk, MD, MPH Professor Nov 6, 2015 Learning Objectives By the end of this talk participants will be able to discuss: Why oral health matters for overall health for all women Different hormonal states in life affect gum health which affects many health conditions Dental treatments are SAFE throughout life What can you do specifically to help patients with their oral health and therefore their overall health 1

2 Disclosures I have no financial disclosures. Why oral health matters for overall health Or Why You Should Care 2

3 The Big Picture 6 You are not healthy without good oral health -David Satcher, MD, 16 th Surgeon General 2000 Surgeon General's Report on Oral Health Dental care is the most common unmet health need Oral disease can severely affect systemic health Much oral disease is preventable or at least controllable Profound disparities in oral health and access to care exist for all ages Interdisciplinary care is necessary to achieve optimal oral and general health 3

4 70% of seniors do have dental insurance 4

5 How Often Oral Disease Affects Us Severe gum disease affects 1/5 th of adults aged ~ links to DM, CAD new oral/pharyngeal cancers; 8000 deaths; 2.5% all CA; people 50% of the elderly perceive their dental health as poor/very poor; 33% have untreated cavities 10 5

6 The Consequences Oral pain can cause Poor school performance in children Work loss in adults Difficulty chewing and inadequate nutrition Costly emergency department visits (2% all visits; 2.3 million visits) Photo: Donald Greiner, DDS, MS 11 Dental decay and tooth loss can lead to Aesthetic and self-image issues Speech/language development problems Costly restorations Photo: ICOHP WHY? Pew Charitable Trust Sept

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8 Update in Prenatal Dental Care 15 Safety Dental xrays safe throughout pregnancy Dental pain medications are safe (except NSAIDS 3 rd trim) Dental antibiotics safe during pregnancy (except metronidazole 1 st trim) Cleanings, extractions, restorations (filings), deep root scaling = safe Be aware of hormonal affects 8

9 Managing Anticoagulation Thromboembolism is 3 times more likely than major bleeding if anticoagulation is continued Cleanings, fillings, and simple extractions can be performed without interrupting anticoagulation/antiplatelet Most procedures can be performed with an INR between 1.8 and 2.5 Bleeding can be controlled with pressure, Surgicel, tranexamic acid, or topical thrombin If patients who must remain anticoagulated require major oral surgery that caries a high risk of bleeding, transition to perio-operative heparin should be considered Effective interprofessional communication is vital 9

10 Antibiotic Prophylaxis Only the following medical conditions require antibiotic prophylaxis for dental procedures where bacteremia could occur Prosthetic heart valves, previous endocarditis, unrepaired congenital heart disease, post-transplant valvulopathy See 2007 AHA guidelines Prosthetic joint replacements Vascular grafts (less than 6 months old) Arteriovenous hemodialysis shunts Neurosurgical shunts (dependent on type) Indwelling vascular catheters What can you do specifically to help your patients 10

11 Get further educated Know the MassHealth Dental Benefits MassHealth dental benefits include: complete checkup (once with each new dental provider) regular checkups (twice per 12-month period) cleanings (twice per 12-month period) radiographs (X-rays) extractions emergency dental care fillings for all teeth starting March 1!!! Members under 21 get these additional benefits: Crowns and root canal fluoride treatments sealants custom-fitted mouth guards for sports 11

12 Dentists in MA Accepting Mass Health* Goal = Drive to 65 for state Options for those w/o dental insurance Community Health Centers Dental Schools Dental Hygiene Schools Care Mobiles (e.g. UMassMemorial) Know your local dentists 12

13 Adolescents Recognize hormonal effects in mouth Discourage piercings explain risks Diet promote healthy snacks; devalue sports, soda and energy drinks Sports - mouthguards Appearance as motivation 25 Pre-Conception, Pregnancy Based on ACOG recs: Ask about oral health at intake Have prompts to systemize this Give handouts in prenatal packet Refer all prenatal patients for check up Know safety of treatment MA Guidelines coming soon! 26 13

14 Adults/Geriatrics Look in the mouth especially high risk individuals for oral CA (level C) Know your lesions Discuss hygiene, dental care Make links to their health issue(s) Advocate for full dental benefits in MassHealth; Medicare to cover dental? 27 How to Make it Work Individually ROS review of systems while examining the patient (eyes-vision, ears-hearing, mouth-brush,floss,have dental insurance, visit dentist, etc) Personal motivation e.g. diabetes control better dental care or another pill? Know local resources dentists accepting Medicaid, dental hygiene school, FQHCs 14

15 How to Make it Work Practically Team Approach PCMH CPE/chronic care visit questionnaire, MA/nurse review, MD examine and refer, admin staff have referral info and handouts On admission to nursing home/hospital; proper exam of the mouth EHR prompts for assess and exam, plan, referral and handouts 15

16 Conclusions Oral health matters for overall health Hormones affect oral health Dental treatment is safe You can specifically help patients by asking, examining, documenting, referring knowing and caring 32 16

17 Questions 17