9/30/14. Oral Health Integration: What are Primary Care Clinicians to do? My Patients. My Goal
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1 9/30/14 Oral Health Integration: What are Primary Care Clinicians to do? Tobacco Dependence as a Chronic Disease October 2, 2014 Louisville, KY A. Stevens Wrightson, M.D. My Patients My Goal Remind the audience of tobacco influenced oral pathology Present a brief argument for oral health integration Introduce Smiles for Life: a National Oral Health Curriculum 1
2 Oral Effects of Tobacco Use Tooth stains Altered taste and smell Periodontitis Xerostomia Caries Oral, Head and neck cancers Congenital anomalies in offspring, such as cleft lip and palate Leukoplakia in Bhutanese refugee Periodontal disease 6 2
3 Oral Cancer Iatrogenic xerostomia 65 year old male on multiple medications for depression and heart disease develops severe caries. 8 Oral Health Disparities Children 2.5 times more likely to lack dental coverage than medical coverage 30-50% of low SES children have ECC 80% of the decay is in 20% of children Elderly 43% of the elderly visit the dentist 70% lack dental insurance Poverty, lack of mobility, disability and institutionalization all contribute to poor access to oral health care Rural and poor Geographic and economic barriers to care Minorities Hispanics at all ages have a higher rate of caries and caries experience compared to non Hispanic whites Survival rates of oral cancer lower in African Americans compared to whites 3
4 IOM report: Vision for Oral Health Care The committee envisions oral health care in the United States in which everyone has access to quality oral health care across the life cycle. To be successful, an evidence-based oral health system will: Eliminate barriers that contribute to oral health disparities Prioritize disease prevention and health promotion Provide oral health services in a variety of settings Rely on a diverse and expanded array of providers who are competent, compensated, and authorized to provide evidence-based care Include collaborative and multidisciplinary teams working across the health care system Foster continuous improvement and innovation In addition, the committee established two principles to guide its deliberations: Oral health is an integral part of overall health, and therefore, oral health care is an essential component of comprehensive health care Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care Why Engage Primary Care Children are seen in a primary care provider s office 8-10 times or more before they see a dentist Patients are more likely to be able to identify a medical home than a dental home Urgent dental needs, like abscesses or fractures, are very likely to be seen by a medical provider before the patient sees a dentist, especially for those without dental insurance Preventive services are anticipated, even expected, in the primary care clinician s office Smoking cessation Diet and weight counseling Oral health Dental visit in last 12 months (Income/ education) 4
5 Dental visit in last 12 months (Race) National Goals HRSA: Integration of Oral Health and Primary Care Practice (2014) Creation of core clinical competencies for medical providers Risk Assessment Oral Health Evaluation Preventive Interventions Communication and Education Interprofessional Collaborative Practice Systems analysis Implementation strategies for change Building OH Workforce Capacity IP OH Core Clinical Competency 15 5
6 Education Third Edition Smiles for Life National Oral Health Curriculum: History Surgeon General s Report HRSA and private grants (CT, KY, TX, WA) Development st Edition Pregnancy module Varnish module nd Edition CME credit rd Edition Geriatric Module 2012-Oral Health in Medicine Development Awards (AAMC) Endorsed by the American Dental Association 6
7 curriculum Overview 8 annotated 50 minute modules- web and PowerPoint 1. The relationship of oral to systemic health 2. Child oral health 3. Adult oral health 4. Dental emergencies 5. Oral health in pregnancy 6. Fluoride varnish 7. The oral examination 8. Geriatric oral health Interactive cases, test questions, CME credit with certificate Resources for further learning Smiles)For)Life)User)Professions) Assistant) 1%) Other) 19%) Hygienist) 3%) Den8st) 5%) Physician) 24%) Physician) Assistant) 21%) Nurse)or)NP) 27%) 7
8 9/30/14 Kyhealthnow 2019 Goals Reduce Kentucky s rate of uninsured individuals to less than 5% Reduce Kentucky s smoking rate by 10%. Reduce the rate of obesity among Kentuckians by 10%. Reduce Kentucky cancer deaths by 10%. Reduce cardiovascular deaths by 10%. Reduce the percentage of children with untreated dental decay by 25% and increase adult dental visits by 10%. Reduce deaths from drug overdose by 25% and reduce by 25% the average number of poor mental health days of Kentuckians. 8
9 Final Thoughts Oral health can be integrated into the medical management and care of patients Consistent with PCMH goals for patient, staff and the community Tobacco cessation Hygiene Nutrition and activity Preventive strategies improve oral cancer awareness and may allow for early diagnosis and treatment 9
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