09/12/2012. Tennessee Public Health Association_2012 1

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1 Tennessee Public Health Association_2012 1

2 Integrating Evidence-Based Practices Practice Guidelines and Best Practices Focusing on the Body as a System Evaluating the Literature Strength of Evidence Medical Conditions/Disease Associated with Dental Conditions/Disease Systemic Disease HPV; HIV; Diabetes; Crohn s Disease; Anticoagulation Tx Pregnancy ECC Collaborations/Knox County Programs Contact Information References Goal: Prevent and control oral and craniofacial diseases, conditions, and injuries, and improve access to preventive services and dental care. By what age does your state EPSDT guidance recommend a referral for a dental examination? 3 years oldv.asp?stateid=tn&year= Tennessee Public Health Association_2012 2

3 CDC: A National Call to Action to Promote Oral Health 1. Change perceptions of oral health. 2. Overcome barriers by replicating effective programs and proven efforts. 3. Build the science base and accelerate science transfer. 4. Increase oral health workforce diversity, capacity, and flexibility. 5. Increase collaborations. Tennessee Public Health Association_2012 3

4 35 yobm Health History negative No medications Cause Effect Associated relationship Tennessee Public Health Association_2012 4

5 Case Reports Case Control Study Cohort Study Randomized Controlled Trial Practice Guidelines Systemic Review Meta-Analysis Weakest Strongest Tennessee Public Health Association_2012 5

6 Diabetes Cardiovascular Disease HIV Crohn s Disease Antibiotic Guidelines Premedication AHA Guidelines Joint Replacement Anticoagulation INR Current Practice Guidelines Tennessee Public Health Association_2012 6

7 HIV EBV Kaposi s Sarcoma HPV Diabetes Leukemia HPV ~ 120 virus types 5 low risk HPV types 13 high-risk HPV types Benign sequela Skin warts Cancerous sequela Cervical Cancer Anogenital Cancer H&N Cancer (HPV 16&18) Risk Factors Alcohol Tobacco HPV (16 &18) associated with H&NSCC Diagnosis at a younger age Higher survival rate than non-hpv related OSCC Tennessee Public Health Association_2012 7

8 Two Vaccines Bivalent vaccine (Cervarix) HPV 16 and 18 Quadrivalent vaccine (Guardisil) HPV 6, 11, 16, 18 Will it positively affect the future of the recent rise of OSCC? Decrease Bacterial Load of the Mother Education Nutrition Balance Limited Exposure to Carbohydrates/Sugar Home Care Good Oral Health Care Habits Transmission of Disease Routine Preventive Tx Pregnancy Gingivitis Pyogenic Granuloma Tennessee Public Health Association_2012 8

9 28 yohf Prenatal Anemia Medications: Prenantal vitamins and iron Decrease Bacterial Load of the Mother/Cargiver Education Nutrition Home Care Routine Preventive Tx Early Home Care First Dental Visit by First Birthday Nutrition Home Care Routine Preventive Tx Tennessee Public Health Association_2012 9

10 4 yo with ECC Dry mouth Many medications HAART Psycotrophics Gingival Hyperplasia Antihypertensives nifedipine amlodipine Tennessee Public Health Association_

11 Huge Effect of Diet on Caries Soda Sports Drinks Carbohydrates Night time bottle at bedtime What does is contain? Sippy Cups FREQUENCY OF CONTACT Tennessee Public Health Association_

12 EPSDT Visits Women s Health WIC Ryan White Diabetic Clinics Oncology Chemotherapy & Radiation Treatment Thanks!! Tennessee Public Health Association_

13 Carol Ann Shipley, DDS MPH 140 Dameron Avenue Knoxville, TN Work Phone: Fax: Tennessee Public Health Association_

14 Department of Health & Human Services; Maternal and Child Health Bureau Oral Health Leading Health Indicators Healthy People 2020 healthypeople.gov/2020/lhi/oralhealth.aspx CDC A National Call to Action to Promote Oral Health ; NY Times Sharp Cuts in Dental Coverage for Adults on Medicaid 28 August 2012 Caries Prevention, Risk Assessment, Diagnosis, and Treatment Rothman, M., et al. Nonfluoride caries-preventive agents, JADA 142 (9): , September 2011 Bader, J., et al. Physicians Roles in Preventing Dental Caries in Preschool Children, US Preventive Services task Force; ADA Guidelines for prescribing Dental Radiographs FDA Pregnancy Categories UW Drug Information Center. Medication Exposures During Pregnancy and Lactation Kinkade, K., Which Common Meds Put Pregnant Women, Infants at Risk? 09 August 2012 Radiation and Pregnancy: A Fact Sheet for Public Health Mughal, R., Dentists Not Following Antibiotic Prescribing Guidelines, 06 January 2012 Guidelines on Use of Antibiotic Therapy for Pediatric Dental Patients, American Academy of Pediatric Dentistry, V33: No 6, 11/12 Hulbutt, M., CAMBRA: Best Practices in Dental Caries Management, Dental CE Digest, August 2011 Watterson, D., Emerging Concepts in Periodontitis and Overall Health Separating Fact from Fiction, Professional Dental Management Oral Health During Pregnancy & Early Childhood: Evidenced-Based Guidelines for Health Professionals ADA Center for Evidenced-Based Dentistry Tennessee Public Health Association_

15 Section on Evidence Based Health Care, The New York Academy of Medicine Chaturvedi,A., et al. Incidence Trends for Human Papillomavirus Related and Unrelated Oral Squamous Cell Carcinomas in the United States American Society of Clinical Oncology; 01Feb2008 vol.26, no. 4, Clavel C, et al. Hypbrid Capture II-based human papillomavirus detection, a sensitive test to detect in routine high-grade cervical lesions: a preliminary study on 1518 women. Br J Cancer. 1999;80; Reddout, N. High risk HPV types 18 and 16 are potent modulators of oral squamous cell carcinoma phenotypes in vitro. Infectious Agents and Cancer 2007,2:21. DynaMed search: cavities; anticipatory guidance (pediatric preventive care); Updated 2012August 1:37pm (Pediatrics2012 Jun); oral health-oral health recommendations. "What is EBM?". Centre for Evidence Based Medicine Retrieved Alan L Lin; Dorthea A Johnson; Carol Ann (Shipley) Sims; Kevin T Stephan; Chih-Ko Yeh. Salivary gland function in HIV-infected patients treated with highly active antiretroviral therapy (HAART). Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 2006;102(3): Tennessee Public Health Association_