The Health of a Population is the Sum Total of the Health of its Individuals

Transcription

1 The Health of a Population is the Sum Total of the Health of its Individuals Jed Jacobson, DDS, MS, MPH Chief Science Officer and Senior Vice President, Professional Services

2 Uncle Sam Wants You to brush your teeth!

3 Normal Functions of the Oral Cavity Speech (phonation) Display of emotions Digestion (mastication chewing) Diet (U.S. Surgeon Generals Report) Weight loss, fiber-rich foods Salivary enzymes

4 Normal Functions of the Oral Cavity Self image psychology research (hair, eyes, mouth)

5 Oral Infections Mouth contains: Millions of bacteria More than 700 different types of bacteria Most are harmless and/or helpful Dirty Dozen, these are pathologic bacteria Biofilm production is the one common characteristic of the Dirty Dozen Most people know about biofilm through the term plaque (combination of biofilm and bacteria)

6 Oral Infections Dental Caries: Tooth decay (60% of children) Caused by specific oral organisms, Strepptococcus mutans, and other acid producers Periodontal Disease: Caused by specific oral bacteria Gingivitis affects the soft tissue surrounding the teeth the gums (greater than 90%) Periodontitis bacterial infection results in loss of bone and ligament attachment of the tooth (47%)

7 Figure 17-1: Pathways of Infection Arising From Oral Bacteria Oral bacteria Oral infection (odontogenic, salivary, periodontal, mucositis) Distant site Local spread and invasion (osteomyelitis, cellulitis, fascial space) Permission granted by B.C. Decker Inc.

8 By Mary Otto Washington Post Staff Writer Wednesday, February 28, 2007 For Want of a Dentist Twelve-year-old Deamonte Driver died of a toothache Sunday. A routine, $80 tooth extraction might have saved him.

9 North Bay Nursing Home Blamed For Woman's Death NBC (TV) 11 - San Francisco Bay Area, July 6, 2007 PETALUMA, Calif. -- An investigation following the death of a resident at a nursing home in Petaluma determined the facility's negligence of a health problem led to the resident's death, Dr. Mark Horton, director of the California Department of Public Health said. The resident, a 76-year-old woman who required total assistance with daily living activities, died from dental abscess that led to cardiopulmonary arrest, according to the CDPH. The CDPH established the Pleasant Care Convalescent of Petaluma, the nursing facility where the resident lived, failed to provide routine dental services to ensure oral health. The Pleasant Care Convalescent of Petaluma received the severest citation and highest fine possible under state law, an AA citation and a $100,000 fine, according to Horton.

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11 Outcomes of Bacterial Endocarditis Average six weeks of hospitalization 20% (10 50%) mortality 10 20% prosthetic heart valves Average costs of hospitalization = $150,978 Giessel B, Koenig C, and Blake R. Management of Bacterial Endocarditis. American Family Physician, March 15, American Heart Association, Circulation 2003; 107: e185. Bacterial Endocarditis, The Disease, Treatment, and Prevention. Cabelle, Abrutyn E and Karchmer, A. Healthcare Cost and Utilization Project, 2002 Michigan State Inpatient Database. AHRQ, 2002.

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13 Outcomes of Bacterial Endocarditis UAW Chrysler population will experience 17 cases 17 cases = $2,415,649

14 Outcomes of Bacterial Endocarditis UAW Chrysler population will experience 17 cases 17 cases = $2,415,649

15 Outcomes 1 million total joint replacements are performed annually Cases of late prosthetic join infections = 1.7% (0 11.4%) Cost estimates: Salvage = $25,033 ($15,000 $30,000) Loss of prosthetic joint = $90,042 ($26,000 $267,000) Amputation = $79,480 ($27,000 $260,000) Death = $49,875 ($6,809 $122,574) * Jacobson JJ, Schweitzer SO, et al. Antibiotic Prophylaxis for Dental Patients with Joint Prosthesis? A Decision Analysis. Int J Technol Assess Health Care 1990; 6:

16 Average (Weighted) Direct Medical Costs of a Late Prosthetic Joint Infection Adjusted to 2014 $238,264 Average length of stay in the hospital (lost productivity): 100 days

17 Oral Cancer The Grim Statistics Approximately 45,780 Americans are diagnosed with oral cancer, claiming more than 8,650 lives 1 out of 100 will get oral cancer (3% of all cancers) The five-year survival rate is 60% Ranked #9 in deaths in the U.S. The mortality rate has not improved in the last 40 years As many people die of oral cancer each year as skin cancer or cervical cancer

18 Oral Cancer The Grim Statistics $94,491 One of the costliest cancers to treat 52% of people treated for head and neck cancer are unable to return to work (disabled)* If caught early, the survival rate is 81% If oral cancer is detected in its pre-cancerous stage, the disease is prevented * Cancerfacts.com June 22, 2004 Archives of Otolaryngology Head and Neck Surgery

19 Everyone. Why? Oral Cancer Who s at Risk? 25-50% of all oral cancer patients are non-smokers and non-drinkers 50-75% have risk factors Smoking, chewing tobacco, drinking alcohol Fastest growing segment being diagnosed is among young adults and women

20 Tobacco-Alcohol Account for 50-75% of Oral Cancer Chewing tobacco is advertised as a safer alternative to smoking but it s not. Increase in cancer risk: One pack/day = 4.5 times Smokeless tobacco = 4 times Six drinks/day = 3.3 times Tobacco and alcohol = 100 times Oral cancer is no longer an old man s disease in the U.S.

21 What s Changed?

22 v v 22

23 How Many People Have HPV in Their Mouths? Quite a few, say researchers.

24 v About 3.7% have high-risk oral infections from HPV 16 & HPV 18 Men are more likely to have HPV 10.1% vs. 3.6% v

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28 What Do I Do? Brush your teeth daily and floss regularly. Visit your dentist at least once/year. Ask if he/she performed an oral cancer exam. How do I know? If you have tooth decay or periodontal disease, get it treated. Consider HPV vaccine for your kids.

29 Questions? Thank you!