Oral Health for Rural Primary Care. Umass Rural Health Track August 31, 2015

Transcription

1 Oral Health for Rural Primary Care Umass Rural Health Track August 31, 2015

2 The case of Ms. N

3 Ms. N is an otherwise healthy 28 year old who presents to your clinic with CC: I have been up all night because my tooth hurts. She reports acute 10/10 pain localized to the back right molar starting last night She reports The tooth broke a few months ago and hurt a little then, but eventually the pain went away so I didn t do anything about it.

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10 Ludwig s Angina

11 Cavernous sinus thrombosis

12 Management Assist patient with finding dental home MassLeague search engine, MassHealth dental portal Many CHCs are not accepting new patients or have long waiting lists Call from healthcare provider can often get a patient care sooner than if patient called herself

13 Antibiotics or no antibiotics? Antibiotics are not curative for any odontogenic infection Extraction of tooth or pulp extirpation (root canal) are necessary to definitively treat infection Antibiotics can palliate infection on a shortterm basis

14 Antibiotic guidelines General guidelines advise antibiotic rx only if evidence of systemic infection (fever, chills) or localized spread (facial asymmetry, loss of nasolabial fold, trismus) However, in patients with limited access to a dentist, it can be appropriate to rx antibiotics for short-term control of dental pain and infection

15 RJ

16 Background RJ is a 2 ½ year old boy who presents to the clinic on your ambulatory care rotation with his mother RJ s family immigrated from El Salvador 3 years ago Mom says he has been fussy and refusing to eat, and has been holding his jaw for the past few days

17 How should you examine RJ s mouth? How many teeth should RJ have?

18 Lap-to-lap exam

19 Rule of 4 s Children have 20 teeth 4 new teeth erupt every 4 months starting at 7 months The first teeth to erupt are the mandibular incisors

20 What s wrong here?

21 What s bothering RJ?

22 What should we ask RJ s mother/caregivers?

23 RJ s family drinks bottled water because in El Salvador, tap water was not safe to drink RJ sleeps with a bottle of milk in his crib each night RJ s mother leaves for her job at a restaurant before he wakes up each morning, and the babysitter does not brush his teeth because he doesn t like it

24 Caries Risk Analysis

25 Treatment Apply topical fluoride Refer RJ to a pediatric dentist (likely he will need treatment in the operating room under general anesthesia) Follow up with family regarding dietary and behavioral changes, possibly refer to WIC, social worker, nutritionist

26 Baby L

27 Background Baby L is a healthy 9 month old who presents to you with her mother for a well-baby checkup Baby L lives with both of her parents in a home that they own in a rural area. The family gets their water from a well She has reached all normal developmental milestones

28 How many teeth might Baby L have? Which ones will most likely have erupted?

29 What questions might we have for Baby L s mom? What recommendations might we give?

30 Is mom breastfeeding? Breast milk alone is not cariogenic, but mixed with food it can be Are Baby L s teeth being cleaned? Recommend wiping babies mouths with a washcloth until teeth erupt Start brushing teeth as soon as they erupt Does she have a dentist? Recommend first dental visit by age 1

31 Anticipatory Guidance Prevent vertical transmission of S. mutans Pacifier use Snacking

32 Baby L s mother asks you, I heard that fluoride is actually a poison. Is it safe for my baby to drink water with fluoride in it, or use fluoride toothpaste?

33 Fluoridation There is no evidence of adverse health effects of fluoride at normal levels All children can use fluoride toothpaste Smear or rice-sized until age 2/3, then small pea size Ideal water fluoridation level is.7 ppm Families may have well water tested by state laboratories Consider fluoride supplements if non-fluoridated

34 In-office Prevention Topical fluoride varnish Local, rather than systemic, mechanism of action Inhibits bacterial enolase Fluorhydroxyapatite is more acid resistant than hydroxyapatite Use lap-to-lap positioning; it s okay if baby cries! Wipe teeth with gauze, then paint varnish onto all tooth surfaces No eating or drinking for 30 minutes for maximum effectiveness