Sugar Gums Diabetes and Gum Disease
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1 Sugar Gums Diabetes and Gum Disease Royal Flying Doctor Service South Eastern Section Dr. Lyn Mayne, Dental Team Leader
2 Background The RFDS and Oral Health Around the federation Various approaches/models Oral Health as an integral service in Primary health care SE Section Partners: Maari Ma and FWLHD Lyn Mayne / Linda M Cutler
3 TOOTH Program The Outback Oral Treatment and Health Program(Dubbo) Dentist Oral therapist Benevolent funds Students partnerships
4 Sugar Gums the project Aim To Reduce the HbA1c level in diabetic patients in Menindee who have an existing HbA1c >7, following dental evaluation, treatment and education within a 6 month period Lyn Mayne / Linda M Cutler
5 Team Members Dentists from RFDS GPs from RFDS Practice Nurse from RFDS Oral Health Therapist from FWLHN, Broken Hill Dental Assistants from FWLHN, Broken Hill Aboriginal Health Workers from FWLHN, Menindee Health Service Manager from FWLHN, Menindee
6 Periodontal Disease Periodontal disease is a chronic inflammatory disease, which results in the loss of the supporting structures of the teeth, through the formation of pathological pockets around the diseased teeth. Periodontal disease is responsible for a substantial proportion of tooth loss in adults.¹ 1 Harold Löe, Diabetes Care 16: , 1993
7 Identification of the problem: Review of medical history of diabetic patients in Menindee, identified Significant number identified as aboriginal Significant number had HbA1c >7 Significant number had not had oral health treatment or education So why is this an issue?
8 Diabetes and Periodontal Disease People with diabetes are two times more likely to develop periodontitis compared with those that do not have diabetes.² Effective treatment of periodontal infection and reduction of periodontal inflammation is associated with a reduction in the level of glycated hemoglobin.³ Periodontitis is recognised as the sixth complication of diabetes.¹ Aboriginal people are 3 4 times more likely to have diabetes. 4 Aboriginal people are 1.3 times more likely to have periodontal disease.5 2. Mealey BL, Ocampo GL Diabetes Mellitus and Periodontal Disease Periodontal ;44: Grossi S,Skrepcinski F,DeCaro T, Robertson D, Ho A,Dunford R, Genco R : Treatment of Periodontal Disease in Diabetics reduces Glycated Hemoglobin Journal of Periodontology August 1997;Vol 6: Diabetes Australia Aboriginal and Torres Strait Islanders and Diabetes Action Plan: 12 March Roberts Thomson K, Slade GD: 2007 Australia s dental generations: the national survey of adult oral health
9 Diabetes is on the increase and is one of the most common chronic diseases amongst Aboriginal people. Poorly controlled chronic disease patients, are often the cause of emergency call outs
10 High Level Flow Client Patient comes into prison Diabetic patient Referred to dentist Detailed Level Flow Diagnosed with diabetes NO Yes Data HbA1C >7 Patient List Data Chronic disease GP Cardiologist Endocrinologist Renal Specialist Podiatrist Referral to dentist Oral health treatment and education Follow up with Practice Nurse/case manager Patient makes own appointment Outside desired range Re-Referred Chronic disease GP/ Case / Practice manager Dental exam including periodontal Oral health education and follow up treatment Blood test HbA1c Routine Dental follow up Within desired Range
11 Ishikawa Diagram Clinicians Patients Scheduling Importance of oral health Attendance Cost Time Compliance Instruments Rostering Increased time required ( steri) Clinic Availability Staff Communication costs Resources Organisation
12 Interventions Posters to create awareness of the problem Educate GP and Health Workers to refer diabetic patients
13 Clinical Evaluation Full Medical History Oral Examination soft tissues, including: Basic Periodontal Examination (BPE) 0 No pockets > 3.5mm, calculus 1 No pockets > 3.5mm, no calculus, bleeding 2 No pockets > 3.5mm, calculus 4 1 3* Probing depth mm 4 Probing depth >5.5mm BPE Grid * Furcation hard tissues, including: Caries Existing restorations Broken teeth Dentures present or required Initial scaling ( cleaning)
14 Patient Education Pack Tooth brush Toothpaste for sensitive teeth Interdental Brushes Diabetes and Dental Care pamphlet Home Dental Care Instructions
15 Patient Results No Name Sex DOB Initial HbA1c Date Final date dental 1 EB F 13/06/ Aug Mar 14 incomplete 3 2 PD F 15/09/ Feb May 14 incomplete 2 3 NF F 14/03/ Nov Feb 14 incomplete 2 4 MH M 29/12/ Aug Feb 14 complete 1 dentures 5 DJ M 12/04/ Dec May 14 complete 3 dentures 6 CJ F 10/10/ Dec Jan 14 complete 1 7 EK F 23/10/ Nov May 14 complete 1 8 LK F 11/05/ Dec 14 9 Feb 14 complete 2 9 DK F 14/11/ Sep May 14 incomplete 4 10 LM F 3/09/ Feb Mar 14 complete 1 dentures 11 DM F 12/03/ Aug May 14 complete 1 dentures 12 KP M 2/06/ Sep Apr 15 complete 1 13 VQ M 20/10/ Dec Jan 14 complete 1 14 KS M 6/05/ Oct May 14 incomplete 1 15 BS F 31/01/ Aug 13 7 Mar 14 complete 2 16 DS F 30/05/ Sep Feb 14 complete 2 dentures 17 RT M 26/02/ May Apr 14 complete 2 18 RW M 15/07/ Sep Apr 14 complete 1
16 Before and After Oral Health Intervention 12 HbA1c Pre and Post Treatment Pre Treatment Post Treatment Patient Number Lyn/Mayne/Linda M Cutler
17 Data Analysis/ Results 12 patients had a decrease in HbA1c of 0.1 to 2.9 = 66.66% 4 patients had a decrease of 0.5 or more = 22.22% 4 of the 5 patients with dentures had a decrease 1 patient informed us that he keeps his high because it makes him feel better ( had a decrease from 9.7 to 9.3) Equal number of completed treatment and incomplete treatment
18 Patient Outcomes Improved periodontal health: increases chances of keeping dentition Improves HbA1c Improves stability of diabetes Decreases acute exacerbations of disease Promote Healthy Living Educate patients in importance of oral health Promote self care Targets high risk groups, elderly, chronic diseases and aboriginals
19 Teamwork and Partnerships Multidisciplinary approach to treatment of diabetic patients within oral health team within FWLHD, including nurses, aboriginal health workers and administrative staff across organisation of FWLHD, RFDS and Maari Ma
20 Sustainability Referral of diabetic patients Utilise hygienist skills of oral health therapist for cleaning and education Follow up HbA1c Ongoing oral health treatment and education as required
21 What did we learn? impact of collaborative approach importance of oral health care to and for the patient importance for the services involved
22 Conclusions oral health status of diabetic patients makes a difference to HbA1C levels Bringing together the multidisciplinary team to focus on one issue has multiple impacts This approach is easily adapted into business as usual and is able to be sustained post project
23 Questions?
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