Oral Health Care: The window to overall health Head 2 Toe Conference May 9, 2013 Christy Cogil, RN, CFNP and Dr. Melissa Ravago, DMD
Oral Health in America Oral health is essential to the general health and wellbeing of all Americans. You cannot be healthy without oral health. David Satcher, MD, PhD Oral Health in America, 2000
Oral health is not just about strong teeth! Oral and craniofacial structures Gums Palate Lips Tongue
Oral Health affects overall Health Poor oral health leads to: Higher blood sugar levels in diabetics Pre-term labor in pregnant women More pain in people with rheumatoid arthritis Worsening of pneumonia and chronic obstructive pulmonary disease (COPD) Possible links to: Increased risk for heart disease Dementia
Poverty is the most significant risk factor predicting oral disease.
New Mexico Dental Shortage The number of dentist to population is 1:3,297 compared to U.S. standard of 1:1,050 Inner-city and rural communities struggle to recruit and retain dental providers 3 New Mexico counties do not have a dentist New Mexico Department of Health - Oral Health Data
It HURTS!!! 51 million school hours lost each year due to dental related illness Oral Health in America, 2000 2000 screening of a sample of New Mexico third graders 37% had untreated decay 64% experience dental decay 43% had one or more sealants New Mexico Department of Health - Oral Health Data
Children and oral health Early childhood caries is the #1 chronic disease in preschool children Dental caries are 5 times more common than asthma AND 7 times more common than allergies AAP recommends that children have first dental visit by age 1 USDHHS, 2000 Oral Health in America
Anatomy of the Tooth
This can be prevented!
Dental Caries and Children Can be acquired with first tooth Associated with poor growth 1 out of 3 miss school 1 out of 4 don t smile or laugh Treatment often means going to the hospital
Knowledge, Beliefs, Attitudes Baby teeth are going to fall out anyway Tooth loss is part of growing old Wait until it hurts Wait until pain outweighs fear of dentist
Reasons for inability to obtain dental services 1. Cannot pay for services (#1 overall) 2. Difficulty scheduling appointment 3. Cannot leave work or responsibility 4. Insurance was not accepted 5. Cannot get transportation 6. Too far away HPC Household Survey 1999
Dental Caries Infectious bacteria Streptococcus mutans Progressive Increases the risk for future decay
Recipe for Cavities
White Spot Lesions Demineralization of the tooth Early signs of decay
Plaque Harbors Strep mutans
CAMBRA Caries Management By Risk Assessment
Luke s Oral Health History Luke is 14 year old coming to the SBHC for the first time this year. You have seen Luke in previous school years for preparticipation sports physicals. You want to use the Caries Management by Risk Assessment (CAMBRA) tool to determine Luke s risk for caries. He lives with his younger brother and mother who works as a teacher s aide in the elementary school. Luke has no learning issues and qualifies for Salud Medicaid. Luke went to see the dentist over Christmas break. He proudly states that he had no cavities. He tells you that his last cavity was when he was in second or third grade. Luke doesn t know for sure, but he thinks his mom hasn t had any cavities for a long time. Luke doesn t like milk. He drinks juice or chocolate milk with his meals. During the summer months he drinks soda pop or Gatorade 2 or 3 times a day. In the winter, he only drinks it after football or basketball practice and games. The town where Luke lives no longer adds fluoride to the city water. He uses Crest toothpaste (has fluoride) to brush his teeth once or twice a day, when he remembers.
Connecting the CAMBRA and Plan of Care Low Risk Review oral hygiene and diet Support current oral health practices Moderate risk Review oral hygiene and diet Note to parent encouraging dental appointment Follow up in three months to reassess oral health High risk Review oral hygiene and diet Referral to dentist Follow up in a month to assess plan of care
Lifestyle Prevention Measures Diet eat sweets with meals not in between meals Personal oral hygiene brushing twice daily Fluoride
Who should receive fluoride varnish? Bulimic patients Orthodontic patients Those with meth mouth
Erosion Caused from vomiting Bulimia Acid reflux
Meth Mouth Methamphetamine decay Caused by: decrease in salivary flow bruxism (grinding of teeth) high sugar intake disregard for oral hygiene during times of drug use.
Causes of Fluorosis Birth place (commonly seen in Mexico born population) Taking fluoride supplements Using fluoridated tooth paste before patient can expectorate
Infection/Abscess Palpate area If fluctuant and tender to touch it is an abscess Antibiotics of choice for dental infections Penicillin If allergic to Penicillin, use Clindamycin Patient needs an appointment with a dentist soon
Periodontitis
Gingival Hyperplasia Caused by: Poor Oral Hygiene Dilantin Valproic acid Cyclosporine Sometime drugs can be altered. Can be improved with good oral hygiene
Normal Anatomy
Common Unusual Presentations
Risk Assessment: Protective Factors Establish a dental home Drink fluoridated water Fluoride varnish every 3-6 months for children Teeth brushed twice daily Daily flossing Use fluoride mouthwash daily Sugar-free chewing gum with xylitol prevents the build up of Strep mutans
How much toothpaste for kiddos?
Intra-oral exam Oral Examination Lips lift lip; look at gums and teeth Mucosa of the cheeks look for ulcerations Open wide Teeth check biting surfaces Palate look for unusual discoloration of skin Tongue Stick out tongue and look for anything unusual Lasso the tongue and look at lateral sides, then lift and look underneath for anything unusual
Thank You!
References American Academy of Pediatrics. Children s Oral Health. http://www2.aap.org/oralhealth/index.html American Academy of Pediatric Dentistry Caries-Risk Assessment Tool(CAT). Retrieved from http://orthodontics.org/caries-riskassesmenttool(cat).pdf Council on Clinical Affairs. (2011). Guideline on caries-risk assessment and management for infants, children, and adolescents. American Academy of Pediatric Dentistry, 34(6), 118-125. Department of Health and Human Services. (2000). Oral health in America: A report of the Surgeon General. Washington D.C.: Author. New Mexico Department of Health Oral Health Data. Retrieved from http://www.health.state.nm.us/phd/ooh Reynis, L.A. & Alcantara, A. (2000). Health care coverage and access in New Mexico: An analysis of the 1999 health policy commission survey of health care coverage. Bureau of Business and Economic Research. University of New Mexico.