TACHC 27th Annual Conference October 2010


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  • www.ihi.org When care is PC, unneeded and unwanted services can be reduced
  • Currently, there’s a disconnect between dept, hospitals, all levels of providers- PCP, specialists etc
  • Preeclampsia- 50% of placentas from women w PE were positive for one or more periodontal pathogens
  • Periodontist- 3 yrs additional residency who is uniquely qualified to identify and utilize surgical and nonsurgical procedures for treating PD
  • CHC do serve a need and provide access
  • Shift gears: why is it important for your patient to be integrated with oral health professional???
  • Plaque and calculus build on the gum-line Plaque’s bacteria produce enzymes that begin to breakdown the connection between the supporting soft tissue and the tooth As the disease progresses, bacteria destroy bone tissue
  • A major disease with an oral health connection is heart disease-
  • Although CVD risk screening is a valuable preventive approach to detect those at risk of developing disease and refer them accordingly, another preventive strategy is through education, encouragement and reinforcement of healthful lifestyle behaviors such as diet. HTN: Painless,See dental when toothache,Only provider, more frequent, first line for diagnosis Understand why HTN is a silent killer
  • Examples of coordinated care Oral and pharyngeal cancer is the sixth most common malignancy reported worldwide and one with high mortality ratios among all malignancies.
  • lost 3 teeth, alot of gum and the inside lining of my cheek 37 lymphnodes removed, my jawbone was shaven to half of it's thickness and a plate was added with screws to strengthen my jaw. Leg tissue was removed and used to replace what was removed. General dentist Oral Surgeon Oncologist
  • The death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intra oral area. Besides the metastasis, at these later stages, the primary tumor has had time to invade deep into local structures. Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors. This means that patients who survive a first encounter with the disease, have up to a 20 times higher risk of developing a second cancer.
  • Prevention #7 most common chronic Missing school Pain Transmissable disease between generations
  • Never seen pedi or dentist- only for immunizations Came in for emergency exam to Pedi MD, walked over to dental and asked to see pt Mucocoele removed 1 week before school started, time to heal Unfortuneately, years of neglect had caused this patient several abscesses
  • TACHC 27th Annual Conference October 2010

    1. 1. TACHC 27 th Annual Conference October 2010 San Antonio, TX Dr. M. Zamora Dental Director
    2. 2. <ul><li>Makes Patients and their loved ones an integral part of the care team who collaborate with health care professionals in making clinical decisions </li></ul><ul><li>Makes Patients responsible for important aspects of self care and monitoring – along with tools and support they need to carry out that responsibility </li></ul><ul><li>PCC considers: </li></ul><ul><ul><li>Cultural traditions </li></ul></ul><ul><ul><li>Personal Preferences and Values </li></ul></ul><ul><ul><li>Family situations </li></ul></ul><ul><ul><li>Lifestyles </li></ul></ul><ul><li>Ensures that transitions between providers, departments, and health care settings are respectful, coordinated and efficient </li></ul><ul><li>Integrative: To make whole by bringing all parts together; unify ( American Heritage Dictionary of the English Language, Fourth Edition copyright 2000 by Houghton Mifflin Company. Updated in 2009.) </li></ul>
    3. 3. <ul><li>Oral Health Care Professionals rarely address mental or physical systemic health </li></ul><ul><li>Medical Health Professionals rarely address Oral Health </li></ul><ul><li>A new paradigm between Dentistry and Medicine is now developing regarding patient care </li></ul><ul><li>Informed Patients </li></ul><ul><li>Health Care Reform </li></ul><ul><ul><li>HH model: incentives for managing pt’s outcomes by integrative care </li></ul></ul>
    4. 4. Lifesaving Checkup: The Dentist A healthy mouth reduces your risk for heart attack and stroke. Learn why seeing the dentist could save your life.
    5. 5. <ul><ul><li>Research has identified periodontal disease as a risk factor for heart and lung disease, diabetes, premature, low birth weight babies and a number of other conditions </li></ul></ul><ul><ul><li>The most significant areas identified with systemic connection: </li></ul></ul><ul><ul><ul><li>CVD </li></ul></ul></ul><ul><ul><ul><li>Pulmonary disease </li></ul></ul></ul><ul><ul><ul><li>Fetal development, Preeclampsia </li></ul></ul></ul><ul><ul><ul><li>Diabetes </li></ul></ul></ul><ul><ul><ul><li>Orthopedic Implant Failure </li></ul></ul></ul><ul><ul><ul><li>Kidney Disease </li></ul></ul></ul><ul><ul><ul><li>*Dementia </li></ul></ul></ul><ul><li>(Moffett, Frances. 2010. Oral –Systemic Relationship. Retrieved from http://www.adha.org/CE_courses/course_13/systemic_relationship.htm) </li></ul>
    6. 6. <ul><li>The 2000 Surgeon General’s report, Oral Health in America, has called attention to this connection and states that, if left untreated, poor oral health is a “silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year.” </li></ul><ul><li>(Moffett, Frances. 2010. Oral Health-Total Health: Know the Connection. Retrieved from http://www.adha.org/media/facts/total_health.htm) </li></ul><ul><li>As the oral-systemic connection is more clearly understood, dentists will play a greater role in the overall health of their patients </li></ul><ul><li>Many times, the signs of unnatural systemic health conditions reveal themselves with changes in the oral cavity </li></ul><ul><li>(Moffett, Frances. 2010. Oral –Systemic Relationship. Retrieved from http://www.adha.org/CE_courses/course_13/systemic_relationship.htm) </li></ul>
    7. 7. <ul><li>Dentist’s role </li></ul><ul><ul><li>RMH to identify ‘at risk’ patients </li></ul></ul><ul><ul><ul><li>EX: Uncontrolled HTN </li></ul></ul></ul><ul><ul><li>Comprehensive periodontal (PD) exams </li></ul></ul><ul><ul><li>Results of these exams should be sent to the patient’s physician(s) </li></ul></ul><ul><li>Physician’s role </li></ul><ul><ul><li>Play a more active role in oral systemic connection </li></ul></ul><ul><ul><li>Screen at risk patients for common signs of PD, which include bleeding gums, swollen gums, pus, shifting teeth, chronic bad breath and family history of PD </li></ul></ul><ul><ul><li>Referral to Dentist or Periodontist </li></ul></ul><ul><li>This new era of interdisciplinary dental/medical cooperation will undoubtedly result in improved patient health, as well as an improvement in overall patient longevity. </li></ul>
    8. 8. <ul><li>EX: Forms </li></ul>
    9. 9. <ul><li>Insurance </li></ul><ul><ul><li>In 2000, 108 million lack DI( SG report) </li></ul></ul><ul><ul><li>Limited coverage </li></ul></ul><ul><li>Cost of Delivering Care </li></ul><ul><ul><li>From 1996 to 2004, average cost of dental procedure rose 25% </li></ul></ul><ul><li>Shortage of Dentists </li></ul><ul><ul><li>Fewer Dental School graduating less students </li></ul></ul><ul><ul><li>5750 in 1982, 4440 in 2003 (ADA) </li></ul></ul><ul><li>CHC Programs </li></ul><ul><ul><li>2008 UDS: 1200 CHC in US; 888 with Dental Programs </li></ul></ul>
    10. 10. <ul><li>~80% of American adults have some form of PD and the majority of them do not realize they have it, because its early stages are usually painless (http://www.nlm.nih.gov/medlineplus /gumdisease.html) </li></ul><ul><li>It ranges from simple gum inflammation, called gingivitis, to serious disease that results in damage to the bone </li></ul>
    11. 12. Periodontology
    12. 13. The Chairside Instructor. A pictorial guide to case presentation. ADA . 2005.
    13. 14. Periodontology
    14. 15. Periodontology
    15. 16. <ul><li>PD affects 15% of women of childbearing age </li></ul><ul><li>Gingivitis affects 30-100% of pregnant women </li></ul><ul><li>Pre-term birth (<37 wks) </li></ul><ul><ul><li>75% of all US neonatal mortality </li></ul></ul><ul><ul><li>35% of all health care expenditures on infants </li></ul></ul><ul><ul><li>No improvement in 40 years </li></ul></ul><ul><li>Low birth weight (< 5.5 pounds) </li></ul><ul><ul><li>Higher risk of complications </li></ul></ul><ul><li>Studies have found that expectant mothers with PD are up to 7x more likely to deliver premature, low birth babies </li></ul><ul><li>(Douglass, Alan M.D., F.A.A.F.P. and Joanna B.D.S., D.D.S. University of Connecticut School of Dental Medicine.) </li></ul>
    16. 17. <ul><li>Serious, costly and increasingly common chronic disease </li></ul><ul><li>Affects 23.6 million children and adults in the US </li></ul><ul><li>Contributes to more than 200,000 deaths a year </li></ul><ul><li>~95% of Americans with Diabetes also have PD </li></ul><ul><li>Research shows that people with PD have more difficulty controlling their blood sugar levels </li></ul><ul><li>After physician has made a conclusive diagnosis, it is critical that patients with diabetes receive professional oral health care regularly and follow a customized home care routine to help keep their blood sugar levels in check </li></ul><ul><li>(Moffett, Frances. 2010. Oral Health-Total Health: Know the Connection. Retrieved from http://www.adha.org/media/facts/total_health.htm) </li></ul>
    17. 18. <ul><li>THE number one killer of men and women- claiming more victims that all forms of cancer and AIDS combined </li></ul><ul><li>Approximately one American dies every 7 seconds </li></ul><ul><li>Numerous research studies have shown a connection between heart disease and key bacteria in periodontal disease </li></ul><ul><ul><li>Bacteria or viruses directly effect atherosclerotic lesions contributing to the inflammatory process </li></ul></ul><ul><li>Animal model studies investigating the relationship between CVD and periodontal disease have demonstrated that clinically induced oral infection with P. gingivalis will increase atheroma size and elevate CRP levels </li></ul><ul><li>(Touger-Decker, Riva, PhD, RD, FADA. “Diet, cardiovascular disease and oral health” JADA February 2010: pages 167-170. Print.) </li></ul>
    18. 20. <ul><li>Images of Box 1: JADA Feb 2010 </li></ul><ul><ul><li>High Blood Pressure </li></ul></ul><ul><ul><li>High cholesterol levels </li></ul></ul><ul><ul><li>Overweight and obesity </li></ul></ul><ul><ul><li>Physical inactivity </li></ul></ul><ul><ul><li>Poor diet (high in cholesterol; sodium; saturated and/or trans fats; and/or high calories) </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><ul><li>Type 2 Diabetes </li></ul></ul>
    19. 21. <ul><li>Investigators have outlined roles for oral health care professionals (OHCPs) in primary prevention </li></ul><ul><ul><li>Screening in the dental office </li></ul></ul><ul><ul><ul><li>Ex: HTN </li></ul></ul></ul><ul><ul><li>Medical Referral </li></ul></ul><ul><ul><li>Education, encouragement and reinforcement of Lifestyle behaviors such as diet </li></ul></ul><ul><li>The 2000 surgeon general’s report on Oral Health in America recommended dietary prevention strategies and supported the concept that “oral health is integral to general health”. </li></ul><ul><li>More recently, Lamster and colleagues stated that ‘dentists can become advocates for a general health promotion and disease prevention message.’ </li></ul><ul><li>Through education, OHCP, like other health care professionals, can play a role in primary prevention of CVD. </li></ul><ul><li>(Touger-Decker, Riva, PhD, RD, FADA. “Diet, cardiovascular disease and oral health” JADA February 2010: pages 167-170. Print.) </li></ul>
    20. 22. <ul><li>OC can affect any area of the oral cavity including the lips, gum tissues, cheek lining, tongue, and the hard or soft palate </li></ul><ul><li>The most frequent sites for cancer are the tongue, floor of the mouth, tissues in the back of the tongue, lips and gums </li></ul><ul><li>30,000 case of oral cancer are diagnosed annually </li></ul><ul><li>This year Oral cancer will kill one person every hour </li></ul><ul><li>Oral cancer is more common than Leukemia, Skin Melanoma, Hodgkin’s disease and cancers of the brain, liver, thyroid gland, stomach, ovaries and cervix </li></ul><ul><li>(Moffett, Frances. 2010. Oral Health-Total Health: Know the Connection. Retrieved from http://www.adha.org/media/facts/total_health.htm ) </li></ul><ul><li>(Dr. Dan Peterson. (February 6, 2008). Facts about Oral Cancer. Retrieved from http://www.dentalgentlecare.com/facts_about_oral_cancer.htm) </li></ul>
    21. 23. <ul><li>Oral cancer is more likely to strike after the age of 50 however there has been a significant increase in oral cancer in people under age 30 </li></ul><ul><li>Poorest 5 year survival rates- Only 52% survive after 5 years of diagnoses </li></ul><ul><li>Radiation can NOT cure it, it can help, along with chemotherapy </li></ul><ul><li>Surgery has devastating results due to the loss of a part of one’s tongue, jaw or roof of the mouth </li></ul><ul><li>Surgery can be very disfiguring </li></ul><ul><li>(Dr. Dan Peterson. (February 6, 2008). Facts about Oral Cancer . Retrieved from http://www.dentalgentlecare.com/facts_about_oral_cancer.htm) </li></ul>
    22. 24. <ul><li>Squamous Cell Carc: 30 yrs Hx of Smokeless Tob </li></ul>Outdoor texan.com
    23. 26. <ul><li>The five year survival rate with oral cancer is directly related to the stage at which the cancer is diagnosed, that is why early detection is so important. </li></ul><ul><li>Regular visits to the dentist can increase the chance of early detection which can improve the potential for successful treatment. </li></ul><ul><li>(Dr. Dan Peterson. (February 6, 2008). Facts about Oral Cancer . Retrieved from http://www.dentalgentlecare.com/facts_about_oral_cancer.htm) </li></ul>
    24. 27. <ul><li>Tooth decay is the most common, preventable, chronic childhood disease, 7x more common than Asthma (HRSA, Surgeon General, Healthy People 2010) </li></ul><ul><li>Caries: Bacterial infection (mutans streptococci and lactobacilli) causing acid production leads to demineralization and eventually cavitations of the tooth surface </li></ul><ul><li>Multi-factorial Etiology: levels of cariogenic bacteria, oral hygiene, genetics, enamel defects, radiation therapy, eating disorders, irregular dental care, cariogenic diet, developmental disorders, etc(Selwitz,Ismail, Pitts, 2007) </li></ul><ul><li>The single greatest risk factor predicting dental caries in populations is low socio-economic status, especially for children under the age of three(NIH, 2001; ADA,2006;CDC 2001a) </li></ul>
    25. 29. <ul><li>Pediatrician referral </li></ul>
    26. 30. <ul><li>60% of abusive injuries involve the oro-facial area (Cairns, Mok, & Welbury, 2005) </li></ul><ul><li>1,760 child fatalities in 2007 in the US </li></ul><ul><li>According to Chapter 261 of the Family Code 9 re-codified in 1995) child abuse is; </li></ul><ul><ul><li>An act or omission that endangers or impairs a child’s physical, mental or emotional health and development </li></ul></ul><ul><ul><li>Child abuse may take the form of physical or emotional injury, sexual abuse, sexual exploitation, physical neglect, medical neglect or inadequate supervision </li></ul></ul>
    27. 32. <ul><li>7 yo male patient with palatal petichiae </li></ul><ul><ul><li>Dentist </li></ul></ul><ul><ul><li>CPS </li></ul></ul><ul><ul><li>Center for Miracles </li></ul></ul><ul><ul><li>Pediatrician </li></ul></ul>Courtesy of Dr. H. Kessler
    28. 33. <ul><li>It is incumbent of all health care professional to integrate strategies to ameliorate these diseases. </li></ul><ul><li>It is important for dentists, physicians and other health care professionals- work together with the patient to integrate primary prevention and risk reduction strategies in their practices. </li></ul><ul><li>This new era of interdisciplinary dental/medical cooperation will undoubtedly result in improved patient health, as well as an improvement in overall patient longevity. </li></ul>