MCC San Diego
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  • 1. BOP Oral Health Services Current Therapies Current Challenges UCSF Dental School DPH Seminar Series November 12, 2007 CDR (Select) Phillip D. Woods BOP National Periodontal Consultant Diplomate, American Academy of Periodontology Chief Dentist, MCC San Diego
  • 2. Quick Facts about the BOP
    • BOP Inmates
      • Average Age = 37 yrs
      • 93% Male
      • 7% Female
    • Ethnicity
      • 32.1% Hispanic
      • 69.9% Non-Hispanic
  • 3. Quick Facts about the BOP
    • Sentence Imposed
  • 4. Quick Facts about the BOP
  • 5. Background
    • Oral Health in America: A Report of the Surgeon General (2000).
        • Poor oral health is concentrated primarily among low-income, minority and immigrant populations.
        • Access to dental care is major problem for these populations
  • 6. MCC San Diego
    • The Metropolitan Correctional Center (MCC) San Diego, California is an administrative facility housing male and
    • female inmates
  • 7. Delivery of Dental Care
    • Length of Incarceration
      • Short-Term Offender (12 months or less)
      • Long-Term Offender
      • (> 1 year sentence)
    • Level of Care
      • Intake exams, patient education, extractions, temporary & permanent fillings, pain relief.
      • Above + oral hygiene education, general dentistry, oral surgery, limited root canal and periodontal treatment, removable dentures.
  • 8. General Dentistry
  • 9. Periodontal Procedures Provided
    • Dental Cleanings
    • Periodontal Scaling
    • Surgical Procedures for Long -Term Inmates
    • Periodontal Maintenance
  • 10. Periodontal Therapies
  • 11. CPITN
    • Community Periodontal Index of Treatment Needs
      • World Health Organization
      • Useful in public health surveys and screening
      • Requires use of a Periodontal Probe
      • Modified by American Academy of Periodontology as PSR System
  • 12. CPITN Codes, Diagnostic Features & Tx CPITN Score Dx Feature Recommended Tx 0 Healthy tissue None 1 Bleeding upon probing Education 2 Calculus or overhangs and no PD > 3mm Education, Prophy 3 At least one PD 4-5mm Education, Prophy, ScRP 4 At least one PD of 6mm or > Education, Prophy, ScRP, Surgery prn X Fewer than 2 teeth function in sextant Exclude from needs assessment
  • 13. Gingival Abscess
  • 14. Periodontal Abscess
  • 15. Pericoronal Abscess
  • 16. Necrotizing Ulcerative Periodontitis
  • 17. What’s Really a Dental Emergency?
    • Dental Emergency
      • Broken Jaw
      • Swollen Face
      • Knocked out tooth or other facial trauma
      • Tooth abscess/tooth requiring extraction
    • NOT a Dental Emergency
      • “ My gums bleed”
      • “ I need a cleaning”
      • “ I have a cavity”
      • “ I’d like a check-up”
      • “ My appointment slip says today and he didn’t call me down!”
  • 18. Dental Emergency
  • 19. We Need Your Help . . .
    • Refer all Dental Emergencies to the Duty PA or phone me at extension 1552.
    • Advise all other inmates with dental concerns to complete a Dental Sick Call form.
  • 20. MCC San Diego
    • The Metropolitan Correctional Center (MCC) San Diego, California is an administrative facility housing male and
    • female inmates
  • 21. Recent Trends in Prison Health Budgets and Prison Staffing
    • Reflect a significant decrease in net federal spending for healthcare as more funds are diverted for war against terror.
    • New Prisons are coming online each year.
    • Recent Changes in Staffing Guidelines.
  • 22. Crystal Meth: A Growing Domestic Threat Crystal Meth’s Impact on Oral Health of Federal Inmates
  • 23. Crystal Meth – A Recent Challenge to BOP Oral Health Care Program
  • 24. What is Meth?
    • Powerfully addictive synthetic stimulant that causes brain to release a surge of dopamine; high lasts 6-24 hours.
    • Two Forms
      • Powder
      • Rock (Crystal)
  • 25. Also Known as. . .
    • Speed
    • tina
    • chalk
    • ice
    • crystal
    • glass
  • 26. Crystal Meth
  • 27. How Prevalent is Meth Use?
    • 12 Million kids aged 12 and older have used meth at least once ( U.S. DHHS ).
    • 597,000 persons aged 12 and older used in the past month.
  • 28. Methamphetamine Prevalence of Abuse, Monitoring the Future Survey, 2006 8 th Grade 10 th Grade 12 th Grade Lifetime 2.7% 3.2% 4.4% Past Year 1.8 1.8 2.9 Past Month 0.6 0.7 0.9
  • 29. Who Uses Meth?
  • 30.  
  • 31.  
  • 32.  
  • 33. The Ravages of Meth: “Meth Mites”
  • 34.  
  • 35. Federal Drug Arrests for Meth Use
    • For FY 2001 there were 4000 Federal Drug arrests for meth and amphetamine, representing 12% of all Federal Drug arrests.
  • 36. Where is Meth Coming From?
    • Major suppliers in the West and Southwest are Mexican criminal gangs cooking in superlabs and bringing the product over the border for distribution.
    • Local gangs and some private cookers are main suppliers in many communities.
    • Methamphetamine is a money maker for local gangs and is often used in recruitment of members.
  • 37. Number of meth users in rehab per 100,000 state residents in 2003
  • 38. Is Meth Really a National Epidemic?
    • SAMHSA Treatment Episode Data Sheet
      • 1992 - 1 state reporting; 2002 - 18 states reporting
    • National Association of Counties
      • 500 counties report meth is their biggest drug problem
    • National Drug Intelligence Center (NDIC)
      • Random sample of 3400 US DEA agencies – 40% agree
      • meth is their leading drug threat
    • United Nations – Meth is most abused hard drug on earth; 26 million meth addicts world-wide
  • 39. Signs of Possible Meth Use
    • Poor hygiene
    • Chemical smell
    • Tremor
    • Bruxism (teeth grinding)
  • 40. Healthy Dental Picture
    • Healthy Mouth
      • Firm, pink or pigmented gums
      • Follow the shape of the tooth
      • Teeth are free of stains or tartar.
  • 41.  
  • 42. “ Meth Mouth”
  • 43. “ Meth Mouth”
  • 44.  
  • 45. “ Meth Mouth”
  • 46.  
  • 47. Kris is still in the process of getting ALL his teeth removed. By age 25 , no natural teeth will remain.
  • 48.  
  • 49. Meth Mouth
  • 50.  
  • 51. Ralph’s X-rays
  • 52. Difficult Extractions Often, the gingiva will grow over the remaining stumps of roots and extractions become extremely difficult, as teeth have been reduced to extremely soft mush by crystal meth use.   
  • 53.  
  • 54. THE NET RESULT OF METH MOUTH = Dentures .
  • 55.       Many crystal meth users are unable to hold jobs as they have no short term memory , making it hard for them to learn new procedures, they are unreliable , jittery , and paranoid .  Additionally, severe decay in their teeth, especially their front teeth where the smoke from crank touches the mouth first, is readily apparent when they speak; a ' flashing red light ' of sorts, to any prospective employers.
  • 56. The U.S. National Strategy
    • The Combat Methamphetamine Epidemic Act of 2005
      • Limits sales of ephedrine/pseudoephedrine
    • White House Office of National Drug Control Strategy for 2006
      • Multi-pronged approach
        • Congress
        • Other countries exporting base ingredients
        • Cooperation with Canada and Mexico
  • 57.  
  • 58. “ Meth Mouth ” is becoming more and more prevalent in current and former users of this extremely addictive drug.  Teeth decay rapidly, causing the destruction known as “ Meth Mouth .”  It is the culmination of years of crystal methamphetamine use.
  • 59. Special Thanks
    • Dean Jane Weintraub, UCSF School of Dentistry
    • CAPT Nick Makrides, Chief Dentist, BOP
    • CAPT Jeff Gaskin, Western Regional Consultant
    • Rodel Leyba, HSA, MCC San Diego
    • Debra Lacy, MD, CD, MCC San Diego
    • http://www.pbs.org/wgbh/pages/frontline/meth
    • Escapemeth.com
    • Faces of Meth – OregonLive.com