Oral Health Presentation by Diane Oakes


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  • Slide 3: Oral Health—Overall Health Connection “ You cannot be healthy without oral health.” Surgeon General’s Report on Oral Health ~May 2000 Oral health and overall health are related. What happens in the mouth is often a reflection of what is happening elsewhere in the body. We cannot view the mouth as an isolated area, disconnected from the rest of the body. Often the first signs of a medical condition may show in the mouth. Example 1 : An undiagnosed or uncontrolled diabetic may have gum problems or difficulty healing because the blood sugar is not regulated properly. Example 2 : People with gum disease often have heart problems as well. The exact relationship is not fully understood, whether one causes the other or exactly how they are associated. Trainer Note : If you do not present the “Why Oral Health?” section separately, include some of that information here. Choose those items most relevant for your audience.
  • Slide 11: Gum Problems - Photos Photo 4 – Gingivitis: Gums are red and swollen and may bleed easily. Brushing and flossing can help improve this condition, or professional care may be needed. If plaque remains on the teeth, it hardens to form tartar or calculus, which irritates the gums. The tartar or calculus cannot be removed by brushing. Eventually, the gums detach and pull away (recede) along the length of the teeth. Tartar on the teeth may need to be removed (by having the teeth cleaned) before the gingivitis will improve. Photo 5 - Periodontal Disease: If the gingivitis is not treated or controlled, it can progress to a more serious condition, periodontal disease , where the bone holding the teeth in place is destroyed. Eventually, the gums may pull away from their original position, exposing the roots of the teeth. This allows decay and infection into tooth roots and also into the bone that supports the teeth. As the bone dissolves, the teeth will become loose. The loose teeth may become so painful that eating becomes difficult and severe infections may develop. The disease may be treatable or may require the teeth to be removed. These teeth have been partially cleaned, but tartar deposits remain visible.
  • Slide 36: Dry Mouth – Side Effects & Photos Photo 11 – Root Decay (Cavities, Caries): See how the decay progresses from #1 to #6: 1. A tooth without caries. 2. The beginning stage of tooth decay, the “white spot.” Proper prevention can halt the decay from progressing further. 3. The enamel surface has broken down. (Note also the red gum tissue.) 4. A filling was placed, but the disease has not been stopped and new decay surrounds the filling. 5. The decay process continues and breaks down more of the tooth. The tooth has fractured - the effect of a process which could have been stopped at an early stage! Photo 12 – Cracks on Corners of Lips Cracks on the corners of the mouth may have a number of causes, including fungal infections and simple irritation, but often they are related to dry mouth. Caregivers should alert their supervisor or their client’s case manager if they observe this condition. Photo 13 – Dry, Painful Tongue (Also note cracks at corner of lips): A dry tongue often appears smooth, red, and slightly swollen. A dry tongue can make speaking, tasting, and swallowing difficult. Photo 14 – Possible Fungal Infection on Tongue: Some medical conditions may result in a fungal (yeast) infection that often affects the tongue. The heavy white coating is a possible indication that this type of infection is present. Alert your supervisor.
  • Conclusion Slide 48: The Caregiver Helps Prevent Oral Disease P rompt, assist, or perform the oral health care for client. Allow your client as much independence as possible, but remember that s/he may need assistance in one or more oral care routines . Monitor client’s mouth for changes. You may be the first person to spot an unusual condition or change in your client’s oral health. Caregivers CANNOT make a diagnosis, but CAN report changes or unusual conditions. We do not expect you to become an expert or to make any kind of diagnosis, but you can be a caring observer. Educate client about oral health information. Be willing to share your knowledge and help your client make better oral health decisions. Refer problems to supervisor or case manager. If you notice signs of oral disease in the mouth tissues, lips, tongue, or teeth, make a note in your client’s service/care plan AND report to your supervisor or your client’s case manager.
  • Slide 17: Tooth Decay—Process Here is an easier way to understand the steps in getting tooth decay: Germs + Refined Carbohydrates = Acid Acid Attacks + Tooth = Decay Untreated Decay  Infection, Abscess, Loss of Tooth
  • Slide 14: Activity: Check Your Mouth Using a hand mirror, look at your gums, teeth, and tongue. What do you see? Does it look normal or not normal? Do you see anything unusual? Note to trainer : Students may be uncomfortable in publicly displaying their own teeth or mouths, and may not want to participate. The purpose of this exercise is to help students become more comfortable looking at their own teeth, gums, and tongue before they attempt extended oral care with their clients. Take a 10-minute break before moving to the next section.
  • Oral Health Presentation by Diane Oakes

    1. 1. Oral Health and Older Adults W4A Advisory Councils and State Council on Aging October 16 th , 2008
    2. 2. Seniors are at increased risk for oral disease <ul><li>Poor oral health throughout life – worsens with time </li></ul><ul><li>New disease due to: </li></ul><ul><ul><li>Breakdown of previous restorations </li></ul></ul><ul><ul><li>New health condition which affects the mouth (including dry mouth) </li></ul></ul><ul><ul><li>Gum recession leaves tooth roots vulnerable to decay </li></ul></ul><ul><ul><li>Physical/mental conditions make home care challenging – must rely upon caregiver </li></ul></ul><ul><ul><li>Lack access to preventive care </li></ul></ul><ul><li>Expectation to need dentures (seems to be fading) </li></ul><ul><li>Competing financial priorities – lower value on oral health </li></ul>
    3. 3. Magnitude of the Problem <ul><li>Nationwide, seniors’ oral health is improving: </li></ul><ul><ul><li>Untreated decay is down 30% </li></ul></ul><ul><ul><li>Untreated root caries is down 36% </li></ul></ul><ul><ul><li>Edentulism (toothlessness) is down 20% </li></ul></ul><ul><li>However, too many seniors still experience oral disease: </li></ul><ul><ul><li>1 in 5 currently have decay </li></ul></ul><ul><ul><li>1 in 4 have severe periodontal disease (gum disease) </li></ul></ul><ul><ul><ul><li>Jumps to 1 in 3 among low-income </li></ul></ul></ul>
    4. 4. Gum Disease Increases with Age
    5. 5. Racial/Ethnic Disparities
    6. 6. Income Disparities
    7. 7. Difficulties Accessing Care <ul><li>Medicare doesn’t cover dental </li></ul><ul><li>75% of seniors in WA are dentally uninsured </li></ul><ul><li>Only ~20% on Medicaid access care </li></ul><ul><li>Seniors are age group most likely to have had no dental visit in 5 years (BRFSS) </li></ul><ul><li>Causes missed opportunities for prevention </li></ul><ul><li>Many seniors put off paying for care until problem is significant </li></ul>
    8. 8. Oral Health - Overall Health Connection <ul><li>“ You cannot be healthy without oral health.” </li></ul><ul><li>Surgeon General’s Report on Oral Health </li></ul><ul><li>~May 2000 </li></ul>
    9. 9. Periodontal Disease – Medical Link <ul><li>Diabetes: </li></ul><ul><ul><li>Diabetes increases risk for gum disease </li></ul></ul><ul><ul><li>People with diabetes and severe gum disease are more likely to have problems with glycemic control </li></ul></ul><ul><ul><li>Treating gum disease may improve glycemic control and prevent costly diabetic complications </li></ul></ul><ul><li>Heart Attack/Stroke </li></ul><ul><li>Pnemonia </li></ul>
    10. 10. Gum Problems - Photos 4. Gingivitis 5. Periodontal Disease
    11. 11. Dry Mouth (xerostomia) <ul><li>Estimated that 25% of seniors have dry mouth </li></ul><ul><li>Saliva is protective: </li></ul><ul><ul><li>cleanses the mouth; </li></ul></ul><ul><ul><li>neutralizes acid; </li></ul></ul><ul><ul><li>kills bacteria and other germs </li></ul></ul><ul><ul><li>remineralizes teeth (fluoride and calcium) </li></ul></ul><ul><li>Causes: </li></ul><ul><ul><li>Health conditions (diabetes, Sjögren’s Syndrome) </li></ul></ul><ul><ul><li>Cancer treatments </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><ul><li>7 out of 10 most commonly prescribed medications </li></ul></ul></ul><ul><ul><ul><li>Antidepressants, antipsychotics, antihistamines, decongestants, antihypertensives, diruetics, antiparkinsonian drugs </li></ul></ul></ul>
    12. 12. Dry Mouth Incidence <ul><li>Risk increases with the number of medications taken. </li></ul>Nederfors, et. al, 1997
    13. 13. Dry Mouth – Side Effects & Photos 11. Root Decay 12. Cracks on Corners of Lips 13. Dry, Painful Tongue 14. Possible Fungal Infection Tongue
    14. 14. Dry Mouth Prevention and Remedies <ul><li>Saliva substitutes (Biotene, Orajel, etc…) </li></ul><ul><li>Increase water intake </li></ul><ul><li>Increase fluoride </li></ul><ul><li>Avoid alcohol (including in mouthwash), tobacco, sugary drinks </li></ul><ul><li>Xylitol: </li></ul><ul><ul><li>Plant-derived sugar alcohol. </li></ul></ul><ul><ul><li>Sugar alcohols - reduce tooth decay interferes with the production of acids. </li></ul></ul><ul><ul><li>Xylitol the most effective sugar alcohol at reducing tooth decay. </li></ul></ul>
    15. 15. Washington Dental Service Foundation <ul><li>Non-Profit Corporate Foundation </li></ul><ul><li>Mission: to eliminate oral disease for all </li></ul><ul><li>Values: </li></ul><ul><ul><li>All people should have an equal opportunity to be healthy. </li></ul></ul><ul><ul><li>We strive to end racial, ethnic and income disparities as barriers to oral health. </li></ul></ul><ul><ul><li>We make a positive impact on people’s lives by influencing environments that affect oral health over the long-term. </li></ul></ul><ul><ul><li>We are creative, innovative, adaptive and take calculated risks. </li></ul></ul><ul><ul><li>We are outcomes-driven. </li></ul></ul><ul><ul><li>We value teamwork, integrity, trust, diversity and shared purpose in our work internally and externally. </li></ul></ul>
    16. 16. Public values the importance of oral health; understands the mechanics and link to overall health; demands services and is motivated to conduct good oral health behaviors and nutrition habits <ul><li>Policy/decision-makers buy-in to the importance of oral health and establish policies that support: </li></ul><ul><li>Prevention of oral disease </li></ul><ul><li>Access to services </li></ul><ul><li>Good oral health behaviors </li></ul>Financial system provides incentives for and eliminates barriers to serving the underserved; all patients have coverage for care. Biology People routinely assess and manage their risk for oral disease based on their individual biology Physical Environment The physical environment promotes good oral health: WA residents drink fluoridated water, healthy snacks are available in schools and work places Social Environment Social norms define behaviors and policies that promote oral health as an essential element of overall health as the accepted and expected standard Eliminating oral disease in order to improve overall health Adequate pool of providers , which contains the appropriate balance of disciplines (including medical professionals) , offers oral health services efficiently in easily–accessible and geographically distributed settings. Community systems and services facilitate access to care for everyone in their local community Personal Behavior People regularly and effectively practice oral self-care and avoid practices that increase their risk for oral disease Science-based best practices for prevention and treatment are understood and implemented by health professionals . Science continually advances in the understanding of the biology of oral disease . Culturally competent and diverse workforce increases the comfort and quality of care for all populations and participates in efforts to improve oral health at the community level Determinants of Oral Health Access to Quality Healthcare People access oral health care including preventive and restorative services Conditions for Success WDSF Mission The Theory of Change for Eliminating Oral Disease
    17. 17. WDSF Role Identify and drive strategic changes in systems to improve oral health
    18. 18. WDSF Initiatives <ul><li>Seniors’ Dental Access Pilot Project </li></ul><ul><li>Caregiver Curriculum </li></ul><ul><li>Media Campaign </li></ul>
    19. 19. Seniors Dental Access Pilot <ul><li>Goal: Improve oral and overall health of seniors through increased access to preventive and restorative dental care in medical and dental settings. </li></ul><ul><li>Medicaid-insured adults age 55 and up </li></ul><ul><li>3-Year Pilot project </li></ul><ul><ul><li>July 09 – June 2010: systems, training, provider recruitment </li></ul></ul><ul><ul><li>July 2010 – June 2012: Medicaid payments </li></ul></ul>
    20. 20. Pilot Sites Clark County- Clark County Health Department Southeast Region- Southeast WA Aging and LTC Whatcom Snohomish Okanogan Chelan Douglas Franklin Benton Yakima Lewis Thurston Island Mason Spokane Whitman Columbia Garfield King Skagit Stevens Klickitat Skamania Cowlitz Wahkiakum Kittitas Grant Pierce Clark Ferry Pend Oreille Lincoln Adams Walla Walla Asotin Clallam Jefferson Grays Harbor Pacific San Juan Kitsap
    21. 21. Partners WASHINGTON SENIOR CITIZENS’ LOBBY ELDERCARE ALLIANCE University of Washington School of Dentistry
    22. 22. How it will work <ul><li>Based on Access to Baby and Child Dentistry model </li></ul><ul><li>Links with other chronic disease management programs </li></ul><ul><li>WDSF funds local coordinating agencies to conduct patient outreach and provider recruitment </li></ul><ul><li>UW School of Dentistry offers training events for dental and medical providers </li></ul><ul><li>Medicaid provides enhanced rates to dentists and payments to physicians for oral health services </li></ul><ul><li>Track utilization rates and study improvements in health for patients with diabetes </li></ul>
    23. 23. Key Metrics <ul><li>Dental utilization rates - are more seniors accessing care in dental setting? </li></ul><ul><li>Preventive oral health services - does improved network lead to more preventive screening and services in medical and dental settings? </li></ul><ul><li>Attracting participating providers - are more dental and medical providers serving Medicaid-insured seniors? </li></ul><ul><li>Medical and dental costs – will increased dental care for this population that is at risk for chronic diseases reduce medical costs associated with those diseases? </li></ul>
    24. 24. Caregiver Training <ul><li>Curriculum developed in 2004,pilot-tested by PRN, certified by DSHS to qualify for 10 hour c.e. rolled-out to caregiver training agencies </li></ul><ul><li>Goal is to engage caregivers in oral health and teach skills for improving oral health of clients/family members </li></ul><ul><li>6 modules: tooth decay, gum disease, oral cancer, dentures, nutrition, dry mouth </li></ul>
    25. 25. Caregivers Can Improve Oral Health! <ul><li>Prompt, assist, or perform the oral health care. </li></ul><ul><li>Monitor client’s mouth for changes. </li></ul><ul><li>Educate client about oral health information. </li></ul><ul><li>Refer problems to supervisor or case manager. </li></ul>
    26. 26. Tooth Decay - Process <ul><li>Germs + Refined Carbohydrates = Acid </li></ul><ul><li>Acid Attacks + Tooth = Decay </li></ul>Untreated Decay  Infection, Abscess, Loss of Tooth
    27. 27. Activity: Check Your Mouth <ul><li>Look at your gums, teeth, and tongue </li></ul><ul><li>What do you see? </li></ul><ul><li>Normal? </li></ul><ul><li>Not normal? </li></ul>
    28. 28. Evaluation <ul><li>Conducted in 2007 – 96 participants </li></ul><ul><li>Key Question: Does training impact how caregivers provide oral health care to clients/loved ones? </li></ul><ul><li>Qualitative design: </li></ul><ul><ul><li>14 focus groups – </li></ul></ul><ul><ul><ul><li>6 trained, 6 untrained, 2 mixed </li></ul></ul></ul><ul><ul><ul><li>11 IPs, 3 agency </li></ul></ul></ul><ul><ul><ul><li>2 Russian </li></ul></ul></ul><ul><ul><li>17 phone interviews </li></ul></ul><ul><ul><li>Survey </li></ul></ul><ul><li>King, Pierce, Lewis, Yakima Counties </li></ul>
    29. 29. Partners <ul><li>Professional Registry of Nursing </li></ul><ul><li>AAAs: </li></ul><ul><ul><li>LMT AAA </li></ul></ul><ul><ul><li>Pierce County AAA </li></ul></ul><ul><ul><li>King County Aging and Disability Services </li></ul></ul><ul><ul><li>Southeast Washington Aging and LTC </li></ul></ul><ul><li>ResCare HomeCare (formerly Armstrong) </li></ul><ul><li>Elite International </li></ul>
    30. 30. Key Findings <ul><li>Trained caregivers are more active participants in their clients’ oral health care (60% vs. 20%) </li></ul><ul><li>Trained caregivers are more likely to: </li></ul><ul><ul><li>Look in the mouth – screen for problems </li></ul></ul><ul><ul><li>Help clients access dental care </li></ul></ul><ul><ul><li>Prompt or assist with brushing </li></ul></ul><ul><ul><li>Prompt or assist with cleaning dentures </li></ul></ul><ul><ul><li>Encourage wearing dentures </li></ul></ul><ul><ul><li>Recommend dry mouth remedies </li></ul></ul>
    31. 31. Key Findings continued <ul><li>Trained caregivers are more confident in ability to care for client’s teeth and mouth </li></ul><ul><li>Trained caregivers mentioned improvements to their own oral health care following the training: </li></ul><ul><ul><li>Eating healthier </li></ul></ul><ul><ul><li>Brushing right after meals </li></ul></ul><ul><ul><li>Flossing more regularly </li></ul></ul><ul><ul><li>Making a dentist appointment </li></ul></ul><ul><ul><li>Using gum with xylitol </li></ul></ul>
    32. 32. Challenges <ul><li>Caregivers experience the following challenges in providing oral health care for their clients: </li></ul><ul><ul><li>Client resistance </li></ul></ul><ul><ul><li>Conflict of roles with family members </li></ul></ul><ul><ul><li>Client dementia </li></ul></ul><ul><ul><li>Access to dental care for clients </li></ul></ul>
    33. 33. Implications/Recommendations <ul><li>Need tips and support for overcoming client resistance </li></ul><ul><li>Need additional content on providing oral health care for clients with dementia </li></ul><ul><li>Oral health needs a greater role in care plans – currently falls in personal hygiene section, not health </li></ul><ul><li>Develop programs to improve access to dental care for this population </li></ul><ul><li>Engage medical community </li></ul>
    34. 34. Media Campaign <ul><li>Television and radio spots </li></ul><ul><ul><li>Summer 2007: greater Puget Sound area </li></ul></ul><ul><ul><li>Fall/Winter2007 and early 2008: Major WA markets </li></ul></ul><ul><ul><li>        </li></ul></ul><ul><li>Op-Ed pieces </li></ul><ul><ul><li>Tacoma News Tribune </li></ul></ul><ul><ul><li>Spokane Spokesman Review </li></ul></ul><ul><ul><li>Seattle PI </li></ul></ul><ul><ul><li>Tacoma News Tribune </li></ul></ul>
    35. 35. Resources <ul><li>Geriatric Dental Group – Federal Way (253-839-1300) </li></ul><ul><li>Community Clinics </li></ul><ul><li>Local Health Jurisdictions/Oral Health Coalitions </li></ul><ul><li>WSDA Senior Discount Program – through I and R </li></ul><ul><li>Preventive services by hygienists in senior centers </li></ul><ul><li>Dental societies – community access programs </li></ul>
    36. 36. Vision… <ul><li>Public and leaders understand the link between oral health and overall health </li></ul><ul><li>Medical providers screen and provide preventive services </li></ul><ul><li>Pharmacists counsel on dry mouth </li></ul><ul><li>Oral health services available in community-based settings </li></ul><ul><li>Medicare includes dental benefit </li></ul><ul><li>Anything else???????? </li></ul>