Whole 9 Yards

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You've wanted to understand how good oral health contributes to good health. This presentation is filled with scientific proofs and ways to use the science.
Talk to your dental hygienist or contact the author of this presentation for more information on how to make your health better by improving oral health.

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  • Pneumonia is a biofilm infection.
  • http://redscrubs.com/2008/02/reducing-the-risk-of-aspiration-pneumonia/
  • http://redscrubs.com/2008/02/reducing-the-risk-of-aspiration-pneumonia/Aspiration pneumonia is AP
  • http://redscrubs.com/2008/02/reducing-the-risk-of-aspiration-pneumonia/Dental hygienists are not allowed to practice without the prescription of a dentist. This offers an unnecessary hurdle to access those who need it most.
  • J Am Geriatr Soc. 2006 Jan;54(1):138-43.Oral care provided by certified nursing assistants in nursing homes.Coleman P, Watson NM.Center for Clinical Research on Aging, School of Nursing, University of Rochester, Rochester, New York 14642, USA. patricia_coleman@urmc.rochester.eduAbstractThe purpose of this study was to describe the actual daily oral care provided by certified nursing assistants (CNAs) for dentate elderly nursing home (NH) residents who required assistance with oral care. The study was conducted in five nonrandomly selected NHs in upstate New York using real-time observations of CNAs providing morning care to residents, retrospective chart review, and CNA screening interviews. Oral care standards developed and validated by a panel of 10 experts (dentists, dental hygienists, registered nurses) to be appropriate for dentate NH residents were used to evaluate the oral care provided by 47 primary dayshift CNAs to a convenience sample of 67 residents. CNAs were blinded to the study's specific focus on oral care. Adherence to individual standards was low, ranging from a high of 16% to a low of 0%. Teeth were brushed and mouths rinsed with water in 16% of resident observations. One resident had her tongue brushed. Standards never met were brushing teeth at least 2 minutes, flossing, oral assessment, rinsing with mouthwash, and wearing clean gloves during oral care. Most residents (63%) who received oral care assistance were resistive to CNA approaches. For most observations, oral care supplies were not evident. Actual oral care provided to residents contrasts sharply with CNAs' self-reported practices in the literature and suggests that NH residents who need assistance receive inadequate oral health care.
  • http://newoldage.blogs.nytimes.com/2009/02/04/elder-abuse-all-in-the-family/Elder abuse is not just about striking or starving. Elder abuse also includes neglect, neglect of the mouth is included. Specially if the biofilm on the teeth leads to illness and death that is traceable to poor oral care.
  • For example, one day a resident may be playing cards with their friends or other residents.
  • The following day they may be ill
  • And even die just as suddenly.
  • All from the biofilm on their teeth.This is the condition of the teeth of a typical resident in a long term care facility. The dark blue is a biomass that has accumulated on their teeth, the lighter blue is lighter because the dye couldn’t penetrate the mass. The red is the biofilm that is less than 24 hours old.
  • Oral biofilm is very much like the biofilm on these pillars. The biofilm is loaded with corosive pathogens that contribute to pneumonia, COPD, bronchitis, sinusitis, and other respiratory diseases. This biofilm also contributes to fetid halitosis, that means really bad breath.
  • CNA cannot dress to address thos with super bad breath. Those residents do not get cared for as well as those who do not. See my Slideshare on Halitosis for further exploration of this important topic.
  • There’s nothing sad about a goofy smile. Clean teeth are great!
  • Older adults have more teeth than ever before.
  • Dentistry and dental hygiene has spent a lot of time making sure people kept their teeth for a lifetime. For the 4% of those in long term care and the other dependent adults living under the care of a family member cannot take care of their own teeth any longer. Someone has to do it for them, and nurses are not trained or educated or motivated to care for the mouth.
  • Nursing assistants have only 30 minutes of oral care instruction by a nursing instructor. Their books are written by nurses with a nursing perspective. Very few nursing texts invite dental hygienists to offer expertise to their text books.
  • CNA are fearful of dealing with the mouth. For good reason…
  • Fear of being bitten.
  • Fear of being bitten. People with dementia and Alzheimer’s can actively reach out to bite a nurse or nursing assistant.
  • Fear of being spit on.Being spat on is another big reason that nurses and nursing assistants are fearful to provide adequate oral care to dependent adults.
  • This is a post from a nurse on a nursing internet community.
  • They have come up with their own word for Resistant and Combative residents, resistive.
  • Uncooperative residents are like small children. However the dependent adult may have good reason to be un cooperative. Care facilities often use the least expensive tooth paste or tooth brush to provide care. The brush is painfully stiff and the tooth paste often tastes like a crap sandwich.
  • How would you propose to get in there?
  • Dental hygienists are licensed and take a national board exam. Most have an associates degree, however many are flocking back to college to finish degrees in geriatrics, hospital administration and many other related disciplines.
  • Hygienists only see dependent adults under poor circumstances.
  • Dental hygienists became alarmed at the level of oral care that dependent adults receive. That’s where they become afraid.
  • Some dental hygienists see residents in long term care settings. However they must have a dentist to write a prescription.
  • Dental hygienists are not part of the interdisciplinary team meetings. Dental hygienists with undergraduate degrees are on the same level as BSN. As an employee of the facility, a dental hygienist can develop oral hygiene plans to avoid pneumonia, respiratory diseases, malnutrition, isolation and so much more.
  • Breathing or respiration bring the pathogens into the lungs.
  • The objective for oral care is not brushing or flossing it is reduction of oral biofilm.
  • Brushing is not the only way to reduce biofilm
  • Flossing is only one other way to achieve that end.
  • Some people achieve biofilm reduction by using a water jet device.
  • Functional foods can also reduce oral biofilm
  • The list of functional foods is growing every day. In general foods high in flavinoids are good for reducing oral biofilm.
  • Cranberry juiceCranberry Slush recipe - 192 caloriesIngredients:4 cups cranberry juice cocktail1/4 cup vodka1 cup grapefruit juicePreparation:1. Combine all the ingredients in a large freezer container.2. Freeze for at least 8 hours (until slushy).3. Spoon into cocktail glasses and serve immediately while still slushy.Servings: 4Nutritional information for one serving:Calories: 192Calories from fat: 2Total fat: 0.3gCholesterol: 0mgTotal carbs: 39.9gFiber: 0.1gProtein: 0.3gWW points: 4Photo credit: JustJanS
  • Cranberry juiceLowers HDLhttp://heartcurrents.wordpress.com/2010/03/08/cranberry-juice-increases-hdl/
  • Certain sugars are helpful in reducing biofilm too. Xylitol has nearly medicinal properties.
  • Xylitol is a sweet as regular sugar but is only half the calories.
  • You an find xylitol in foods or in a crystal form for baking or putting on your cereal in the moring.
  • Gum seems to be the best vehicle for xylitol. Look for gum with only one sweetener, xylitol. The effects of five or more servings of xylitol containing gum for 18 months last for five or more years.
  • www.xlear.comOffers gum, candies, toothpaste and other products with xylitol as the only sweetener.
  • Foods with xylitol are available if you look at the label.
  • There are companies who make soft candies with xylitol
  • And gummy candies can be made with xylitol. So far they only made them for study purposes, so don’t look too hard.
  • Malitol is another sugar that helps reduce cavities and oral biofilm.
  • http://www.charlieschocolatefactory.com/diabetic/diabetic.shtml
  • Maltitol is in many more products than xylitol. It mixes easier in recipes.
  • Xylitol comes from corn stalks and leaves and cobs. Pharmaceutical grade xylitol is used in the products from Xlear. Other company products contain various levels of purity, namely food grade, which is also completely safe to eat. Xlear has no ties with this presentation at all, I just happen to know more about those products.
  • Sugar contributes to the biomass on teeth by stimulating excretion of the slimy substrate that keeps the bacteria safe.
  • http://www.ijdr.in/article.asp?issn=0970-9290;year=2009;volume=20;issue=4;spage=466;epage=470;aulast=DeoJ Periodontol. 2006 Sep;77(9):1465-82.Systematic review of the association between respiratory diseases and oral health.Azarpazhooh A, Leake JL.http://www.ncbi.nlm.nih.gov/pubmed/16945022
  • http://jdr.sagepub.com/cgi/content/abstract/79/4/970Sugar eventually contributes to oral biomass. Intense sweeteners, like Spenda, have not been studied with respect to oral health. They do not contribute to the biomass, but they do not stop it from growing.
  • Good oral care can affect all kinds of body systems.
  • Diabetes numbers!
  • Research from CIGNA Supports Potential Association between Treated Gum Disease and Reduced Medical Costs for People with DiabetesSUNRISE, Fla., March 29, 2011 - The results from a new CIGNA study support that there is a potential association between treated periodontal (gum) disease and reduced medical costs for patients with diabetes. The findings of the three-year claims study were presented during a recent meeting of the International Association for Dental Research (IADR) in San Diego.The study was presented by Dr. Clay Hedlund, a CIGNA dental director, Dr. Marjorie Jeffcoat, Dean Emeritus and professor, University of Pennsylvania School of Dental Medicine, Dr. Robert Genco, a SUNY Distinguished Professor, University at Buffalo Schools of Dental Medicine, and Dr NipulTanna, clinical assistant professor, University of Pennsylvania School of Dental Medicine. Drs. Jeffcoat and Genco are members of the CIGNA Dental Clinical Advisory Panel.* IADR is a non-profit organization dedicated to advancing research and increasing knowledge to improve oral health worldwide.CIGNA's Dr. Hedlund said the study corroborates the results of CIGNA's prior research, presented at the IADR meeting in 2009, in support of a possible association between the treatment of gum disease and lower medical costs in the treatment of diabetes. In the current study, patients who were treated for gum disease in the first year of the study and then received regular maintenance care thereafter had lower medical costs than those patients who had previously been treated for gum disease but did not receive regular maintenance care. On average, medical costs were $2,483 per year lower, or 23 percent less, for patients with diabetes who had proper gum disease treatment.“With the increase in the prevalence of diabetes, and great concern for our ever-increasing medical costs, this study suggests that periodontal therapy may help reduce the disease burden, as well as medical costs of treatment for patients with diabetes,” said Dr. Robert Genco.“The link between periodontal disease and diabetes has been firmly established and the association is a concern," said Dr. Marjorie Jeffcoat. “Periodontal disease can place individuals with diabetes at greater risk for diabetic complications, including mortality from cardiovascular disease and diabetic nephropathy. Advancing our understanding on how treatment for gum disease can affect the health of people with diabetes will help lead to the creation of evidence-based treatment standards that could benefit millions of people and help reduce medical costs at the same time.”Dr. Clay Hedlund noted, “These results suggest that treating gum disease has benefits beyond better oral health and may also help to control medical costs for some patients as well. We are pleased to be part of the dental community’s ongoing research into the links between good oral health and good overall health.”About the ResearchThe length of the study period was three full years, 2006 to 2008. It included an examination of medical and dental claims of over 46,094 individuals aged 18-62 who were enrolled in both CIGNA medical and CIGNA dental plans. The medical cost analysis included 3,449 patients from this group who received treatment for diabetes. These patients were presumed to also have had gum disease since they had received periodontal (gum) therapy at some point.Two different groups of patients with gum disease were then compared. Individuals in the first group received initial treatment for gum disease during the first (baseline) year of the study and received regular maintenance care thereafter (1,355 patients). Individuals in the second group received treatment for periodontal disease prior to the baseline year, and did not receive regular maintenance care during the study period (2,094 patients).Lower medical costs among patients being treated for diabetes were observed in the group who received periodontal treatment in the first year and then regular maintenance care thereafter. Conversely, medical costs were higher in the group of patients who received treatment prior to the baseline year and did not receive regular maintenance care thereafter. These medical cost differences averaged $2,483 per patient in 2008. These results are part of ongoing studies at CIGNA.CIGNA is an industry leader in providing integrated medical and dental plans to address the emerging association between periodontal disease and chronic medical conditions and between periodontal disease and pregnancy. In 2006, CIGNA launched its Oral Health Integration Program, the first program of its kind to be offered by a health services company. Through this program, CIGNA dental plan customers with certain health care conditions, or those who are pregnant, are eligible to receive 100 percent reimbursement for out-of-pocket costs associated with periodontal scaling and root planing and periodontal maintenance. In addition, expectant mothers may receive extra dental cleanings as needed during pregnancy. The program was expanded earlier this year to include more people and coverage for more conditions. These integrated programs are designed to help eliminate cost as a barrier to seeking appropriate treatment for gum disease and ultimately improve health.*About the CIGNA Dental Clinical Advisory Panel – The CIGNA Dental Clinical Advisory panel helps to create innovative approaches to new technologies, medical/dental integration and evidence-based strategies. Organized by CIGNA, this independent panel consists of leaders in the dental profession, many of whom are published and have served in leadership roles within their specialty or the American Dental Association. Several panel members have current academic appointments in major schools of dentistry, including the University of PA, Tufts, SUNY, and UCLA.
  • Research from CIGNA Supports Potential Association between Treated Gum Disease and Reduced Medical Costs for People with DiabetesSUNRISE, Fla., March 29, 2011 - The results from a new CIGNA study support that there is a potential association between treated periodontal (gum) disease and reduced medical costs for patients with diabetes. The findings of the three-year claims study were presented during a recent meeting of the International Association for Dental Research (IADR) in San Diego.The study was presented by Dr. Clay Hedlund, a CIGNA dental director, Dr. Marjorie Jeffcoat, Dean Emeritus and professor, University of Pennsylvania School of Dental Medicine, Dr. Robert Genco, a SUNY Distinguished Professor, University at Buffalo Schools of Dental Medicine, and Dr NipulTanna, clinical assistant professor, University of Pennsylvania School of Dental Medicine. Drs. Jeffcoat and Genco are members of the CIGNA Dental Clinical Advisory Panel.* IADR is a non-profit organization dedicated to advancing research and increasing knowledge to improve oral health worldwide.CIGNA's Dr. Hedlund said the study corroborates the results of CIGNA's prior research, presented at the IADR meeting in 2009, in support of a possible association between the treatment of gum disease and lower medical costs in the treatment of diabetes. In the current study, patients who were treated for gum disease in the first year of the study and then received regular maintenance care thereafter had lower medical costs than those patients who had previously been treated for gum disease but did not receive regular maintenance care. On average, medical costs were $2,483 per year lower, or 23 percent less, for patients with diabetes who had proper gum disease treatment.“With the increase in the prevalence of diabetes, and great concern for our ever-increasing medical costs, this study suggests that periodontal therapy may help reduce the disease burden, as well as medical costs of treatment for patients with diabetes,” said Dr. Robert Genco.“The link between periodontal disease and diabetes has been firmly established and the association is a concern," said Dr. Marjorie Jeffcoat. “Periodontal disease can place individuals with diabetes at greater risk for diabetic complications, including mortality from cardiovascular disease and diabetic nephropathy. Advancing our understanding on how treatment for gum disease can affect the health of people with diabetes will help lead to the creation of evidence-based treatment standards that could benefit millions of people and help reduce medical costs at the same time.”Dr. Clay Hedlund noted, “These results suggest that treating gum disease has benefits beyond better oral health and may also help to control medical costs for some patients as well. We are pleased to be part of the dental community’s ongoing research into the links between good oral health and good overall health.”About the ResearchThe length of the study period was three full years, 2006 to 2008. It included an examination of medical and dental claims of over 46,094 individuals aged 18-62 who were enrolled in both CIGNA medical and CIGNA dental plans. The medical cost analysis included 3,449 patients from this group who received treatment for diabetes. These patients were presumed to also have had gum disease since they had received periodontal (gum) therapy at some point.Two different groups of patients with gum disease were then compared. Individuals in the first group received initial treatment for gum disease during the first (baseline) year of the study and received regular maintenance care thereafter (1,355 patients). Individuals in the second group received treatment for periodontal disease prior to the baseline year, and did not receive regular maintenance care during the study period (2,094 patients).Lower medical costs among patients being treated for diabetes were observed in the group who received periodontal treatment in the first year and then regular maintenance care thereafter. Conversely, medical costs were higher in the group of patients who received treatment prior to the baseline year and did not receive regular maintenance care thereafter. These medical cost differences averaged $2,483 per patient in 2008. These results are part of ongoing studies at CIGNA.CIGNA is an industry leader in providing integrated medical and dental plans to address the emerging association between periodontal disease and chronic medical conditions and between periodontal disease and pregnancy. In 2006, CIGNA launched its Oral Health Integration Program, the first program of its kind to be offered by a health services company. Through this program, CIGNA dental plan customers with certain health care conditions, or those who are pregnant, are eligible to receive 100 percent reimbursement for out-of-pocket costs associated with periodontal scaling and root planing and periodontal maintenance. In addition, expectant mothers may receive extra dental cleanings as needed during pregnancy. The program was expanded earlier this year to include more people and coverage for more conditions. These integrated programs are designed to help eliminate cost as a barrier to seeking appropriate treatment for gum disease and ultimately improve health.*About the CIGNA Dental Clinical Advisory Panel – The CIGNA Dental Clinical Advisory panel helps to create innovative approaches to new technologies, medical/dental integration and evidence-based strategies. Organized by CIGNA, this independent panel consists of leaders in the dental profession, many of whom are published and have served in leadership roles within their specialty or the American Dental Association. Several panel members have current academic appointments in major schools of dentistry, including the University of PA, Tufts, SUNY, and UCLA.
  • Research from CIGNA Supports Potential Association between Treated Gum Disease and Reduced Medical Costs for People with DiabetesSUNRISE, Fla., March 29, 2011 - The results from a new CIGNA study support that there is a potential association between treated periodontal (gum) disease and reduced medical costs for patients with diabetes. The findings of the three-year claims study were presented during a recent meeting of the International Association for Dental Research (IADR) in San Diego.The study was presented by Dr. Clay Hedlund, a CIGNA dental director, Dr. Marjorie Jeffcoat, Dean Emeritus and professor, University of Pennsylvania School of Dental Medicine, Dr. Robert Genco, a SUNY Distinguished Professor, University at Buffalo Schools of Dental Medicine, and Dr NipulTanna, clinical assistant professor, University of Pennsylvania School of Dental Medicine. Drs. Jeffcoat and Genco are members of the CIGNA Dental Clinical Advisory Panel.* IADR is a non-profit organization dedicated to advancing research and increasing knowledge to improve oral health worldwide.CIGNA's Dr. Hedlund said the study corroborates the results of CIGNA's prior research, presented at the IADR meeting in 2009, in support of a possible association between the treatment of gum disease and lower medical costs in the treatment of diabetes. In the current study, patients who were treated for gum disease in the first year of the study and then received regular maintenance care thereafter had lower medical costs than those patients who had previously been treated for gum disease but did not receive regular maintenance care. On average, medical costs were $2,483 per year lower, or 23 percent less, for patients with diabetes who had proper gum disease treatment.“With the increase in the prevalence of diabetes, and great concern for our ever-increasing medical costs, this study suggests that periodontal therapy may help reduce the disease burden, as well as medical costs of treatment for patients with diabetes,” said Dr. Robert Genco.“The link between periodontal disease and diabetes has been firmly established and the association is a concern," said Dr. Marjorie Jeffcoat. “Periodontal disease can place individuals with diabetes at greater risk for diabetic complications, including mortality from cardiovascular disease and diabetic nephropathy. Advancing our understanding on how treatment for gum disease can affect the health of people with diabetes will help lead to the creation of evidence-based treatment standards that could benefit millions of people and help reduce medical costs at the same time.”Dr. Clay Hedlund noted, “These results suggest that treating gum disease has benefits beyond better oral health and may also help to control medical costs for some patients as well. We are pleased to be part of the dental community’s ongoing research into the links between good oral health and good overall health.”About the ResearchThe length of the study period was three full years, 2006 to 2008. It included an examination of medical and dental claims of over 46,094 individuals aged 18-62 who were enrolled in both CIGNA medical and CIGNA dental plans. The medical cost analysis included 3,449 patients from this group who received treatment for diabetes. These patients were presumed to also have had gum disease since they had received periodontal (gum) therapy at some point.Two different groups of patients with gum disease were then compared. Individuals in the first group received initial treatment for gum disease during the first (baseline) year of the study and received regular maintenance care thereafter (1,355 patients). Individuals in the second group received treatment for periodontal disease prior to the baseline year, and did not receive regular maintenance care during the study period (2,094 patients).Lower medical costs among patients being treated for diabetes were observed in the group who received periodontal treatment in the first year and then regular maintenance care thereafter. Conversely, medical costs were higher in the group of patients who received treatment prior to the baseline year and did not receive regular maintenance care thereafter. These medical cost differences averaged $2,483 per patient in 2008. These results are part of ongoing studies at CIGNA.CIGNA is an industry leader in providing integrated medical and dental plans to address the emerging association between periodontal disease and chronic medical conditions and between periodontal disease and pregnancy. In 2006, CIGNA launched its Oral Health Integration Program, the first program of its kind to be offered by a health services company. Through this program, CIGNA dental plan customers with certain health care conditions, or those who are pregnant, are eligible to receive 100 percent reimbursement for out-of-pocket costs associated with periodontal scaling and root planing and periodontal maintenance. In addition, expectant mothers may receive extra dental cleanings as needed during pregnancy. The program was expanded earlier this year to include more people and coverage for more conditions. These integrated programs are designed to help eliminate cost as a barrier to seeking appropriate treatment for gum disease and ultimately improve health.*About the CIGNA Dental Clinical Advisory Panel – The CIGNA Dental Clinical Advisory panel helps to create innovative approaches to new technologies, medical/dental integration and evidence-based strategies. Organized by CIGNA, this independent panel consists of leaders in the dental profession, many of whom are published and have served in leadership roles within their specialty or the American Dental Association. Several panel members have current academic appointments in major schools of dentistry, including the University of PA, Tufts, SUNY, and UCLA.
  • Research from CIGNA Supports Potential Association between Treated Gum Disease and Reduced Medical Costs for People with DiabetesSUNRISE, Fla., March 29, 2011 - The results from a new CIGNA study support that there is a potential association between treated periodontal (gum) disease and reduced medical costs for patients with diabetes. The findings of the three-year claims study were presented during a recent meeting of the International Association for Dental Research (IADR) in San Diego.The study was presented by Dr. Clay Hedlund, a CIGNA dental director, Dr. Marjorie Jeffcoat, Dean Emeritus and professor, University of Pennsylvania School of Dental Medicine, Dr. Robert Genco, a SUNY Distinguished Professor, University at Buffalo Schools of Dental Medicine, and Dr NipulTanna, clinical assistant professor, University of Pennsylvania School of Dental Medicine. Drs. Jeffcoat and Genco are members of the CIGNA Dental Clinical Advisory Panel.* IADR is a non-profit organization dedicated to advancing research and increasing knowledge to improve oral health worldwide.CIGNA's Dr. Hedlund said the study corroborates the results of CIGNA's prior research, presented at the IADR meeting in 2009, in support of a possible association between the treatment of gum disease and lower medical costs in the treatment of diabetes. In the current study, patients who were treated for gum disease in the first year of the study and then received regular maintenance care thereafter had lower medical costs than those patients who had previously been treated for gum disease but did not receive regular maintenance care. On average, medical costs were $2,483 per year lower, or 23 percent less, for patients with diabetes who had proper gum disease treatment.“With the increase in the prevalence of diabetes, and great concern for our ever-increasing medical costs, this study suggests that periodontal therapy may help reduce the disease burden, as well as medical costs of treatment for patients with diabetes,” said Dr. Robert Genco.“The link between periodontal disease and diabetes has been firmly established and the association is a concern," said Dr. Marjorie Jeffcoat. “Periodontal disease can place individuals with diabetes at greater risk for diabetic complications, including mortality from cardiovascular disease and diabetic nephropathy. Advancing our understanding on how treatment for gum disease can affect the health of people with diabetes will help lead to the creation of evidence-based treatment standards that could benefit millions of people and help reduce medical costs at the same time.”Dr. Clay Hedlund noted, “These results suggest that treating gum disease has benefits beyond better oral health and may also help to control medical costs for some patients as well. We are pleased to be part of the dental community’s ongoing research into the links between good oral health and good overall health.”About the ResearchThe length of the study period was three full years, 2006 to 2008. It included an examination of medical and dental claims of over 46,094 individuals aged 18-62 who were enrolled in both CIGNA medical and CIGNA dental plans. The medical cost analysis included 3,449 patients from this group who received treatment for diabetes. These patients were presumed to also have had gum disease since they had received periodontal (gum) therapy at some point.Two different groups of patients with gum disease were then compared. Individuals in the first group received initial treatment for gum disease during the first (baseline) year of the study and received regular maintenance care thereafter (1,355 patients). Individuals in the second group received treatment for periodontal disease prior to the baseline year, and did not receive regular maintenance care during the study period (2,094 patients).Lower medical costs among patients being treated for diabetes were observed in the group who received periodontal treatment in the first year and then regular maintenance care thereafter. Conversely, medical costs were higher in the group of patients who received treatment prior to the baseline year and did not receive regular maintenance care thereafter. These medical cost differences averaged $2,483 per patient in 2008. These results are part of ongoing studies at CIGNA.CIGNA is an industry leader in providing integrated medical and dental plans to address the emerging association between periodontal disease and chronic medical conditions and between periodontal disease and pregnancy. In 2006, CIGNA launched its Oral Health Integration Program, the first program of its kind to be offered by a health services company. Through this program, CIGNA dental plan customers with certain health care conditions, or those who are pregnant, are eligible to receive 100 percent reimbursement for out-of-pocket costs associated with periodontal scaling and root planing and periodontal maintenance. In addition, expectant mothers may receive extra dental cleanings as needed during pregnancy. The program was expanded earlier this year to include more people and coverage for more conditions. These integrated programs are designed to help eliminate cost as a barrier to seeking appropriate treatment for gum disease and ultimately improve health.*About the CIGNA Dental Clinical Advisory Panel – The CIGNA Dental Clinical Advisory panel helps to create innovative approaches to new technologies, medical/dental integration and evidence-based strategies. Organized by CIGNA, this independent panel consists of leaders in the dental profession, many of whom are published and have served in leadership roles within their specialty or the American Dental Association. Several panel members have current academic appointments in major schools of dentistry, including the University of PA, Tufts, SUNY, and UCLA.
  • Increased CRP in people with poor oral health, reduces when periodontal therapy is instituted.
  • Measurements are altered with periodontal treatment.
  • Studies look at weight and how it effectes periodontal health, or the other way ‘round.
  • Increased oral care should alter the number of hospitalizations.
  • Lower respiratory infections.
  • Getting close with clean fresh breath.
  • Potential outcomes of good oral care provided by a dental hygienists.
  • Pneumonia costs over $15000 per occurrenceVentilator Acquired Pneumonia costs over $30000 per occurrence.Savings of $2K per person per year in people with diabetes (30% of dependent adults have diabetes)And so much more.
  • This course is copyrighted by Exploring Transitions, LLC and is available for use by PrevMed. Only a small number of copies are allowed due to restrictions on the photographs. Contact Shirley Gutkowski if this is past year 2018. crosslinkpresent@aol.com.
  • Whole 9 Yards

    1. 1. A leading killer of residents in nursing homes is…<br />
    2. 2. Pneumonia<br />
    3. 3. Aspiration Pneumonia<br />
    4. 4.
    5. 5. The Studies Say...<br />Researchers have found poor oral health to be among the most common risk factors of acquired pneumonia in nursing homes.<br />
    6. 6. The Studies Say...<br />In fact, the only two risk factors to show significant associations with pneumonia were difficulty swallowing and poor oral care.<br />
    7. 7. The Studies Say...<br />Recent studies have demonstrated that microbacterium and fungi present in plaque of patients with poor oral hygiene can also be found in lung aspirates of patients with AP. <br />
    8. 8. The Studies Say...<br />These organisms are associated with poor oral hygiene practices in residents of LTC facilities in both edentulous and non-edentulous residents.<br />American Medical Directors Association<br />
    9. 9. Actual oral care provided to residents contrasts sharply with CNAs' self-reported practices in the literature and suggests that NH residents who need assistance receive inadequate oral health care.<br />J Am Geriatr Soc. 2006 Jan;54(1):138-43.<br />
    10. 10. Leslie G. Aronovitz, Director, Health Care-Program Administration and Integrity, testified before the United States Senate about the prevalence of nursing home abuse and prevention efforts. More than 30% of the country's 17,000 operating nursing homes, according to a report by the Government Accounting Office, were cited for violations involving patient care. <br />
    11. 11.
    12. 12.
    13. 13.
    14. 14.
    15. 15.
    16. 16. CNA Protective Garb<br />
    17. 17. Biofilm = Plaque<br />
    18. 18. The problem with teeth<br />
    19. 19. Decrease in edentulism <br />
    20. 20. We save teeth!<br />
    21. 21. Teeth are for<br />
    22. 22. Socializing<br />
    23. 23. Nutrition<br />
    24. 24. Hydration<br />Raw foods<br />Hard to chew<br />Hard to digest<br />Filled with water<br />
    25. 25. Who is caring for the teeth<br />
    26. 26. Nursing Assistant<br />30 minutes of education on oral care<br />
    27. 27. Fear<br />
    28. 28.
    29. 29.
    30. 30.
    31. 31. Just wondering, I've seen soooo many posts about nurses being spit on, cursed, bitten....what is the recourse for nurses, if any? Do you have to continue to care for the patient, how do you handle it? Thanks<br />
    32. 32. Resistant<br />Combative<br />
    33. 33.
    34. 34.
    35. 35. This is not a fluoride deficiency<br />
    36. 36. Dental hygienists to the rescue<br />
    37. 37.
    38. 38.
    39. 39. Most dental hygienists work in private practice and only see residents who are in pain.<br />
    40. 40. Don’t fully understand the limitations in adult care facilities<br />Become alarmed<br />Become accusatory, preachy, angry<br />
    41. 41.
    42. 42.
    43. 43. American Dental Hygienists Association<br />Over 95 percent of U.S. adults who have been treated by a dental hygienist without a dentist on the premises say they felt comfortable with the care they received. <br />
    44. 44. American Dental Hygienists Association<br />In 2007, Americans made about 500 million visits to dentists and spent an estimated $98.6 billion on dental services. <br />
    45. 45. American Dental Hygienists Association<br />Restrictive supervising laws for dental hygienists make oral health care more difficult to find. <br />
    46. 46.
    47. 47. The airway is very close to the mouth – ahem.<br />
    48. 48. 2005<br />Calculation of population-based attributable fractions showed that 21% of all cases of pneumonia in our cohort could have been avoided if inadequate oral care and swallowing difficulty were not present.<br />
    49. 49. ~ $15,000Per person with NHAP<br />
    50. 50. Objective for oral care<br />
    51. 51. Reduction Biofilm<br />
    52. 52.
    53. 53.
    54. 54.
    55. 55. Functional Foods<br />
    56. 56.
    57. 57.
    58. 58.
    59. 59. Sweetness Comparison<br />
    60. 60.
    61. 61. Xylitol<br />
    62. 62. Xylitol <br />Benefits<br />Measures like sugar<br />Proven to decrease oral biofilm<br />Tastes like sugar<br />Many oral and systemic benefits<br />Made by the body<br />Fewer calories than sugar<br />Drawbacks<br />Can cause GI upset<br />Expense <br />
    63. 63.
    64. 64.
    65. 65.
    66. 66.
    67. 67.
    68. 68. Maltitol<br />
    69. 69. Maltitol<br />Benefits<br />Measures the same as sugar<br />Tastes like sugar<br />Does not promote dental decay<br />Fewer calories than sugar<br />Drawbacks<br />GI upset<br />
    70. 70.
    71. 71.
    72. 72.
    73. 73. Xylitol and Maltitol come from plants<br />
    74. 74. Sugar<br />
    75. 75. Sugar<br />Benefits<br />Measures the same as sugar<br />No aftertaste<br />No GI effects<br />Drawbacks<br />Stimulates biofilm production<br />Stimulates acid production from bacteria<br />Increases decay risk<br />
    76. 76. More plaque on teeth translates to higher rate of COPD<br />Indian J Dent Res. 2009 Oct-Dec;20(4):466-70.<br />
    77. 77. Quality of Life<br />Poor self-perceived oral health and relatively poor quality of life co-exist groups of older adults.<br />
    78. 78.
    79. 79. Proposed<br />
    80. 80. Affects of good oral care <br />
    81. 81. A1c<br />
    82. 82. Insurance saves money!<br />3 year study<br />3500 people with diabetes<br />
    83. 83. Insurance saves money!<br />Periodontal Treatment<br />Saved <br />$2,483 in medical costs<br />
    84. 84. Insurance saves money!<br />Periodontal Treatment<br />Saved <br />$2,483 in medical costs<br />
    85. 85. Insurance saves money!<br />$2,483 in medical costs<br />Per Year<br />
    86. 86. $2,483<br />By managing the risk, each person with diabetes saved over $2K in other medical expenses per year!<br />Research from CIGNA Supports Potential Association between Treated Gum Disease and Reduced Medical Costs for People with Diabetes<br />
    87. 87. C-Reactive Protein<br />
    88. 88. CALCIUM<br />
    89. 89. WEIGHT<br />
    90. 90. HOSPITALIZATIONS<br />
    91. 91. Respiratory Infections<br />
    92. 92. Socialization<br />
    93. 93. Outcomes<br />Cost of prevention outweighed by<br /><ul><li>Reduction in hospitalization
    94. 94. Respiratory disease rate
    95. 95. Plaque accumulation
    96. 96. Oral health</li></li></ul><li>Save Money<br />Health care costs<br />Hospitalizations<br />Costs associated with pneumonia and respiratory disease<br />
    97. 97. Conclusion<br />Oral Care is proven critical for health in dependent adults.<br />Only a dental hygienist can provide that care, it’s too much to ask a nursing assistant or nurse to provide this level of oral care.<br />Dentist do not need to provide a prescription for oral care. They are in place to fix whats broken. Dental hygienists are a workforce that is willing, educated, licensed and able to take up this challenge.<br />
    98. 98. Find out the laws restricting dental hygienists in your state! <br />Mandating a dental hygienist on the staff of all Medicaid funded care facilities can save millions of dollars a year just in people with diabetes.<br />
    99. 99. Credits<br />PowerPoint designed by <br /> Cross Link Presentations, LLC<br />Presentation design<br /> Shirley Gutkowski, RDH, BSDH, FACE<br /> crosslinkpresent@aol.com<br />ScriptShirley Gutkowski, RDH, BSDH, FACE<br />Photos: Dreamstime, Gutkowski, StoneCharacters: PresenterMedia<br />Copyright 2011 Exploring Transitions, LLC<br />

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