TACHC 27th Annual ConferenceOctober 2010

San Antonio, TX

Dr. M. ZamoraDental Director

Makes Patients and their loved ones an integral part of the care team who collaborate with health care professionals in making clinical decisions

Makes Patients responsible for important aspects of self care and monitoring – along with tools and support they need to carry out that responsibility

PCC considers: Cultural traditions Personal Preferences and Values Family situations Lifestyles

Ensures that transitions between providers, departments, and health care settings are respectful, coordinated and efficient

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.)

Oral Health Care Professionals rarely address mental or physical systemic health

Medical Health Professionals rarely address Oral Health

A new paradigm between Dentistry and Medicine is now developing regarding patient care

Informed Patients Health Care Reform

HH model: incentives for managing pt’s outcomes by integrative care

Lifesaving Checkup: The Dentist A healthy mouth reduces your risk for heart attack and stroke. Learn why seeing the dentist could save your life.

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

The most significant areas identified with systemic connection:

CVD Pulmonary disease Fetal development, Preeclampsia Diabetes Orthopedic Implant Failure Kidney Disease *Dementia

(Moffett, Frances. 2010. Oral –Systemic Relationship. Retrieved from http://www.adha.org/CE_courses/course_13/systemic_relationship.htm)

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.”(Moffett, Frances. 2010. Oral Health-Total Health: Know the Connection. Retrieved from http://www.adha.org/media/facts/total_health.htm)

As the oral-systemic connection is more clearly understood, dentists will play a greater role in the overall health of their patients

Many times, the signs of unnatural systemic health conditions reveal themselves with changes in the oral cavity(Moffett, Frances. 2010. Oral –Systemic Relationship. Retrieved from http://www.adha.org/CE_courses/course_13/systemic_relationship.htm)

Dentist’s role RMH to identify ‘at risk’ patients

EX: Uncontrolled HTN Comprehensive periodontal (PD) exams Results of these exams should be sent to the patient’s physician(s)

Physician’s role Play a more active role in oral systemic connection 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

Referral to Dentist or Periodontist

This new era of interdisciplinary dental/medical cooperation will undoubtedly result in improved patient health, as well as an improvement in overall patient longevity.

EX: Forms

Insurance In 2000, 108 million lack DI( SG report) Limited coverage

Cost of Delivering Care From 1996 to 2004, average cost of dental procedure rose 25%

Shortage of Dentists Fewer Dental School graduating less students 5750 in 1982, 4440 in 2003 (ADA)

CHC Programs 2008 UDS: 1200 CHC in US; 888 with Dental Programs

~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)

It ranges from simple gum inflammation, called gingivitis, to serious disease that results in damage to the bone

Periodontology

The Chairside Instructor. A pictorial guide to case presentation. ADA . 2005.

Periodontology

Periodontology

PD affects 15% of women of childbearing age Gingivitis affects 30-100% of pregnant women Pre-term birth (<37 wks)

75% of all US neonatal mortality 35% of all health care expenditures on infants No improvement in 40 years

Low birth weight (< 5.5 pounds) Higher risk of complications

Studies have found that expectant mothers with PD are up to 7x more likely to deliver premature, low birth babies(Douglass, Alan M.D., F.A.A.F.P. and Joanna B.D.S., D.D.S. University of Connecticut School of Dental Medicine.)

Serious, costly and increasingly common chronic disease

Affects 23.6 million children and adults in the US

Contributes to more than 200,000 deaths a year

~95% of Americans with Diabetes also have PD

Research shows that people with PD have more difficulty controlling their blood sugar levels

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(Moffett, Frances. 2010. Oral Health-Total Health: Know the Connection. Retrieved from http://www.adha.org/media/facts/total_health.htm)

THE number one killer of men and women- claiming more victims that all forms of cancer and AIDS combined

Approximately one American dies every 7 seconds

Numerous research studies have shown a connection between heart disease and key bacteria in periodontal disease Bacteria or viruses directly effect atherosclerotic lesions contributing to the

inflammatory process

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(Touger-Decker, Riva, PhD, RD, FADA. “Diet, cardiovascular disease and oral health” JADA February 2010: pages 167-170. Print.)

Images of Box 1: JADA Feb 2010 High Blood Pressure High cholesterol levels Overweight and obesity Physical inactivity Poor diet (high in cholesterol; sodium; saturated

and/or trans fats; and/or high calories) Smoking Type 2 Diabetes

Investigators have outlined roles for oral health care professionals (OHCPs) in primary prevention Screening in the dental office

Ex: HTN Medical Referral Education, encouragement and reinforcement of Lifestyle behaviors such as diet

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”.

More recently, Lamster and colleagues stated that ‘dentists can become advocates for a general health promotion and disease prevention message.’

Through education, OHCP, like other health care professionals, can play a role in primary prevention of CVD.

(Touger-Decker, Riva, PhD, RD, FADA. “Diet, cardiovascular disease and oral health” JADA February 2010: pages 167-170. Print.)

OC can affect any area of the oral cavity including the lips, gum tissues, cheek lining, tongue, and the hard or soft palate

The most frequent sites for cancer are the tongue, floor of the mouth, tissues in the back of the tongue, lips and gums

30,000 case of oral cancer are diagnosed annually

This year Oral cancer will kill one person every hour

Oral cancer is more common than Leukemia, Skin Melanoma, Hodgkin’s disease and cancers of the brain, liver, thyroid gland, stomach, ovaries and cervix(Moffett, Frances. 2010. Oral Health-Total Health: Know the Connection. Retrieved from http://www.adha.org/media/facts/total_health.htm)

(Dr. Dan Peterson. (February 6, 2008). Facts about Oral Cancer. Retrieved from http://www.dentalgentlecare.com/facts_about_oral_cancer.htm)

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

Poorest 5 year survival rates- Only 52% survive after 5 years of diagnoses

Radiation can NOT cure it, it can help, along with chemotherapy

Surgery has devastating results due to the loss of a part of one’s tongue, jaw or roof of the mouth

Surgery can be very disfiguring

(Dr. Dan Peterson. (February 6, 2008). Facts about Oral Cancer. Retrieved from http://www.dentalgentlecare.com/facts_about_oral_cancer.htm)

Squamous Cell Carc: 30 yrs Hx of Smokeless Tob

Outdoor texan.com

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.

Regular visits to the dentist can increase the chance of early detection which can improve the potential for successful treatment.

(Dr. Dan Peterson. (February 6, 2008). Facts about Oral Cancer. Retrieved from http://www.dentalgentlecare.com/facts_about_oral_cancer.htm)

Tooth decay is the most common, preventable, chronic childhood disease, 7x more common than Asthma (HRSA, Surgeon General, Healthy People 2010)

Caries: Bacterial infection (mutans streptococci and lactobacilli) causing acid production leads to demineralization and eventually cavitations of the tooth surface

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)

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)

Pediatrician referral

60% of abusive injuries involve the oro-facial area (Cairns, Mok, & Welbury, 2005)

1,760 child fatalities in 2007 in the US

According to Chapter 261 of the Family Code 9 re-codified in 1995) child abuse is; An act or omission that endangers or impairs a

child’s physical, mental or emotional health and development

Child abuse may take the form of physical or emotional injury, sexual abuse, sexual exploitation, physical neglect, medical neglect or inadequate supervision

7 yo male patient with palatal petichiae Dentist CPS Center for Miracles Pediatrician

Courtesy of Dr. H. Kessler

It is incumbent of all health care professional to integrate strategies to ameliorate these diseases.

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.

This new era of interdisciplinary dental/medical cooperation will undoubtedly result in improved patient health, as well as an improvement in overall patient longevity.