The Meaning of Oral Health

1. The Meaning of Oral Health Terry Frankovich, M.D., M.P.H. Medical Director Marquette County Health Department Dickinson-Iron District Health Department Public Health, Delta & Menominee Counties Western Upper Peninsula Health Department

2. What is oral health?

3. Oral health means much more than healthy teeth • Teeth and the gums (gingiva) and their supporting structures • Hard and soft palate • Mucosa • Tongue, the lips, the salivary glands • Chewing muscles and the temporo-mandibular joints. • Branches of the nervous, immune, and vascular systems

4. A changing game • At the start of the twentieth century, most Americans expected to be toothless by age 45, and most were. • In 2014, most people assume that they will keep their teeth for their lifetime, and must take some active measures to do so.

6. What does good oral health look like?

7. healthy Teethhealthy gumshealthy mucosahealthy structures

8. What Does poor oral health look like?

9. Dental caries is a disease in which acids produced by bacteria (primary culprit: strep mutans) on the teeth lead to loss of minerals from the enamel and dentin, the hard substances of teeth. Dental caries is the most common chronic disease among children age 6-11 years (25%) and adolescents aged 12-19 years (59%).

10. Gingivitis Plaque, the sticky film that builds up on teeth, if not removed daily by brushing and flossing between teeth, can harden into tartar. Brushing and flossing become more difficult as tartar collects at the gum line. As the tartar, plaque and bacteria continue to increase, the gum tissue can become red, swollen and possibly bleed when you brush your teeth. …. • .

11. periodontitis • When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). • Gums pull away from the teeth and form spaces (pockets) that become infected. • The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. • Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. • If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose. It is the major cause of about 70 percent of adult tooth loss, affecting nearly 80 percent of people at some point in their life.

12. periodontitis

13. Oral Cancer • Historically the death rate associated with this cancer is high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development.

14. Methamphetamine use

16. Why do we care? What are the consequences of poor oral health?

17. Oral Health Problems Are Preventable, Common, and Painful

18. Physical Effects • Pain • Impact on speech and physical appearance • Infection • Nutritional loss due to chewing difficulties • GI problems due to poor chewing • Newer research suggests links between oral disease and cardiovascular disease, stroke, diabetes and poorer pregnancy outcomes (low birthweight and preterm birth) • Deaths related to oral cancer or infection

19. Social/emotional • School absenteeism: In a recent study, students with poor dental health were nearly 3 times more likely than their healthy peers to miss school due to dental pain.  Absences were linked to weaker academic performance. The Surgeon General estimates that children with oral disease miss over 51 millionhours of school each year • Decreased employability: for adults with visible dental issues • Lost work days:According to the U.S. Surgeon General, employed adults lose an estimated 164 million hours of work due to oral health problems or dental visits each year • Decreased self-esteem

20. Childhood Disease Burden • Tooth decay affects more than 25% of U.S. kids aged 2–5 years and 50% of those aged 12–15 years. • About 50% of all children and 66% of adolescents aged 12–19 years from lower-income families have had decay. • Among all adolescents aged 12–19 years, 20% currently have untreated decay.

21. Disparities • In the United States: • 80% of tooth decay occurs in 25% of America’s children, primarily low-income and minority children

22. Proportion of Michigan 3rd grade children with caries experience, by free/reduced lunch program participation and geographic region, 2009-10

23. Proportion of Michigan 3rd grade children with untreated dental disease, by free/reduced lunch program participation and geographic region, 2009-10

24. Adult Disease Burden • Advanced gum disease affects 4%–12% of U.S. adults. • Half of the cases of severe gum disease in the United States are the result of cigarette smoking. • One-fourth of U.S. adults aged 65 or older have lost all of their teeth. • About 43,000 Americans will be diagnosed with oral or pharyngeal cancer this year (only slightly more than half will be alive in 5 years). It will cause over 8,000 deaths

25. You cannot be healthy without oral health!

26. What Does poor oral health cost?

27. The Economic cost of poor oral health • In 2010, an estimated $108 billion was spent on dental services in the United States. This figure does not include associated costs (decreased productivity, work loss etc.)

28. How do we achieve oral health?

29. Prenatal dental care • Most data suggests that less than 50% of women see a dentist during pregnancy….Why? • Perception that dental care is not important • Financial issues • Availability of dentists • Fear of dental treatment • Concerns about harm to fetus • Lack of practice guidelines

30. Early and regular dental care • First dental visit is recommended within 6 months of first tooth erupting and no later than 1 year of age (Baby teeth are important!!!) • Fluoride supplements • Most children are recommended to see the dentist every 6 months • Cleaning gums first, then brushing and fluoride toothpaste, adding flossing as teeth fill in • Adults need regular dental care too as well as twice daily brushing, flossing and fluoride toothpaste

31. Are kids getting early dental care ? • In 2012, only 3.6% (4,653 of 129,864) of Michigan Medicaid-eligible under two years of age received an Oral Evaluation • In 2011, only 38% of Michigan Medicaid-enrolled children under age 21 received dental care

32. AGE ONE DENTAL EXPERIENCE The following chart ranks each U.P. counties by the percentage of Medicaid-enrolled children, less than Age Two who received an Oral Evaluation (D0145) during the state’s Fiscal Year 2011-12. • Luce 14.7% Gogebic 5.3% • Mackinac 13.1% Schoolcraft 4.2% • Marquette 10.9% Iron 4.0% • Chippewa 10.9% Menominee 2.1% • Baraga 7.6% Houghton 1.9% • Alger 7.5% Delta 1.7% • Ontonagon 7.3% • Dickinson 7.0% • Keweenaw 5.9% • *Medicaid coverage is based on Fee-for-Service and Healthy Kids Dental counties as of September 30, 2012.

33. Good Nutrition • Breastfeed infants! • No bedtime/nap bottles for infants and avoid sippy cups for toddlers and older children • Limiting sugars and starches for all • Plenty of fruits and vegetables (Vitamin A, C) • Dairy for calcium • Avoid sugary drinks (soda, coffee or tea with sugar), sports drinks

34. No tobacco..period

35. Sealants • Sealants are protective coatings placed on the grooved surfaces of teeth to prevent tooth decay. Despite high annual dental utilization, just 26.4% of Michigan 3rd grade children had sealants present on their first molars.

36. SEALANTS • Children should get sealants on their permanent molars as soon as the teeth come in -- before decay attacks the teeth. • The first permanent molars -- called "6 year molars" -- come in between the ages of 5 and 7. • The second permanent molars -- "12 year molars" -- come in when a child is between 11 and 14 years old. • Other teeth with pits and grooves also might need to be sealed.

37. Fluoridation • In 1945, nine cities, including Grand Rapids, Michigan, • began adding 1 ppm of fluoride to their • drinking water in order to observe its • effect on tooth decay. Ten to fifteen yrs • later, children in those cities had • 50-70 percent less tooth decay than • the baseline groups not exposed to • Fluoride. • (Coffel 1992, ADA 1993). About every $1 invested in community water fluoridation saves $38 in averted costs.

38. And…. • In Michigan, approximately 89.6% of the population served by public water systems received optimally fluoridated water in 2011…Not so in the U.P.

40. BARRIERS (in brief…more to come) • Financial barriers remain the primary reason individuals lack access to oral health services. • About 35 percent of the U.S. population has no dental coverage—significantly more than those medically uninsured.

41. Other possible barriers • Shortage of dentists • Shortage of dentists who accept public insurance • Practice standards (3/4 dentists are aware of standard to see kids by 1 year but only 1/3 recommend this in their own practice) • Transportation • Awareness • Cultural • Access to good nutrition • Access to fluoridated water

42. The part can never be well unless the whole is well. ~Plato

43. Questions?????