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Interdisciplinary Oral Health . Adapted from ICC 2008 May 2008 Mark Deutchman MD Terry Batliner DDS Rich Call DDS Brad Potter DDS MS John D. McDowell, DDS, MS Lonnie Johnson DDS David Gaspar MD Bonnie Jortberg PhD

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interdisciplinary oral health
Interdisciplinary Oral Health

Adapted from ICC 2008

May 2008

Mark Deutchman MD Terry Batliner DDS

Rich Call DDS Brad Potter DDS MS John D. McDowell, DDS, MS

Lonnie Johnson DDS David Gaspar MD Bonnie Jortberg PhD

Katherine Anderson MD Robin Michaels PhD Inis Bardella MD

Kent Voorhees MD Colleen Conry MD Frank deGruy MD

40 Dental Students Ruthie Wilson Mark Osvirk

Delta Dental Frontier Foundation

Society of Teachers of Family Medicine Group on Oral Health

objectives
Objectives
  • Developing your understanding of the importance of oral health to systemic health
  • Recognize oral lesions
  • Developing your skills to perform the oral/head/neck examination
major information source smiles for life a national oral health curriculum for family medicine

Major information source :Smiles for LifeA National Oral Health Curriculum for Family Medicine

STFM Group on Oral Health

Module 1

The Relationship of Oral to Systemic Health

prevalence of oral disease
Prevalence of Oral Disease
  • Severe gum disease affects 19% of adults aged 25-44
  • 30,000 oral cancers diagnosed annually; 8000 die
  • Dental caries most common chronic disease of childhood
    • 5 times more common than asthma
    • 50% in low income children- up to 70% in Native Americans
consequences of untreated oral disease
Consequences of Untreated Oral Disease
  • Pain, infection, tooth loss
  • Impaired chewing & nutrition
  • Systemic complications
  • ER visits, hospitalizations, surgeries
  • Extensive and costly dental treatments (OR $5,000+)
  • Missed school and work
    • 52 million school hours lost/yr
prevention in both medical and dental homes
Prevention in both medical and dental homes
  • Caries resistance
    • Water fluoridation
    • Fluoridated toothpaste
    • Fluoride topical application
    • Sealants
  • Gum disease prevention
    • Brushing
    • Flossing
    • Regular dental visits
  • Oral cancer prevention
    • Smoking cessation
    • Alcohol
colorado s realities
Colorado’s realities

• In April 2000, nearly one-third of Colorado

counties lacked access to dental services for low income

and at-risk (Medicaid, CHP+, Medicare)

populations.

• 9 Colorado counties have NO LICENSED

DENTIST at all.

• Only 11% of Colorado’s dentists participate in

Medicaid’s Dental Program. 40% of Colorado

counties (25) do not have a dentist that accepts

Medicaid.

• Only 19 of the 182 counties in the three state

area of Colorado, South Dakota and North

Dakota have any pediatric dentists.

the disconnect
The Disconnect
  • Most patients have a medical home; many fewer have dental home
  • Children are 2.5 times more likely to lack dental coverage than medical coverage
  • Dentists per capita declining
  • Few pediatric dentists
  • >90% of physicians think oral health should be addressed at well visits, yet…
    • Surveys of physicians
      • > 50% had little or no oral health training
      • Only 9% could answer 4 simple questions correctly
      • Averaged <2 hours of oral health training
oral and systemic health are linked so care should be too
Oral and systemic health are linked so care should be too

Oral Health

Dental Home

Systemic Health

Medical Home

systemic conditions with oral manifestations
Systemic conditions with oral manifestations
  • Poor glucose control in diabetics  oral candidiasis and periodontal disease
  • Immunosuppression due to illness or chemotherapy  periodontal disease
  • Dry mouth from illness or medications  periodontal disease
    • Sjogren’s syndrome
    • Rheumatologic disorders
oral effects of medications
Oral effects of medications
  • Candidiasis from inhaled or oral steroids
  • Xerostomia from diuretics, anticholinergics, antihistamines and many antihypertensives
  • Gingival hyperplasia from phenytoin
  • Ulcerative stomatitis from methotrexate
  • Mucositis from chemotherapy or radiation treatment
oral and systemic conditions that appear linked
Oral and systemic conditions that appear linked
  • Adverse pregnancy outcome
    • Preterm labor
    • Preterm delivery
  • Atherosclerosis (Coronary heart disease and stroke)
  • Obesity
  • Osteoporosis also affects alveolar bone
  • Potential mechanisms:
    • Bacteremia from infected gums (evidence: oral bacteria in atherscloerotic plaque)
    • Inflammatory mediators leak into bloodstream
slide14

Oral Anatomy

1. Tongue

2. Palatine tonsil

3. Tonsillar pillar

4. Tonsillar pillar

5. Uvula

6. Palate (soft and hard)

7. Posterior wall of pharynx

8. Teeth

primary dentition
Primary Dentition

8 incisors + 4 canines + 8 molars = 20 by age 3

primary tooth eruption
Primary Tooth Eruption

Newborn

6 -12 months

Age 1

Age 3

adult dentition
Adult Dentition

8 incisors + 4 canine + 8 premolars + 12 molars = 32 Teeth

caries etiology triad
Caries: Etiology Triad

Oral bacteria (Mutans Strep) break down dietary sugars into acids which eat away the tooth

Bacteria

Teeth

Caries

Sugars

white spots
White Spots
  • White spots indicate acids have demineralized enamel
  • First clinical signs of caries
  • White spots place a child at high risk for developing cavities
  • Indication for dental referral
oral head neck exam checklist
Oral/head/neck exam checklist
  • Wash hands
  • Greet the patient
  • Confirm supplies: light, gloves, mouth mirror, tongue blade, gauze pad
  • Inspect the face and neck for obvious lesions, masses, nodes
  • Palpate the TM joint
  • Palpate the neck for nodes and masses
  • Anterior triangle, Posterior triangle, Submandibular,
  • Supraclavicular and infraclavicular areas
  • Put on gloves for intraoral examination
  • View and palpate the buccal mucosa including sulci
  • Inspect gingival tissues
  • Inspect teeth
  • Inspect palate
  • Inspect tonsillar pillars
  • Inspect tongue: top, lateral edges, under-surface. Use gauze pad to grasp tip of tongue when examining lateral edges.
  • Palpate floor of mouth
  • Explain exam findings to patient
  • Discard gloves
child oral exam knee to knee
Child Oral Exam (Knee to Knee)

1: Child is held facing caregiverin a straddle position

2: Child leans back onto examiner while caregiver holds child’s hands

3: Provider performs exam while caregiver holds child’s hands and legs

oral head neck exam checklist1
Oral/head/neck exam checklist
  • Wash hands
  • Greet the patient
  • Confirm supplies: light, gloves, mouth mirror, tongue blade, gauze pad
  • Inspect the face and neck for obvious lesions, masses, nodes
  • Palpate the TM joint
  • Palpate the neck for nodes and masses
  • Anterior triangle, Posterior triangle, Submandibular,
  • Supraclavicular and infraclavicular areas
  • Put on gloves for intraoral examination
  • View and palpate the buccal mucosa including sulci
  • Inspect gingival tissues
  • Inspect teeth
  • Inspect palate
  • Inspect tonsillar pillars
  • Inspect tongue: top, lateral edges, under-surface. Use gauze pad to grasp tip of tongue when examining lateral edges.
  • Palpate floor of mouth
  • Explain exam findings to patient
  • Discard gloves