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Oral Health

Oral Health

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Oral Health

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  1. Milestones in Public Health: Chapter 9 Oral Health Lectures for Medical and Clinical Education January 2011

  2. Learning Objectives Describe the history of dentistry in becoming a profession Discuss the impact of major innovations in dental health Describe major oral diseases Explain the impact of fluoridation on oral health Describe the impact of dental sealants on oral health Identify health disparities in oral health

  3. Lecture Outline Looking Back Milestones in Dental Innovation Oral Health and Public Health The Major Oral Diseases Looking Ahead: Oral Health Disparities

  4. Oral Health Looking Back

  5. Looking Back Pfizer Inc. (2006). Chapter 9: Oral health: Looking back. In Milestones in public health : Accomplishments in public health over the last 100 year. (p.171). New York, NY: Pfizer Inc. The Earliest known dentist, Hesi-Re, lived in Egypt around 2600 BC, where ancient skulls have been found with small holes in the jaw-bone, possibly representing efforts to alleviate the pressure of abscesses, secondary complications of dental caries Royalty in ancient Egypt, who had a diet rich in carbohydrates, show an 80% caries rate, while lower class ancient Egyptians had a very low caries rate due to lower carbohydrate consumption Dentistry was a part of medicine in ancient Mesopotamia. The code of Hammurabi (1900 BC) reveals that the government regulated the medical profession (including dentistry) as far back as 2500 BC

  6. Looking Back:Dentistry Becomes a Profession Historically, scientists, educators, and practitioners in the health field have disconnected the mouth from the rest of the body. As a result of the Maryland legislature’s unwillingness to incorporate dentistry as a department at the University of Maryland medical school due to attendant costs, dentistry did not become a medical specialty, but rather its own discipline Dr. Chapin A. Harris, considered the father of American dental sciences, along with Dr. Horace H. Hayden, co-founded the Baltimore College of Dental Surgery, the world's first dental college, in 1840. Between 1840 and 1867, nine more freestanding dental schools were founded using the Baltimore model

  7. Looking Back:Dentistry Becomes a Profession (Cont.) Pfizer Inc. (2006). Chapter 9: Oral health: Looking back. In Milestones in public health : Accomplishments in public health over the last 100 year. (p.169). New York, NY: Pfizer Inc. In 1867, Harvard established the Harvard School of Dental Medicine in association with the Massachusetts General Hospital, becoming the first university-affiliated dental school By 1870, 85% of the 8,000 practicing dentists in the U.S .had trained under preceptors, or declared themselves as dentists, while only 15% had graduated from dental schools According to the Bills of Mortality, dental infections and complications represented a leading cause of death during this time

  8. Looking Back: Dentistry Becomes a Profession (Cont.) Pfizer Inc. (2006). Chapter 9: Oral health: Looking back. In Milestones in public health : Accomplishments in public health over the last 100 year. (p.170). New York, NY: Pfizer Inc. With the advent of more dental schools in the U.S. in the late 1800’s, fewer dentists employed the preceptorship model for their education, and dental school graduates began to dominate the ranks of their profession By the mid 1920’s, less than 3% of practicing dentists had trained under preceptorship arrangements The 1926 Gies Report advocated that incoming dental students should have at least two years of university education in addition to instruction on the basic biology of oral structure and the pathology of oral facial disease

  9. Looking Back:Dentistry Becomes a Profession (Cont.) Dougherty, M. (2003, March 26). A biochemist who lead dental history: William Gies' 1926 report on dental education is still relevant today. In VIVO: Columbia University Health Sciences, 2(6). Retrieved June 13, 2010 from http://cumc.columbia.edu/publications/in-vivo/Vol2_Iss06_mar26_03/medical-history.html • According to Dr. Allan Formicola, president of the William J. Gies Foundation, the field of dentistry moved closer to becoming an oral specialty of medicine as a result of the Gies Report • The report established stricter accreditation standards and admission requirements to dental schools • This “higher bar” raised the caliber of and quality of dental students and education, and led to a new respect for dentistry

  10. Looking Back:Dentistry Becomes a Profession (Cont.) Pfizer Inc. (2006). Chapter 9: Oral health: Looking back. In Milestones in public health : Accomplishments in public health over the last 100 year. (p.169). New York, NY: Pfizer Inc. However, dental schools and dental societies continued to operate separately from medical schools and societies, and subsequently many health care professionals were never fully educated on the impact of oral disease on overall health

  11. Looking Back:Dentistry Becomes a Profession (Cont.) • The dental health profession includes: • Dentists, dental hygienists, dental assistants, and dental laboratory technicians • There are nine dental specialties • Dental public health, endontics, oral and maxillofacial surgery, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, and radiology

  12. Oral Health Milestones in Dental Innovation

  13. Milestones in Dental Innovations Pfizer Inc. (2006). Chapter 9: Oral health: Looking back. In Milestones in public health : Accomplishments in public health over the last 100 year. (p.170). New York, NY: Pfizer Inc. While significant improvements in preventive dentistry and oral health have occurred since dentistry became a profession in 1839, presently, the silent epidemic of tooth decay disproportionately affects the: • uninsured, inner-city and rural, low-income, developmentally disabled, homebound, and homeless populations

  14. Milestones in Dental Innovations (Cont.) Toothbrushes • Chewsticks, the first toothbrushes, borrowed from the Chinese and from Babylonians • Tooth brushing became a daily routine after World War II • Rejection rate of draftees during World War II due to oral health had been so high that standards had been lowered to meet targets

  15. Milestones in Dental Innovations (Cont.) Toothpaste • Origins of toothpaste can be traced back to ancient India and China as far back as 500 BC. In the 19th century toothpaste more similar to what we know today was developed • Procter and Gamble introduced fluoride in toothpaste in 1956, which is necessary to prevent tooth decay • Without fluoride, toothpaste can help prevent gum disease but not tooth decay

  16. Milestones in Dental Innovations (Cont.) • Novocain • Developed in 1905 by Alfred Einhorn as an analgesic substitute for cocaine in 1905. The trade name Novocain comes from a combination of the Latin word "novus," meaning "new," plus "cocaine" • Dental Floss • Silk thread floss developed by Levi Spear Parmly in 1815 and patented by Johnson and Johnson in 1898 • Dr. Charles C. Bass (a physician) developed nylon floss and promoted its use during WW II • Mouth Rinses and High Speed Drill

  17. Oral Health Oral Health and Public Health

  18. “Oral diseases are a neglected epidemic in our country, and the oral health disparities of the underserved are shameful. We need to reconnect the mouth to the rest of the body.” Dr. Myron Allukianformer director of Oral Health Boston Public Health Commission

  19. Oral Health and Public Health In spite of these milestones in dental innovations, presently, poor oral health continues to exist as a silent epidemic, where underserved populations disproportionately suffer from major and often preventable oral diseases, which results in great societal costs

  20. Oral Health The Major Dental Diseases

  21. Major Oral Diseases: Dental Caries National Institute of Dental and Craniofacial Research. (2010). Oral health in America: A report of the Surgeon General (executive summary). Retrieved 6/13/2010 from http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/Report/ExecutiveSummary.htm The most common chronic disease among children 5 to 17 years – five times more common than asthma Bacteria occur normally in the mouth Plaque begins to build up on teeth within 20 minutes after eating (the time when most bacterial activity occurs). If this plaque is not removed thoroughly and routinely, tooth decay will begin and flourish

  22. Major Oral Diseases: Dental Caries (Cont.) MedlinePlus. (2010). Dental cavities: Cavities are holes, or structural damage, in the teeth. Retrieved 6/13/2010 from http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm “The acids in plaque dissolve the enamel surface of the tooth and create holes in the tooth (cavities). Cavities are usually painless until they grow very large and affect nerves or cause a tooth fracture. If left untreated, a tooth abscess can develop. Untreated tooth decay also destroys the internal structures of the tooth (pulp) and ultimately causes the loss of the tooth.”

  23. Preventable Complications of Dental Caries: Tooth Abscesses MedlinePlus.(2010). Tooth abscess [Online image]. Retrieved 8/26/2008 from http://www.nlm.nih.gov/medlineplus/ency/imagepages/9979.htm

  24. Early Childhood Caries National Library of Medicine. Baby bottle tooth decay [Online image]. Retrieved June 13, 2010 fromhttp://www.nlm.nih.gov/medlineplus/mobileimages/ency/fullsize/9090_xlfs.png Early childhood caries (ECC), also referred to as baby bottle tooth decay, stems from sweetened liquids that cling to the infants’ teeth ECC often occurs when a baby is regularly given a bottle with sugary liquid at bedtime or nap-time, most often affects the upper front teeth, and can cause severe tooth decay Although a preventable disease, ECC is prevalent in low-income families, and can cost as much as $6,000 per child to treat (as general anesthesia may be required)

  25. Prevention of Dental Caries MedlinePlus. (2010). Tooth abscess in Dental cavities: Cavities are holes, or structural damage, in the teeth. Retrieved 6/13/2008 from http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm • Good oral hygiene consists of: • Undergoing regular professional teeth cleaning every 6 months, brushing at least twice a day, flossing at least daily, and having x-rays done on a yearly basis • Eating chewy, sticky foods (such as dried fruit or candy) as part of a meal rather than as a snack, and brushing the teeth or rinsing the mouth with water after eating these foods • Minimizing snacking, which creates a constant supply of acid in the mouth • Avoiding constant sipping of sugary drinks or frequent sucking on candy and mints

  26. Prevention of Dental Caries: Dental Sealants MedlinePlus. (2010). Tooth abscess in Dental cavities: Cavities are holes, or structural damage, in the teeth. Retrieved 6/13/2008 from http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm Dental sealants, thin plastic-like coating applied to the chewing surfaces of the molars can prevent cavities, as they block the accumulation of plaque in the deep grooves on vulnerable surfaces While sealants are generally applied on teeth of children, shortly after the molars erupt, older individuals may also benefit from their use

  27. Prevention of Dental Caries: Fluoride MedlinePlus. (2010). Tooth abscess in Dental cavities: Cavities are holes, or structural damage, in the teeth. Retrieved 6/13/2008 from http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm Fluoride is often recommended to protect against dental caries as studies have shown that people who ingest fluoride in their drinking water or by fluoride supplements have fewer dental caries. Fluoride protects the enamel against the action of acids “Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions (applied to a localized area of the teeth) as part of routine visit"

  28. Prevention of Dental Caries: Community Water Fluoridation Centers for Disease Control and Prevention (n.d.) Preventing Chronic Diseases Invetsing Wisely in Health - Preventing Dental Caries. Retrieved 8/26/2008 from http://www.dental.ufl.edu/Patients/Files/PreventingDentalCaries.pdf Pfizer Inc. (2006). Chapter 9: Oral health: Case study. In Milestones in public health : Accomplishments in public health over the last 100 year. (pp.176-178). New York, NY: Pfizer Inc. “Community water fluoridation has been ranked one of 10 great public health achievements in the 20th century” Fluoride occurs naturally in all drinking water in varying concentrations, according to geological features In 1931, Dr. Frederick S. McKay, proved that naturally occurring fluoride in the water supply could inhibit dental caries

  29. Prevention of Dental Caries: Community Water Fluoridation (Cont.) Pfizer Inc. (2006). Chapter 9: Oral health. In Milestones in public health : Accomplishments in public health over the last 100 year. (p. 178). New York, NY: Pfizer Inc. Dr. McKay collaborated with Dr. H. Treandly, Dean of the U.S .Public Health Service, to identify an adjusted fluoridation standard that would have the benefit of reducing dental caries while avoiding tooth discoloration Drs. McKay and Treandly concluded that the water fluoride standard should be one part per million. Several subsequent studies proved that this standard provided optimum dental caries protection with minimum staining of the teeth

  30. Prevention of Dental Caries: Community Water Fluoridation (Cont.) Pfizer Inc. (2006). Chapter 9: Oral health. In Milestones in public health : Accomplishments in public health over the last 100 year. (pp. 178-179). New York, NY: Pfizer Inc. In 1945, Grand Rapids, Michigan became the first city in the world to adjust its fluoride concentration to the new adjusted fluoride standard In 1950, the U.S. Public Health Service recommended community water fluoridation as a public health measure By the early 1980’s, epidemiologic studies revealed that the prevalence of caries was decreasing throughout the U.S.

  31. Prevention of Dental Caries: Community Water Fluoridation (Cont.) Pfizer Inc. (2006). Chapter 9: Oral health. In Milestones in public health : Accomplishments in public health over the last 100 year. (p. 179). New York, NY: Pfizer Inc. In 2005, 170 million people in the U.S. lived in fluoridated communities, including about 10 million who lived in communities with naturally fluoridated water supplies The majority of communities (91%) fluoridate administratively through local or state government In 2005, an additional 30-40 million people were estimated to live without public water supplies, depending on sources such as natural springs or drilled wells

  32. Prevention of Dental Caries: Community Water Fluoridation (Cont.) Pfizer Inc. (2006). Chapter 9: Oral health. In Milestones in public health : Accomplishments in public health over the last 100 year. (p. 180). New York, NY: Pfizer Inc. Yet, community water fluoridation remains controversial to some people who oppose any form of government intervention and regard fluoridation as forced medication and violation of personal freedom • In 2002 and 2004, 26 communities across the U.S. voted in referenda for fluoridation

  33. Prevention of Dental Caries: Community Water Fluoridation (Cont.) Centers for Disease Control and Prevention. (n.d.). Preventing Chronic Diseases Invetsing Wisely in Health - Preventing Dental Caries. Retrieved August 26, 2008 from http://www.dental.ufl.edu/Patients/Files/PreventingDentalCaries.pdf • 66% of individuals on public water systems— more than 162 million people — receive community water fluoridation • “Community water fluoridation effectively prevents dental caries in communities with varying disease prevalence • ”Children in communities with water fluoridation experienced 29% fewer cavities”

  34. Gum Diseases: Gingivitis MedlinePlus. (2009). Medical Encyclopedia, Gingivitis [Online image]. Retrieved August 26,2008 from http://www.nlm.nih.gov/medlineplus/ency/imagepages/1136.htm

  35. Gum Diseases: Gingivitis (Cont.) MedlinePlus. (2010). Gingivitis is inflammation of the gums (gingiva). Retrieved 6/13/2010 from http://www.nlm.nih.gov/medlineplus/ency/article/001056.htm Localized infection or inflammation of the soft tissues characterized by swelling and bleeding of the gums Bacteria in plaque around the teeth release enzymes (collagenases) that can erode the gum tissues. The inflamed gums swell, recede, bleed easily, and can loosen from the teeth Good oral hygiene is the best prevention against gingivitis because it removes the plaque that causes the disorder

  36. Gum Diseases Peridontitis • Also an infection of the soft tissues, involves the supporting alveolar bone around teeth with loss of peridontal attachment • Prevalence increases with age and the condition disproportionately affects immunosuppressed individuals (e.g. HIV/AIDS)

  37. Oral Cancer Source (n.d.): Courtesy of Sonny Johansson, MD, PhD [image].

  38. Oral Cancer (Cont.) • National Institute of Dental and Craniofacial Research. (2010). Oral cancer. Retrieved 5/15/2009 from http://www.nidcr.nih.gov/OralHealth/Topics/OralCancer/OralCancer.htm • Oral cancer includes cancers of the mouth and the pharynx, part of the throat  • About two-thirds of oral cancers occur in the mouth and about one-third are found in the pharynx • An estimated 35,000 Americans will be diagnosed this year and approximately 7,500 deaths will occur from the disease 

  39. Oral Cancer (Cont.) Risk factors include: • Male gender • Alcohol and tobacco use • Age over 40 years old • For lip cancer, sun exposure is a risk factor

  40. Oral Cancer (Cont.) The majority of oral cancers are preventable 75% of oral cancers are related to tobacco use, alcohol use, or both Of all cancers, oral and pharyngeal cancers show the largest disparity in five-year survival rates between whites (56%) and African-Americans (36%)

  41. Oral Cancer (Cont.) The vast majority of oral cancers are squamous cell carcinomas Oral leukoplakia requires follow-up with biopsies as it may be a precursor of squamous cell carcinoma

  42. Oral Leukoplakia Source (1980): Courtesy of Jan Hirsch, MD, PhD., [image].

  43. Oral Health Looking Ahead: Oral Health Disparities

  44. Looking Ahead: Oral Diseases, Still a Neglected Epidemic US. Department of Health and Human Services. (2003).  National call To action to promote oral health: A public-private partnershipunder the leadership of The Office of the Surgeon General . (No. 03-5303). Rockville, MD: National Institutes of Health “There are profound and consequential health oral health disparities within the U.S. population” “The burden of oral diseases and conditions is disproportionately borne by individuals with low socioeconomic status at each life stage and by those who are vulnerable because of poor general health”

  45. What Are Health Disparities? • LaVeist, T. A. (2005). Minority Populations and Health, An Introduction to Health Disparities in the United States. San Francisco, CA: Jossey-Bass A Wiley • “Differences in the incidence, prevalence, mortality, and burden of diseases and other health conditions that exist among specific population groups…” National Institutes of Health, US Department of Health and Human Services • ”Differences in the incidence or prevalence of disease disability, or illness. These differences can be among racial/ethnic groups, socioeconomic groupings, gender groups, or other groupings”

  46. Oral Health Disparities? US. Department of Health and Human Services. (2003).  National call To action to promote oral health: A public-private partnershipunder the leadership of The Office of the Surgeon General . (No. 03-5303). Rockville, MD: National Institutes of Health According to the Surgeon General: • Poor children suffer twice as much dental caries as their more affluent peers • Children living below the poverty line (annual income of $17,000 for a family of four) have more severe and untreated tooth decay

  47. What Factors Determine Oral Health? US. Department of Health and Human Services. (2003).  National call To action to promote oral health: A public-private partnershipunder the leadership of The Office of the Surgeon General . (No. 03-5303). Rockville, MD: National Institutes of Health The major factors that determine oral and general health and well-being are: • Individual biology and genetics • Environment, including its physical and socioeconomic aspects • Personal behaviors and lifestyle • Access to care • Organization of health care “These factors interact over the life span and determine the health of individuals, population groups, communities – from neighborhoods to nations”

  48. Living and working conditions may include: • Psychosocial factors • Employment status and occupational factors • Socioeconomic status (income, education, occupation) • The natural and builtc environments • Public health services • Health care services Broad social, economic, cultural, health, and environmental conditions and policies at the global, national, state, and local levels Living and working conditions Social, family and community networks Individual behavior Innate individual traits: age, sex, race, and biological factors --- The biology of disease Over the life span b SOURCE: The Future of the Public’s Health (IOM, 2003) NOTES: Adapted from Dahlgren and Whitehead, 1991. The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999). Determinants of Population Health

  49. Access to Care US. Department of Health and Human Services. (2003).  National call To action to promote oral health: A public-private partnershipunder the leadership of The Office of the Surgeon General . (No. 03-5303). Rockville, MD: National Institutes of Health “Access to care makes a difference. A complex set of factors underlies access to care and includes the need to have an informed public and policymakers, integrated and culturally competent programs, and resources to pay and reimburse for the care. Among other factors, the availability of insurance increases access to care” “Federal and state assistance programs for selected oral health services exist; however, the scope of services is severely limited, and their reimbursement level for oral health services is low compared to the usual fee for care”

  50. Medical Insurance and Access to Dental Care US. Department of Health and Human Services. (2003).  National call To action to promote oral health: A public-private partnershipunder the leadership of The Office of the Surgeon General . (No. 03-5303). Rockville, MD: National Institutes of Health ”Medical insurance is a strong predictor of access to dental care. Uninsured children are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are 3 times more likely to have dental needs than children with either public or private insurance. For each child without medical insurance, there are at least 2.6 children without dental insurance.”