The Medical-Dental Connection

1. Georgia Tech Educational series The Medical-Dental Connection How dental health impacts your life Presented by Dawn Welch May 27, 2014

2. What you will learn today: • What is the oral health connection? • Medical conditions with oral symptoms • What is periodontal disease and what is the link to overall health? • Current research supporting the connection between medical conditions and dental disease • What can I do?

3. Did you know? • Each year, children lose more than 51 million hours of school due to dental related illness • Employed adults lose more than 164 million hours of work each year due to oral health problems or dental visits Source: U.S. Surgeon General

4. Cost of Dental Disease • Days lost from work = money lost • Today’s average cost of a tooth from the time a cavity first appears to the end of life: $3,500 • With the exception of accidental damage, dental treatment begins with relatively low-cost and non-traumatic diagnostic procedures, such as exams and x-rays • Prevention and early intervention are the key to successful management of oral health and overall health

5. The value of dental health in the workplace… Emotional Capital Intellectual Capital Employee engagement, commitment, motivation, attitudes, work “culture” Knowledge, talent, skills, experience Health Capital Health status (physical and behavioral/psychological), functional capacity • Skilled workers are essential to business success and not easily replaced • Intellectual capital, emotional capital, health capital- combine to form a synergistic relationship responsible for high levels of productivity

6. Healthcare and Today’s Economy • Today’s business models are changing due to declining profit margins and global and domestic competition. • The need to for companies to lower costs is inevitable. • This is evident when it comes to employee benefits, especially healthcare. • #1 concern for executives and CFO’s: double-digit healthcare cost inflation

7. ? Toothy Trivia! A dentist was the inventor of… 1. A: Grape juice B: Chewing gum C: Cotton candy D: All of the above

8. The Oral-Systemic Health Connection “Systemic” refers to the involvement of many organs or systems of the whole body Source: American Academy of Periodontology

9. The Mouth as a portal of entry for infection… • The mouth is a major entry point to the body with mechanisms to defend against toxins or invading pathogens • If integrity of oral tissues is breached, the mouth can become a source of disease affecting other parts of the body • Mouth may be the site for transmission of infectious microbes • 700 strains of bacteria have been identified in the mouth • Bacteria have been found to migrate from the mouth to the lungs or other organs

10. Medical conditions with oral symptoms: • Pregnancy • Osteoporosis • Diabetes • Heart Disease • Pancreatic Cancer • Respiratory Disease • Kidney Disease

11. The Oral Systemic Health Connection • New research is pointing to associations between chronic oral infections and heart and lung diseases, stroke, low-birth-weight and premature births • Periodontal disease is the most common chronic infection • Periodontal disease has links to systemic disease, and affects 3 out of 4 people at some point in their life

12. What happens in your mouth doesn’t just stay in your mouth • Infection and inflammation in the mouth have been linked to a variety of systemic conditions • Many medical illnesses manifest oral symptoms • More research is needed to discover exactly how oral inflammation affects the rest of the body University of Toronto Library: Anatomy from the 1500’s

13. Oral Indicators: • Swollen gums • Bleeding gums • Ulcers • Dry mouth • Bad breath (Halitosis) • Metallic taste • Burning sensation • Growths (tumors) Swollen, red gums (gingivitis) Sqaumous Cell Carcinoma

14. Clues Dentists look for… • Many diseases are detectable through x-rays and by studying dental plaque • Saliva and other oral cells can be used to assess health and disease- without the limitations and difficulties of obtaining blood or urine • Saliva can be used to test for Alzheimer’s disease, mumps, measles, and rubella • Simple cheek swab- scrapings of the inner cheek cells- may be able to detect cancer of head, neck, and lungs

15. What the dentist may detect in your mouth: More then 120 medical conditions can be detected by signs and symptoms in your mouth

16. Mumps Tuberculosis HIV Malignant Melanoma Parkinson’s disease Mononucleosis Addison’s Disease Cystic Fibrosis Vitamin deficiencies Alcoholic cirrhosis Oral Tissues can reflect the presence of…

17. What is Periodontal Disease? • The word periodontal means “Around the tooth” • The periodontium refers to the tissues that surround and support the teeth including the periodontal ligament and bone. • Gum disease (includes gingivitis and periodontitis) is a chronic bacterial infection effecting the gums and bone supporting the teeth. • Gum disease can damage one or more teeth, resulting in their loss.

18. Risk Factors for Periodontal Disease • Bacterial plaque • Smoking/tobacco use • Genetics • Stress • Medications • Clenching/grinding your teeth • Poor nutrition

19. ? Toothy Trivia! Which U.S. president had oral surgery done in secret to prevent a national panic? 1. A: Abraham Lincoln B: John F. Kennedy C: Grover Cleveland D: Franklin Roosevelt

20. Effects of Pregnancy on Oral Health • Pregnancy Gingivitis • Pregnancy Tumors • Pre-term delivery and low-birth weight

21. Pregnancy Gingivitis Studies indicate approximately 50% of women experience some degree of pregnancy gingivitis

22. Pregnancy Tumors • Rare condition seen in the 2nd or 3rd trimester • Also know as Pyogenic Granuloma • A painless lesion that develops in response to plaque • Requires treatment Photos: MUSOD Department of Oral and Maxillofacial Pathology

23. Association with pre-term birth • Increasing evidence suggests a link between periodontal disease as a risk factor for pre-term birth, however, the studies are inconclusive. • Results cannot be generalized to the entire maternal population for studies with a small sample size and skewed demographics. • Research is ongoing.

24. Women’s Health and Osteoporosis • Bone loss is associated with both gum disease and osteoporosis • Estrogen deficiency and osteoporosis speed the progression of oral bone loss following menopause, which could lead to tooth loss • Estrogen supplementation may lower gingival inflammation and help to protect teeth.

25. Diabetes • Diabetics are at higher risk for developing infections, including gum diseases • Inflammatory diseases such as gum disease can increase insulin resistance, thereby affecting glycemic (blood sugar) control • Poorly controlled type 2 diabetic patients are more likely to develop gum disease than diabetics under control with medication • More than 50% of people in the United States diagnosed with diabetes are not achieving control of the disease, as defined by an A1C or blood sugar count of less than 7%.

26. Heart Disease and Stroke • Theory 1: Oral bacteria can affect the heart when entering the blood stream, attaching to the fatty plaques and contributing to clot formation • Theory 2: The inflammation caused by gum disease increases plaque build-up, contributing to swelling of the arteries.

27. Heart Disease • Periodontal disease can exacerbate existing heart conditions • Patients at risk for infective endocarditis may require antibiotics prior to dental procedures: • Prosthetic cardiac valve • Previous endocarditis • Some types of congenital heart disease • Cardiac transplantation recipients with cardiac valvular disease

28. Heart Health • Evidence continues to support an association among periodontal infections, atherosclerosis, and vascular disease • Managing oral health may very well be key to a healthy heart • The emergence of periodontal infections as a potential risk factor for cardiovascular disease is leading to a convergence in oral and medical care that will benefit patients.

29. Pancreatic Cancer • More than 30,000 Americans were expected to die from this disease in 2007. • Established risk factors for pancreatic cancer are cigarette smoking and chronic pancreatitis • The role of inflammation from gum disease may promote the cancer

30. Respiratory Disease • Gum disease increases bacteria in the mouth • Inhaling germ-filled droplets from the mouth and throat into the lungs may cause bacterial infections • People suffering from chronic obstructive pulmonary diseases (COPD) typically lack protective systems making it difficult to eliminate bacteria from the lungs • Patients with respiratory diseases are more at risk for pneumonia

31. Kidney Disease • Patients with Kidney disease are considered an “at risk” population and are more prone to infections. • Oral symptoms of kidney disease: bad breath or a “metallic” taste in the mouth, dry mouth • Maintaining a healthy mouth is crucial for these patients and they need to seek regular dental care

32. ? Toothy Trivia! How many teeth do lions have? How many do great white sharks have? 1. A: Lions have 50, Great Whites have less than 500 B: Lions have 150, Great Whites have about 1,000 C: Lions have 80, Great Whites have over 5,000 D: Lions have 30, Great Whites have over 3,000

33. What can you do? • Visit your dentist regularly • Tell your dentist about your medical conditions • Eat healthy • Brush and floss daily Teeth are meant to last a lifetime: Healthy teeth will keep you healthy!

34. Value and Importance of Dental Insurance • With dental insurance a patient is more likely to visit their dentist and have symptoms diagnosed • People often visit their dentist more often than they visit their regular doctor. This means dentists have a greater opportunity to find symptoms and refer a patient to their general practitioner for diagnosis

35. Dental Insurance Mission The goal for the dental insurance industry is to review research and findings and modify benefits accordingly when proven correlations are found between medical and dental conditions.

36. Sources • American Dental Association. Information gathered: February 2007. www.ada.org • American Academy of Periodontology. Information gathered: February 2007. www.perio.org • “Periodontal Disease And Pancreatic Cancer Linked” Article date: 1/19/07, www.medicalnewstoday.com • Scientific American, a custom publication in collaboration with the Proctor & Gamble Company. Information gathered: February 2007. • Colgate World of Care. Information gathered February, 2007, www.colgate.com

37. Georgia Tech Educational series Thank you for attending!