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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 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 • 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 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 • 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 • 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 • 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 • 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 • 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 Health Dental Home Systemic Health Medical Home
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 • 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 • 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
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 8 incisors + 4 canines + 8 molars = 20 by age 3
Primary Tooth Eruption Newborn 6 -12 months Age 1 Age 3
Adult Dentition 8 incisors + 4 canine + 8 premolars + 12 molars = 32 Teeth
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 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
