Presentation on theme: "Integrating Oral Health and Medical Care"— Presentation transcript:
1 Integrating Oral Health and Medical Care Jacqueline A. Tallman, RDH, MPADental DirectorHealth Disparities CollaborativeNational Network for Oral Health AccessMichigan Primary Care Association
2 Introduction Overview and Impact of Oral Diseases Disparities in Oral Health CareRelationship Between Oral Health and Systemic DiseasesOral Health and the Diabetes CollaborativeOral Health ResourcesQuestions and Discussion
3 Oral Health in America: A Report of the Surgeon General More than teeth and gums!Also includes supporting tissues, hard and soft palate, mucosal lining of the mouth and throat, tongue, lips, salivary glands, chewing muscles, and upper and lower jawsOral Health in America: A Report of the Surgeon General
4 Oral Health in America: A Report of the Surgeon General . . . these tissues allow us to speak and smile; sigh and kiss; smell, taste, touch, chew, and swallow; cry out in pain; and convey a world of feelings and emotions through facial expressions The essence of our humanity!!Oral Health in America: A Report of the Surgeon General
5 Oral Health in America: A Report of the Surgeon General Oral DiseasesProgressive and cumulative – become more complex over timeDental caries (tooth decay) is the single most common chronic childhood disease – 5 times more common than asthma and 7 times more common than hay feverOral Health in America: A Report of the Surgeon General
6 Oral Health in America: A Report of the Surgeon General Oral DiseasesOver 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year-olds.These are improvements compared to a generation ago!Oral Health in America: A Report of the Surgeon General
7 Oral Health in America: A Report of the Surgeon General Oral DiseasesPoor children suffer twice as much dental caries as their more affluent peers, and their disease is more likely to be untreated.Oral Health in America: A Report of the Surgeon General
8 Oral Health in America: A Report of the Surgeon General Dentally UninsuredUninsured children are 2.5 times less likely than insured children to receive dental care and are 3 times more likely to need it!For every child without medical insurance, there are at least 2.6 children without dental insurance.Oral Health in America: A Report of the Surgeon General
9 Vulnerable Populations Those who suffer the worst oral health are found among the poor of all ages, with poor children and poor older Americans particularly vulnerableMembers of racial and ethnic minority groups experience a disproportionate level of oral health problemsOral Health in America: A Report of the Surgeon General
10 Oral Health in America: A Report of the Surgeon General Why the disparities?There are many factors that influence vulnerability to oral diseaseSocioeconomic factorsLack of resources to pay for careInability to take time away from workLack of transportationPhysical disability or other illness that limits accessLack of understanding and awareness of the importance of oral healthOral Health in America: A Report of the Surgeon General
11 Oral Health in America: A Report of the Surgeon General Why the disparities?Cultural values influence oral health and well-being and can play an important role in care utilization practices and in perpetuating acceptable oral health and facial norms.Oral Health in America: A Report of the Surgeon General
12 Oral health is integral to general health Oral Health in America: A Report of the Surgeon General2000
14 Demonstrated relationships between oral health and systemic diseases DiabetesCardiovascular DiseaseAdverse Pregnancy Outcomes
15 Cardiovascular Disease and Oral Health Association has been demonstrated between periodontal disease and cardiovascular disease and research continues to determine the extent to which the association is causal or coincidentalTwo theories: Bacterial and C Reactive Protein
16 Cardiovascular Disease and Oral Health Gum disease may harm the heart, tooTheory: the Porphyromonas gingivalis bacterium can actually migrate from the mouth to the heart and cause inflammation in arteries that promotes atherosclerosis
17 C Reactive Protein C Reactive Protein Test CRP is an inflammatory marker — a substance that the body releases in response to inflammation. High levels of CRP in the blood mean that there is inflammation somewhere in the body.
18 C Reactive ProteinThe researchers theorize that people living with a chronic infection such as gum disease may produce higher levels of C Reactive Protein, which could place them at higher risk of heart attack.
19 C Reactive Protein Another reference: The New England Journal of MedicineVolume 347: November 14, 2002 Number 20Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular EventsPaul M. Ridker, M.D., Nader Rifai, Ph.D., Lynda Rose, M.S., Julie E. Buring, Sc.D., and Nancy R. Cook, Sc.D.
20 Perinatal Health Preterm Birth Preterm birth, resulting in babies born too little and too soon, is a major cause of morbidity today. Evidence indicates that infections can be major risk factors in preterm birth. Case-control studies point to an association between periodontal infection and increased rates of
21 Perinatal Healthpreterm birth. This article summarizes evidence to date, and the strategies the ongoing intervention studies are using to answer the fundamental clinical question: can periodontal therapy reduce the risk of preterm birth?This is part of a P& G mini course on the relationship between oral health, pregnancy, and postmenopausal osteoporosis.
22 Perinatal Health http://www.jhsph.edu/wchpc/pub/oralfacts.pdf Improving Women's Health and Perinatal Outcomes: Snapshot of the Impact of Oral DiseasesFact sheet containing a number of frequently asked questions pertaining to women's oral health, access to oral health services, and potential strategies to improve the oral health status of women.Available online:Source:
23 Oral Health in America: A Report of the Surgeon General Other systemic linksMany systemic diseases and conditions have oral manifestations – may be the initial sign of clinical diseasePharmaceuticals and other therapies commonly used in treating systemic conditions can cause oral complicationsOral Health in America: A Report of the Surgeon General
24 Diabetes and Periodontal Disease Effective treatment of periodontal infection and reduction of periodontal inflammation is associated with a reduction in glucose blood levels.
25 Diabetes and Periodontal Disease Persons with diabetes are at greater risk for periodontal diseasesThere is now some thought that untreated periodontal disease in persons predisposed to diabetes makes them more likely to develop the disease
26 Oral Health ResourcesPERIODONTAL DISEASE TREATMENT PROTOCOL FOR INDIVIDUALS WITH TYPE 2 DIABETES MELLITUSIndian Health ServiceDental ProgramFred B. Skrepcinski, DMD, MPHfor electronic copy
27 Diabetes and Periodontal Disease – Education Resources Diabetes and Oral Health Internet Resources - direct links to websites with provider and patient education resources - Available on the Diabetes Virtual Office (Under Tools/Resources, then Miscellaneous).Includes:Periodontal Complications of DiabetesThis power point presentation has color slides and script ready to download and use for staff in-service training. It was developed from the NIDCR slide series that is no longer available.
28 On the way to the throat and between the ears! Check the teeth and oral tissues!
30 http://oralhealth. dent. umich. edu/VODI/html/index Click on dental caries or periodontal disease, then screening, and then demo for short videos on how to screen in a medical setting. Also check out the Signs & Symptoms section for further information.
31 What Works?Hearing from their medical provider that they need to see the dentist!Hearing from their medical provider that their oral health affects their diabetes and their general health!Repeated messages if necessarySame day quick initial visit to dental – easier to come back if they have had that initial meeting!Escorted by medical staff to dental to make appointmentEstablished referral system that all staff know and use – may take several PDSA cycles to develop!Tracking referrals – will be available electronically in PECS 3.0!!!
32 Sample Referral Form WESTSIDE COMMUNITY HEALTH SERVICES MEDICAL/ DENTAL DIABETES REFERRALPatient name: ______________________________________ Date of birth:________________Last FirstMedical Account Number: ________________________Do you have a dentist? YES NOHave you seen a dentist in the last year? YES NOFor routine exam and cleaning? YES NOFor emergency care or pain relief? YES NO3..Do you have loose or painful teeth? YES NO4 .Do your gums bleed when you brush or floss? YES NO5. Do you have bad breath? YES NOType DiabetesHbA1c=Allergy to Doxycycline Yes NoREFERRING PHYSICIAN:_________________________________ Date:_________________**FORWARD/FAX THIS FORM TO SUE TESSIER AT WESTSIDE DENTAL.FAX #: (651)
33 Sample Referral Response Form DENTAL COMPLETE THIS SECTION:1. Periodontal Status: I. GingivitisII. Early PeriodontitisIII. Moderate PeriodontitisIV. Advanced Periodontitis2. Dental Treatment needs:YesNo3. Treatment Completed :DENTIST NAME: __________________________________ Date___________**DENTIST PLEASE RETURN FORM TO PHYSICIAN
34 Collaborative Resources Dental ListservDental Resources on Virtual OfficeDental Director to contact with questionsDental Breakouts at Learning Sessions and Phase 2 SummitsMechanism to share forms and education tools
35 Dental ListservIncludes persons from Phase 1 and Phase 2 and others who have expressed interest in the collaborative dental initiative.The purpose is to share information, ask questions, and keep the communication open between the face to face meetings!Not just for dental providers!!
36 Dental ListservIf you have not received the initial communications and would like to join, please send an to and request that your name be added.
37 Diabetes Virtual Office A virtual office for the Diabetes Collaborative has been established and has the Oral Health and Diabetes Web Resources document posted for your use. (Under Tools/Resources, then Miscellaneous.) This includes several pages of websites for patient education materials, some in multiple languages; provider in-service training; periodontal references;Other resource materials will be added as they become available.Check with your data specialist if you are not signed on!
38 Colgate Diabetes Program If you are a member of the AADE (American Association of Diabetes Educators), you can register to receive Colgate samples every month by calling When prompted for a PIN number, press O for the operator. They will take it from there!They also have a dental education sheet for persons with diabetes.
39 Free Oral Care Kit for Public Health Centers Colgate is offering “Oral Health from Pregnancy through the Toddler Years” to health centers at no cost through this order form or by ing The kit has oral health messages covering the periods of pregnancy, 0-6 months, 6-18 months, and months. They are available in English and Spanish.
40 Free Bright Smiles, Bright Futures Kits for Kindergarten Classes If your schools have not already signed up for their free dental kits, this will provide them the information to do so. These are also available in English and Spanish.Kits are sent to the schools. For more information, call
41 The Interface Between Medicine and Dentistry in Meeting the Oral Health Needs of Young Children This document is part of the Children’s Dental Health Project that has been a great resource of information through their patient education sheets, CDHP News *Bytes, and website An electronic version of this document is available on their website.
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