1. The Oral-Systemic Link Sarah Eakin, RDH Katie Jackman, RDH Sarah Lyons, RDH How Licensed Practical Nurses (LPN) and Registered Dental Hygienists (RDH) Can Work Together

2. The oral cavity is linked to the rest of the body via the cardiovascular system and lymphatic system. http://www.cvillesmile.com/blog/post/oral-systemic-updates.html

3. Basic homecare on patients including brushing, flossing, and dental prosthesis care. http://www.eurekalert.org/multimedia/pub/31849.php?from=184295

4. Basic oral cancer screenings and when to refer patients for further diagnostics and care. http://fightoralcancer.org/oral-cancer-screening-reviewing-the-new- technologies/

5. Lesson Objectives After the presentation, the students will be able to complete the posttest about the oral-systemic link with 90% accuracy. After the demonstration, the students will be able to perform basic homecare procedures as shown in the presentation and demonstration.

6. Lesson Objectives During the presentation, the students will be able to differentiate between normal oral anatomy and possible abnormal oral conditions through group discussion and picture identification. After the presentation, students will be able to appropriately refer patients out when necessary as defined by the criteria in the presentation.

7. Oral-Systemic Link Linked via cardiovascular system and lymphatic system Traditionally, oral cavity was thought of as separate from rest of body http://www.studiodentaire.com/en/glossary/pulp.php

8. Transfer of Bacteria Bacteria, viruses, etc. Teeth and periodontal tissues Blood & lymph fluid Heart, lungs, & rest of body http://en.wikipedia.org/wiki/Head_and_neck_anatomy

9. Xerostomia (Dry Mouth) Increased plaque = increased periodontal disease Difficulty swallowing/sore throat Increased cavities Decreased taste Uncomfortable Difficulty talking Oral Candidiasis (Thrush) http://www.studyblue.com/notes/note/n/physical-and-chemical-injuries/deck/850913

10. Xerostomia Caused by Medications Over 1,800 drugs can cause xerostomia ▫Anti anxiety and anti depressants ▫Blood pressure ▫Antihistamines ▫Muscle relaxants ▫Parkinson’s Disease ▫Urinary Incontinence http://www.doversherborn.org/index.cfm/page/Medication-Administration-Policy/pid/10371

11. Other Causes of Xerostomia Aging ▫Medications & other health factors Cancer Therapy ▫Radiation of the head & neck Nerve damage of the head & neck ▫Stroke patients Mouth breathing/snoring Smoking

12. Systemic Diseases, Conditions & Oral Health Diabetes Mellitus Cardiovascular Disease Smoking

13. Diabetes Mellitus Two-way street ▫ Diabetes immunosuppression and increased blood sugar ▫ Periodontal Disease affects blood glucose control http://www.palmharbordentistry.com/GumDisease/Diabetes.aspx Diabetes Clip

14. Cardiovascular Disease Direct cause and effect relationship is still being studied Periodontal disease = risk of cardiovascular disease due to inflammation markers released into the blood stream Antibiotic pre-med for some heart conditions (infective endocarditis) http://www.perio.org/consumer/heart_disease

15. Smoking Dry mouth Immunocompromised due to constriction of blood vessels Increases risk for oral cancer and lung cancer Smoking Link http://www.live-in-green.com/health_info/problematic_products/smoking.html

16. Case Study: Gingivitis increases systemic inflammatory markers Objective: investigate if gingivitis increases systemic markers of inflammation related to atherosclerotic plaque development 37 subjects, non-smokers, no inflammatory or cardiovascular disease/risk factors

17. Case Study (cont.): Gingivitis increases systemic inflammatory markers Methods: Cessation of oral hygiene for 21 days Results: Gingival bleeding and Inflammation Systemic inflammatory markers ▫ Reactivation of oral hygiene measures completely eliminated these responses

18. Importance of Home Care It is important that patients receive daily oral care A healthy mouth is crucial for speaking, chewing and overall health http://www.1dental.com/blog/2011/06/17/dental-care-dementia/

19. Techniques Approach patients in an gentle and caring manner. Remember many older adults or patients are sensitive to having their mouths or head touched. Always move slowly and explain exactly what you are going to do While you work speak in a soft and friendly voice to put them at ease.

20. Patients with physical disabilities Some patients may be independent and you can utilize tooth brushing aids to allow them to brush their own teeth You can enlarge the handle by attaching it to a bike handle grip, rubber ball or large marker Strongly encourage an electric brush

21. Tooth brushing basics Utilize a soft bristle brush 45° angle with gentle circular motions Biting surfaces of teeth 2 minutes Tongue http://www.drchetan.com/bass-technique-of-toothbrushing.html

22. Don’t forget to floss Many patients you will be taking care of will not be independent enough to do this on their own Use 18 inches of floss and use index fingers to guide floss between contacts of the teeth (Do not snap) Use a “C” shape to contour between each tooth Floss each tooth with a clean section of floss

23. Denture Use It is recommended to rinse dentures after every meal Remove at night Tissue needs to breathe http://blog.charlottedentistry.com/2011/07/08/perfect-fit-dentures-bring- comfort-success/

24. Denture Care Clean dentures X2 daily with a denture brush and a non-abrasive denture cleanser Regular toothpaste is too abrasive for denture care Remain moist Dentures are fragile http://www.heritagecreekdental.com/des-moines-dentures.htm

25. Conditions that require a closer look by a Dentist Bleeding gums Change in how their teeth fit together Red, swollen or tender gums Discharge at the gumline of a tooth Change in the fit of their dentures or partials Very bad breath Loss of taste and weight loss Loose or chipped teeth

26. Not Oral Cancer! But need to be seen by a DDS! http://smilekraft.blogspot.com/2012/03/preventing-formation-of-dental-plaque.html

27. Oral Cancer Screenings A thorough examination of the oral cavity is essential to the total care of the patient Goal: Identify suspected lesions that require additional testing and refer for medical evaluation

28. Oral Cancer Survival rate of oral cancer is very low Key risk factors: Smoking and alcohol consumption

29. What to look for Mouth sore that doesn’t heal quickly A change in color or texture of the oral tissue

30. Appearance Size and shape- varies. Can be flat or raised Color- red and white are most common. Can be blue, purple gray, yellow, black or brown. Surface texture- May be smooth or irregular Consistency- soft, spongy, hard or indurated

31. Most Common Sites Floor of the mouth Lateral part of tongue Lower lip Soft palate

32. Floor of the mouth Have the patient raise their tongue to the roof of their mouth- look for white and red patches Using bimanual palpation, feel for lumps

33. Floor of the mouth Normal Tori- hard bilateral- OK Refer

34. Lateral border of tongue Have the patient stick out their tongue, grab with gauze. Examine the sides and underside of the tongue for white and red patches, feel for lumps

35. Lateral border of the tongue Healthy Geographic tongue- OK Refer

36. Lower Lip Gently pull the lower lip down to view the inside tissue. Be sure to look in the vestibule. Palpate the lip to feel for any lumps while looking for white or red patches.

37. Lower Lip http://www.skinsight.com/adult/oralMucocele.htm Mucocele- fluid buildup- OK http://www.dentalcare.com/en-US/dental- education/continuing- education/ce348/ce348.aspx?ModuleName=coursecontent&Part ID=1&SectionID=-1 Refer

38. Soft Palate Have the patient open wide and say “Ahh”. Observe the area between the roof of the mouth and the uvula. www.healthhype.com

39. Soft Palate Healthy Strep Throat Refer www.meduweb.com www.rightdiagnosis.com www.cleft.org

40. Screening Explain the procedure to the patient You will be using different kinds of palpation

41. In Clinic Tell, show, do Oral Cancer Screen TB and Floss Denture Care

42. Questions about Clinic Aha moment?

43. Summarize Oral cavity is connected to the entire body 2 way street! Home care is crucial Catching oral cancer early is important

44. Questions What is your muddiest point?

45. References American Academy of Periodontology (2012). Gum disease and cardiovascular disease. Retrieved from http://www.perio.org/consumer/heart_disease Caesy Education Systems (Producer). (n.d.). Periodontal disease systemic effects diabetes. [Online video]. Retrieved from http://www.youtube.com/watch?NR=1&v=0KDQp8OVICQ&feature=endscreen Colgate (2013). Take charge of your diabetes and oral health: Learn about the connection between gum disease and diabetes. Retrieved from http://www.colgate.com/app/ColgateTotal/US/EN/Diabetes.cwsp?cid=ppc_gg_nb_stan_diabetes+oral+health_ broad&kw=gum+disease+and+diabetes Eberhard, J., Grote, K., Luchtefeld, M., Heuer, W., Schuett, H., Divchev, D., Scherer, R., Schmitz-Streit, R., Langfeldt, D., Stumpp, N., Staufenbiel, I., Schieffer, B., & Stiesch, M. (2013, February 7). PubMed: Experimental gingivitis induces systemic inflammatory markers in young healthy individuals. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23408963 Mayo Clinic (2011, April 7). Dry mouth. Retrieved from http://www.mayoclinic.com/health/dry- mouth/HA00034/DSECTION=symptoms

46. Thank you!