Transcript Integration of Oral Health

The
Integration of
oral health for
hospitalized
patients
Lynn Stedman, RDH
Director/Associate
Professor
Columbia Basin College
c
How does it begin?
Red Zone Bacteria
• The 3 most destructive oral bacteria are:
– Porphyromonas gingivalis
– Treponema denticola
– Tannerella forsythia
The body’s immune system is
activated . . .
Bone loss and calculus
buildup
This is what the RDH is
measuring with a periodontal
probe
ORAL DNA
Where does the inflammation go?
Inflammation occurs on the inner
surface of the intima – the inside
layer of the artery wall
Formation of plaque
causes narrowing of
artery and turbulent
blood flow – this can
lead to rupture of the
atheroma = heart
attack or stroke.
Esophageal Squamous Cell
Cancer
Link found in a recent study between P. Gingivalis and Esophageal
Squamous Cell Cancer – 61% of cancerous tissues and 12% of
adjacent tissue had P. Gingivalis present– it was not detected in
normal esophageal tissues.
The Oral Systemic Link
• How did we get started?
• Sam Barry, retired DDS who is a
Representative for Henry Schein
• Lee Ostler, DDS – Richland dentist – guest
speaker for Periodontal class at CBC
• AAOSH = American Academy of Oral
Systemic Health – Dr. Ostler = a founder
– Scientific Session #2 Las Vegas, NV
– Scientific Session #3 St. Louis, MO
“Say Ahh – The Movie” premiered at AAOSH in Las
Vegas
“Say Ahh”
• Clip #1
Clip #2
Pre-term birth
• Any birth that occurs prior to 30 weeks
• Average cost of uncomplicated birth to a
hospital = $1700
• Pre-term births cost an average of $77,000
• It would be worth it to determine as many
risk factors as possible to drive down these
costs.
• Periodontal disease in the mother is a RISK
FACTOR
• P.Gingivalis and Fusiform nucleatum are both
elevated in Periodontal disease
Medical – Dental Summit I
• Oral Health Coalition and Community
Partners for Health joined efforts to create the
Summit
• Several of the national presenters came to the
first Summit to promote our grass roots
efforts
• High Obesity and rates of Type II Diabetes
• One of the highest rates of childhood and
adult caries in the state -- a designated
underserved area
• In need of innovative and effective solutions =
OUT of the BOX THINKING!
The reality of dental care . . .
• Patients without some ‘dental
IQ’ need to be educated to
value their oral health
• Private dental offices provide
excellent care for the insured
with resources
• Uninsured people with
limited resources do not seek
preventive dental care
• Diverse cultures do not have a
concept of ‘prevention;’ care =
“I am in pain.”
• Hospital ERs are seen as their
resource to alleviate pain
Utilization of ERs is costing all of us
• In one 18 month period in WA state dental
visits to the ERs cost taxpayers $36 million.
• For our local area: 3/1/13 through 2/28/14
–
–
–
–
–
Trios Hospital = 298
Lourdes = 227
Prosser = 52
Kadlec = 713
Total = 1,290
Average cost of an ER visit is $500 - $700
Where did we start?
• Decision to utilize
Dental Hygiene
students
• New work venues
needed other than
private dental
practices
• Education is
thorough and
rigorous and can be
used to fill in the gap
of health care in
hospital settings
Clinical Rotations at Kadlec
Students from Class of 2015
And Ian Corbridge, RN, Policy Director of Clinical Issues, from
WA Hospital Association
Rotation on OB Floor Kadlec
Instructor Mellisa McGlinn
Students from Class of 2016
Oral exam being done on
Patient.
Evaluation of Hospitalized Patients’
oral health
• Director of Nursing is now Dean of Health
Sciences
• Director of Nursing Services at Kadlec
Regional Medical Center = a CBC graduate
• Meeting facilitated with Medical Director to
discuss the feasibility of a dental hygiene
student rotation in the hospital
• Goal = to determine how many hospitalized
patients had signs/symptoms of periodontal
disease or past evidence of periodontal
disease
Goals of Rotation
• Identify patients with no regular dental care
• Give them information regarding community
resources
• Teach them how their oral health may be
impacting their general health
• Encourage seeking dental evaluation ASAP
following discharge
What if . . .
• Medical problems had a dental component
that was being ignored or failing to be
evaluated?
• What if many medical problems had a dental
related solution?
• What if, by addressing the dental aspect of
patients’ health there could be better
outcomes in achieving health before or after
hospitalization?
• What if addressing the dental needs could
reduce the number of patients who are now
hospitalized?
Where’s the mouth?
• Assumption = that’s the job of the dentists or
the dental community
• Private, fee for service dental practices are
serving a smaller and smaller % of the
population
• Community based clinics are often plagued
with business challenges . . .
• Too many people are using the ER for their
dental pain and needs – with no real solutions
(antibiotics or pain meds only)
The role of an RDH in the hospital
• Currently the student rotation consists of
– Extra and Intra oral exam/cancer screening
– Looking for Decayed, Missing or Restored teeth;
areas that are painful
– Checking edentulous areas for sores and the fit of
partial or full dentures
– Cleaning these appliances
– Providing oral hygiene instructions and brushing
and flossing patients’ teeth
– Second student does a screening interview
including information regarding periodontal
disease
Screening Forms
Summary of Initial Rotation
of CBC Dental Hygiene
students are in your handout
packet
Cardiac Floor . . .
• FINDINGS:
• Many edentulous patients are not aware of
why they lost their teeth.
• No patient awareness of the oral-systemic link
• No dental care due to lack of dental insurance
or resources
• Limited knowledge of local resources
• Patients and family members were receptive
to the care provided by students
• Nursing team was positive and receptive to
the rotation
• There is a lack of awareness of the education
and role of a Dental Hygienist
Obstetrics . . .
• Are babies born with the bacteria that causes
decay?
• Can a family member pass bacteria to a baby that
causes decay?
• Should a baby be nursed to sleep or given a
bottle at bedtime after age 1?
• At what age should a baby see a dentist for the
first time?
• Is it normal for your gums to bleed during your
pregnancy?
Start them early . . .
To avoid this . . .
White spot lesions
Baby Bottle Mouth
Rampant
Childhood
Caries
(cavities)
Gingivitis = Reversible
Periodontal Disease = Treatable
Gingivitis
Periodontal Disease
Conclusions . . .
• Early prevention, identification and treatment
of caries and periodontal disease can present
a significant difference in long term health
outcomes.
• It is both a financial and educational
endeavor.
• Dental hygienists can be utilized to deliver
oral assessments in medical settings.
• Early identification and treatment or referral
for dental problems can remove oral
inflammation as a risk factor for systemic
illness.