Transcript Smiles for Life Module 1

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
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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
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Major information source :
Smiles for Life
A National Oral Health Curriculum
for Family Medicine
STFM Group on Oral Health
Module 1
The Relationship of Oral to Systemic
Health
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Why is oral health
important?
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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
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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
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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
 Alcohol
cessation
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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.
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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
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Oral and systemic health are
linked so care should be too
Oral Health
Systemic Health
Dental Home
Medical Home
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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
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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
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Oral and systemic conditions
that appear linked
 Adverse pregnancy outcome
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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

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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
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Anatomy of a Tooth
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Primary Dentition
8 incisors + 4 canines + 8 molars = 20 by age 3
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Primary Tooth Eruption
Newborn
Age 1
6 -12 months
Age 3
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Adult Dentition
8 incisors + 4 canine + 8 premolars + 12 molars = 32 Teeth
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Lesion recognition
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Squamous cell carcinoma of lower lip
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Bony Torus of palate
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Torus of mandible
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Mucocele
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Gingival hyperplasia
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Hairy
tongue
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Erythema migrans
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Aphthous stomatitis
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Denture sores
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Pyogenic granuloma
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Candidiasis
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Herpes labialis
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Angular chelitis
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Periodontal disease
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Caries: Etiology Triad
Oral bacteria (Mutans Strep) break down
dietary sugars into acids which eat away
the tooth
Bacteria
Teeth
Caries
Sugars
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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
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Early Caries
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Moderate Caries
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Severe Caries
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Leukoplakia
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Lichen planus
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Erosive lichen planus
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Squamous cancer - tongue
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Cancer
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Cancer
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Cancer
sites
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Squamous cell carcinoma of lateral tongue
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Squamous cell carcinoma of palatal gingiva
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Leukemic infliltrates
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Adult Oral Examination
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Oral/head/neck exam
checklist
Wash hands
Greet the patient
Confirm supplies: light, gloves, mouth mirror, tongue blade, gauze pad
Inspect the face and neck for obvious lesions, masses, nodes
Palpate the TM joint
Palpate the neck for nodes and masses
Anterior triangle, Posterior triangle, Submandibular,
Supraclavicular and infraclavicular areas
Put on gloves for intraoral examination
View and palpate the buccal mucosa including sulci
Inspect gingival tissues
Inspect teeth
Inspect palate
Inspect tonsillar pillars
Inspect tongue: top, lateral edges, under-surface. Use gauze pad to grasp tip
of tongue when examining lateral edges.
Palpate floor of mouth
Explain exam findings to patient
Discard gloves
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Inspect/palpate face/neck
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Inspect lips
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Labial mucosa - upper
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Labial mucosa - lower
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Right buccal mucosa
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Left buccal mucosa
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Gingiva
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Dorsum of tongue
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Tongue left margin
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Tongue right margin
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Ventral tongue
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Floor of mouth
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Hard palate
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Oropharynx
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Palpate floor of mouth
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Child Oral Exam (Knee to Knee)
1: Child is held facing caregiver
in a straddle position
2: Child leans back onto
examiner while caregiver
holds child’s hands
3: Provider performs exam while caregiver
holds child’s hands and legs
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
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Oral/head/neck exam
checklist
Wash hands
Greet the patient
Confirm supplies: light, gloves, mouth mirror, tongue blade, gauze pad
Inspect the face and neck for obvious lesions, masses, nodes
Palpate the TM joint
Palpate the neck for nodes and masses
Anterior triangle, Posterior triangle, Submandibular,
Supraclavicular and infraclavicular areas
Put on gloves for intraoral examination
View and palpate the buccal mucosa including sulci
Inspect gingival tissues
Inspect teeth
Inspect palate
Inspect tonsillar pillars
Inspect tongue: top, lateral edges, under-surface. Use gauze pad to grasp tip
of tongue when examining lateral edges.
Palpate floor of mouth
Explain exam findings to patient
Discard gloves
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