Kansas Public Health Association, Inc. 2006 Fall Conference Oral Health & The Top 10 Leading Health Indicators "Making Oral Health a Priority in Kansas - Because It Matters!" Dawn McGlasson RDH BSDH Deputy Director Office of Oral Health Kansas Public Health Association, Inc. 2006 Fall Conference

INFLAMMATION A Key Indicator in Measuring Health Linking Oral Health to General Health The Oral / Systemic Link to: Cardiovascular Disease Diabetes Pre-term Labor – Low Birth Weight Babies Respiratory Disease Cerebrovascular Disease (Stroke) There is mounting evidence linking poor oral hygiene (gum disease) to a range of medical problems. A number of studies suggest that early prevention and treatment of gum disease may significantly improve outcomes for pregnancy, heart disease, and diabetes, in particular. The bacteria in the mouth can spread to the bloodstream and spread through out the body, inflaming coronary arteries and causing changes in blood pressure, heart rate, and clogging arteries, which can lead to heart attacks and strokes. With diabetes, inflammation makes controlling diabetes more difficult. (Kenneth Krebs, president of the American Academy of Periodontology) Over 200 articles have been written in the past 50 years examining the relationship between these two. Inflammation/gum disease increase C-Reactive Proteins which produce inflammatory-produced cytokines which has been associated with adverse pregnancy outcomes, including premature low-birth weight infants. (Jeffcoat) Expectant mothers with periodontal disease are up to seven times more likely to deliver premature, low birth-weight babies. The bacteria can accelerate the production of labor-producing fluids (Prostaglandin and cytokines) and can result in pre-term births. Also, the bacteria can travel into the lungs and aggravate respiratory ailments. http://www.nidr.nih.gov/sgr/execsumm.htm http://www.nidcr.nih.gov/spectrum/NIDCR2/2menu.htm

The Oral Health Link To The Top 10 Leading Health Indicators Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior President of the American Academy of Periodontology, “…It’s not surprising that periodontal diseases may be associated with increased health care costs and dental costs because periodontal disease my be linked to general health conditions such as heart disease, diabetes, pre-term low birthweight and respiratory disease.” Results of a Japanese study were presented at the 84th General Session of the International Association for Dental Research, held in Brisbane, Australia.

The Oral Health Link To The Top 10 Leading Health Indicators Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care Physical Activity Overweight and Obesity Recent work by James Beck, DDS,PhD, and Steven Offenbacher, DDS, PhD, MMSc, in a paper entitled, “Systemic Effects of Periodontitis: Epidemiology of Periodontal Disease and Cardiovascular Disease” published in the November 2005 supplement to the Journal of Periodontology found obesity was a significant predictor of periodontal disease, and more likely to be insulin resistant ( a precursor to diabetes). Diabetics are twice as likely to have heart disease. Overweight and obesity often equal poor nutritional habits which result in poor oral health and dental caries from sugar, soda, and processed foods. A physical activity link – besides the obvious snacking couch-potato one is the importance of athletes to have mouth guard protection for all activities, including practices.

The Oral Health Link To The Top 10 Leading Health Indicators Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care Tobacco Use Smoking and spit tobacco use results in lesions in the mouth, discoloration of the teeth, and halitosis. Oral cancer rates are not going down significantly, as compared to other cancer rates, and the five year survival rate is not improving.

The Oral Health Link To The Top 10 Leading Health Indicators Substance Abuse Meth Mouth is a serious problem and dental neglect due to chronic substance abuse. This is an eight year progression of the obvious degenerative changes in one woman’s appearance. Shaner JW. Caries associated with methamphetamine abuse.J Mich Dent Assoc. 2002 Sep;84(9):42-7. Creighton University School of Dentistry, Omaha, Nebraska, USA. Rampant caries is one of the hallmarks of chronic methamphetamine abuse. "Meth" is a potent central nervous system stimulant with physical and psychological effects similar to cocaine. Caries associated with methamphetamine abuse is related to three risk factors: 1) xerostomia caused by the drug; 2) a subsequent increase in sugared soft drink consumption; and 3) lack of oral hygiene during extended periods of abuse. Patients in this risk group usually present for treatment due to severe pain. However, they may be reluctant to discuss their illegal drug habit. Anorexia may also be present. Treatment includes cessation of drug abuse, oral hygiene, restrictions on sugar intake, and daily fluoride supplementation. Such patients tend to exhibit poor compliance with treatment recommendations or fail to show for appointments.

The Oral Health Link To The Top 10 Leading Health Indicators Responsible Sexual Behavior Oral manifestations of STDs. The mouth is the orifice at the beginning of the digestive and respiratory systems. In most folks it is a HUGE wound site with contaminates that would not or could not be tolerated by any other orifice of the body. Oral herpes and AIDS hairy leukoplakia are pictured. Infection with genital herpes can be asymptomatic, or it can be associated with severe and painful ulcers in the genital area. Lesions may occur on the vulva, vagina, or cervix. The virus is transmitted by direct contact with an individual who is infected Ñ genital-to-genital contact, or contact of the genital tract with an area that is infected with herpes simplex virus, such as oral-to-genital contact.

The Oral Health Link To The Top 10 Leading Health Indicators Mental Health Anti-depressants typically cause "dry-mouth" and result in increased caries. Dry mouth leaves the mouth without enough saliva to wash away food and neutralize plaque, leaving you more susceptible to tooth decay and periodontal disease. Oral diseases are cumulative and become more complex over time. They progressively affect a person’s ability to eat, communicate, and function in society. People who have poor oral health often are isolated and their socioeconomic status may be affected if they are not able to work with the public, find a "good-paying" job, etc. Researchers evaluated the effects that stress, depression and cortisol may have in the accumulation of dental plaque and gingivitis in individuals 50 years and older. CHICAGO – May 31, 2006 – Caregivers of people under psychological or physical stress, as well as those with the conditions themselves, should not overlook their oral health, according to a new study printed in the Journal of Periodontology.

The Oral Health Link To The Top 10 Leading Health Indicators Injury and Violence Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Damaged teeth and jaws from domestic violence/intentional injury, and unintentional injury/accidents.

The Oral Health Link To The Top 10 Leading Health Indicators Environmental Quality Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Fluoridated water = HP 2010 75% US=67.3% Kansas=62.3%.

The Oral Health Link To The Top 10 Leading Health Indicators Immunizations Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Dental sealants are considered the equivalent of immunizations. Healthy People 2010 initiative national goal of 50% of all 8-year-olds have dental sealants on their permanent molars. Dental decay is the single most common chronic childhood disease. More than half of all children have caries by second grade, and, by the time students finish high school, about 80% have caries.

The Oral Health Link To The Top 10 Leading Health Indicators Access to Health Care Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Limited dentists/hygienists in KS. Half of the dentists over 50 years of age. Many dentists are doing cosmetic (cash) work leaving an even greater need for providers. With only 20% of Kansas dentists accepting the dental Medicaid payment, many children may not be able to see a provider because some dentists limit their practice to private insurance or cash only. (Kansas ranks among the top 14 states nationally in Medicaid reimbursement rates.) Many children lack a “dental home” which helps ensure that problems are noticed early, and that education and prevention can be delivered, and treatment can be provided. Also, since Kansas does NOT have adult dental Medicaid, it becomes more difficult for families to access dental care together and place a priority on dental treatment in the same way they do medical care. Over 43 million Americans are without health insurance, but over 125 million are without dental coverage. 2002 Census Bureau states nationally 12% of people do Not have health insurance and Kansas BRFSS figures 10% are without health coverage. So, following that trend, we would estimate three times as many (30%) do not have DENTAL insurance. U.S. population is est. @ 282,909,885. Rural communities lack an adequate workforce. Kansas has at least 10 counties where there are no dentists. Nearly 30% of the counties do NOT have an enrolled Medicaid dentist! And 39% of the counties do not have dentists with significant claims. (Over $10,00 paid per year according to SRS Medicaid Program FY 2003) 86 out of Kansas’ 105 counties are underserved! Almost 30% of all Kansas dentists practice in Johnson county, but only 13.6% are Medicaid providers. Direct reimbursement issues for the services that dental hygienists provide would increase access to care. Since 2002, ten states allowed RDHs to bill directly for their services. Several other states are pending legislation – Montana; Neb.;Iowa has limited reimbursement; Nev. only needs a form to say who is a provider, not a leg. change. Use existing health care providers such as WIC, Head Start, and Parents as Teachers, Home Visitors,etc., to promote fluoride varnish, fluoride supplement drops/tablets. The United States Health Resources and Services Administration’s (HRSA) Bureau of Health Professions National Center for Health Workforce Information and Analysis recommends expanding the role of dental hygienists to increase the delivery of oral health care services to areas of shortage and to children on Medicaid. School-Based Programs overcome the Barriers of: Lack of Awareness; Lack of Transportation; Lack of Physical Access where Care is Delivered; Uncompensated Time from Work (Parents); Limited Income; Lack of Dental Insurance. If there are to be systemic solutions, most adults expect schools to be involved.

The Oral Health Link To The Top 10 Leading Health Indicators Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior

Oral Health Is A Critical Component Of Total Health 75% of adults have some form of gum / periodontal disease. The majority of people do not know they have it, because it is usually painless in its early stages. Periodontal disease is one of the most common chronic diseases. Oral health is an essential and integral component of health throughout life. Children frequently visit pediatricians, family physicians, and other medical/healthcare providers early in life for routine health care before they ever see a dentist, oftentimes. (The screening is NOT intended to be a definitive diagnosis.) Any suspicious findings should be referred to a dentist. It is important to develop partnerships between oral health professionals and primary care providers (including Pediatricians; Family practice physicians; ob/gyn) to advance health promotion and prevention. Fluoride varnish application by health care providers results in the integration of oral health into medical practices. (Oral health education; anticipatory guidance). Training for non-dental public health personnel, including local health department Public Health Nurses, graduate nurses, Healthy Start home visitors and Head Start Health Specialists. Dental Screenings by Non-Dental Professionals. Training of 56 school nurses and 43 local public health department nurses with a DIAGNOdent, a non-invasive laser fluorescent dental device, to screen approximately 6,000 students for dental caries. They are participating in the second year of a $200,000 oral health-screening grant funded through United Methodist Health Ministry Fund. School nurses are screening third and sixth graders, and health department nurses are screening children ages 5 to 21 years, during their well-child/ EPSDT exams. http://www.nidr.nih.gov/sgr/execsumm.htm http://www.nidcr.nih.gov/spectrum/NIDCR2/2menu.htm

Early Detection and Treatment is Critical to Saving Lives Signs and symptoms of life-threatening diseases appear in the mouth long before they show up in the rest of the body. Early Detection can spot signs of many diseases and conditions such as : * HIV *Oral Cancer * Eating Disorders *Substance Abuse *Osteoporosis *Diabetes It is important to have well-educated, licensed dental personnel who know how to do an assessment/diagnosis of the status of the mouth. http://www.nidr.nih.gov/sgr/execsumm.htm http://www.nidcr.nih.gov/spectrum/NIDCR2/2menu.htm

EVERYTHING YOU PUT IN YOUR MOUTH AFFECTS YOUR (ORAL) HEALTH!

BIBLIOGRAPHY http://journals.apa.org/prevention/index.html http://newsroom.hrsa.gov/efoia.htm http://www.accesskansas.org/kdb http://www.ada.org http://www.adha.org/profissues/access_to_care.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm http://www.health.gov/healthypeople/ http://www.healthfund.org/ http://www.healthmatters.org.uk/ http://www.ncemch.org http://www.nidr.nih.gov/sgr/execsumm.htm http://www.sspd.org