1. Overview of Oral Health Topics for the Community Health Worker
November 17, , 2016
Catherine A. Demko, PhD
Case Western Reserve University
School of Dental Medicine
Created with support from the Ohio MedTAPP HCA

2. As a Community Health Worker, how does oral health fit it?
“You are not healthy without good oral health.”
David Satcher, Surgeon General’s Report, 2000
In 2000, Dr. David Satcher, the Surgeon General at that time, issued a

3. Purpose of the module Brief overview of oral health issues
Raise awareness of oral health in the context of general health
Introduce oral health in the context of CHW scope of practice
Provide resources for oral health promotion
With this mandate in mind that overall good health includes good oral health, all providers who educate and promote health should have a basic working knowledge of oral health and how it can be included in their scope of practice. We therefore created an introductory module for inclusion in the CHW curriculum at CSU. Today, I’m just going to tell you a bit about that module and the role of oral ehalth.

4. What do we mean by oral health?
Dental health refers to teeth and gums.
Oral health includes everything related to your mouth:
• Jaws
• Chewing muscles
• Roof of your mouth
• Linings of the mouth and throat
• Tongue
• Lips
• Salivary glands
• Mouth and face pain
• Oral or throat cancer
When working with clients, talking about the ‘health of your mouth’ is another way of saying oral health

5. Oral health is essential to quality of life
Oral health affects biting, chewing, smiling, speaking, and psychosocial wellbeing
Oral pain can cause:
Poor school performance in children
Work loss in adults
Difficulty chewing and poor nutrition
Costly emergency department visits
Dental decay and tooth loss can lead to:
Aesthetics and self-image issues
Speech and language development problems
Costly restoration
Consequences on general health and quality of life when experiencing oral pain, tooth decay or tooth loss.

6. How common are oral diseases?
Dental caries is the most common chronic disease of childhood.
It is 4-5 times more common than asthma.
In Cleveland schools, 25-30% have untreated decay;
Gum disease affects 47% of U.S. Adults.
50,000 oral cancers are diagnosed annually.
Oral cancer causes 10,000 deaths a year.
Diagnosis is often late; early detection is key

7. The mouth is a gateway. Taking care of the mouth helps keep the rest of the body healthy.
For some clients, linking good oral health to their general health can be motivating to take care of teeth and gums.
For some clients, keeping teeth healthy for a nice smile is most important.
Get to know what is important to your client.

8. Oral health General health
Scientific research has established a link between mouth infections and serious medical problems, such as:
Diabetes*
Heart disease
Lupus
Oral cancer
Rheumatoid arthritis
Stroke
These are links, but we don’t know for sure if the relationships are Causal; mostly associations related to inflammation
Having a healthy mouth is important for its own sake; a healthy mouth is important for chewing, speaking, smiling
An unhealthy mouth has been found more often in people with other types of chronic diseases; diabetes, heart disease, rheumatoid arthritis. We don’t’ know for sure if the mouth infections cause or contribute to the chronic disease or if the disease plays a role in the mouth infection. But they routinely go together, so keeping a healthy mouth may influence other health conditions.

9. Part 2: Basic Issues in Oral Diseases
Describe each of 3 diseases
What are the causes of each disease
What are risk factors
How can we prevent these oral diseases?
There are many other diseases and conditions in the mouth; we are going to focus on just 3

10. Overview
3 most common dental diseases are caries, periodontal disease and oral cancer.
Dental caries is the most common chronic disease of childhood.
Dental is the most unmet health need
There are many other oral health issues that are less common, but still require care.

11. Basic tooth structure & gums
Enamel
Dentin
Pulp
Root
Healthy teeth have strong enamel without discoloration or holes.
Healthy teeth are held in place by gum tissue and bones.
Humans get two sets of teeth; 20 primary (deciduous or baby teeth), followed by 32 adult, permanent teeth.
Primary teeth serve as important role in chewing, speaking, holding space until the permanent teeth are ready.
Keeping primary teeth healthy and in place as long as possible is important; keeping adult, permanent teeth healthy and in place is also very important.
Surrounded by Gum Tissue and Bone

12. Caries: How do teeth develop decay?
Bacteria break down food into acids that eat away at the tooth.
Bacteria
Food
Teeth
DECAY
Decay can occur on any tooth, but molar teeth (in the back) with their chewing surface are particularly vulnerable.
Food particles get caught in grooves and bacteria then break down the food to produce acids that can damage the tooth enamel. Fluoride, if available, can help repair early damage.
Cavities start on the outside enamel, but can get larger, if untreated, and move through the different inside layers of the tooth. A severe cavity can become an abscessed or infected tooth, which can result in a blood-borne infection to other parts of the body, particularly in the head.

13. What increases the likelihood of tooth decay?
Risk factors shared by adults and children include: •Bacteria: High bacterial counts •Family history of (cavities) •Diet: Frequently consuming sugary foods & drinks •Inadequate fluoride •Low Saliva or Dry Mouth from many prescription drugs •Low socio-economic status – may indicate poor diet, lack of access to care •Aging, disease, and disease treatment can contribute to risk for tooth decay in adults
Many factors combine to cause tooth decay. Some can be changed (diet, fluoride, oral hygiene habits); some cannot (age, family history)
Supporting clients to make changes to improve oral health can help their overall health and quality of life.

14. 2. Periodontal (Gum) Disease
Infection of the tissues that hold teeth in place
Healthy
Bacteria and inflammation break down bone & gum tissue
Periodontal disease is also an infectious process combined with other factors.
When bacteria and their products continually challenge gum tissue, the body reacts with its own defense mechanisms.
Sometimes those defenses cause inflammatory responses that actually make matters worse. The inflammatory process can break down gum tissue and
if persistent and untreated, can cause bone loss around the tooth.
Healthy teeth have healthy gums and bones surrounding them.
In periodontal disease, unhealthy gums and bone loss result in loose teeth and lost teeth, if not treated.
Periodontal disease

15. What increases risk of gum disease?
Smoking:  significant risk factors.
Hormonal changes in girls/women.
Diabetes: Increases risk for many infections, including gum disease.
Other illnesses: can negatively affect gums; diseases such as AIDS and its treatments; cancer treatments
Smoking plays a role in so many diseases. Further, it interferes with healing when people have wounds or surgery to recover from.
Smoking is one of the most significant risk factors for gum disease.
Hormonal changes during pregnancy, menopause, using birth control can make gum tissue more susceptible to gum disease.
Patients with uncontrolled diabetes (generally Type 1 or the juvenile diabetes) have a greater risk for periodontal disease or having their periodontal disease progress.
Other illnesses should mean more attention to dental health; better self-care and more routine dental visits

16. 3. Mouth and Throat Cancer
Cancer of the mouth, tongue, throat, tonsils, lymph nodes
Risk of oral cancer increases with age. Most oral cancers occur after age 40.
Survival in AA males is the poorest of any group

17. Risk factors that increase the likelihood of oral cancer & other diseases
Gum disease
Lung Cancer
Liver disease
Oral cancer
Heavy Tobacco and heavy alcohol use combine to greatly increase the risk of oral cancer.
Tobacco use includes cigarette, cigar, and pipe smoking; smokeless tobacco (spit, chew) are important risk behaviors.
Highest risk for Oral Cancer

18. Steps to Reduce Risk for Oral Disease
Caries
Periodontal Disease
Oral Cancer
These are the prevention messages that are most commonly given
Caries: brushing with F toothpaste, F varnish, sealants, alleviate dry mouth
Perio: No smoking, Bursh, Floss, routine Dental visits
Oral cancer: Early detection; don’t smoke, limit alcohol
Strong health promotion messages for these 3 oral diseases

19. Part 3: Prevention and Oral Health Promotion Preventive behaviors for oral health
Routine self-care, brushing & flossing
Fluoride toothpaste
Dietary choices; limit sugar intake
Stop tobacco use; limit alcohol
Alleviate dry mouth symptoms
Routine preventive visits; catch problems early
We cannot completely prevent all oral disease, but there are MANY behaviors that contribute to reducing the chance of these diseases.

20. CHW and Oral Health CANNOT diagnose oral health problems
CANNOT offer advice about treatment
Follow one of the models in your book to understand your client’s belief about oral health
CAN offer reliable information
CAN offer resources for additional information
CAN offer resources for access to care
CAN provide brief health promotion messages
Some health beliefs and attitudes about teeth and dental care you may encounter:
“baby teeth fall out anyway – they don’t matter”;
“everybody loses teeth eventually no matter what they do”’
“fluoride causes other health problems”
“my children like their sweets – I don’t want to take them away”
“ tooth decay will happen no matter what we do”

21. Oral Health Promotion Messages
Professional Care
Establish a dental home; a routine source of care.
Visit your dentist regularly for professional cleanings and exams.

22. Messages: Brushing
Regular brushing and flossing are the foundation of good oral health.
2–3 minutes, twice a day, and floss to get rid of food debris and plaque.
Use a soft toothbrush and focus on the area where the tooth meets the gum.
Use fluoride toothpaste
Supervise children until about 8yrs old.

23. Messages: Dietary Habits
Avoid frequent snacking on sugary foods
Avoid sipping sugary beverages all day
Drinking water throughout the day helps rinse the mouth and neutralize the acids that cause decay.
Choose healthy snacks for self and children

24. Messages: Other Behaviors
Avoid tobacco (all forms); refer to QuitLine
Limit alcohol
Sugar-free chewing gum with Xylitol

25. Summary for CHW Role in Oral Health
Ask Questions
‘Do you have any problems or concern with your teeth?
‘Does anything in your mouth hurt?’
‘Do you have a regular dentist?’
‘When was the last time you visited a dentist?’
‘How often do you brush/floss your teeth?’
Provide health education/promotion messages
Provide resources and/or referrals for dental services

26. CHW and Community Oral Health
What characterizes oral health in a community?
What resources and strengths exist for oral health?
What resources would enhance oral health for community members?
What are existing or possible barriers?
Who would have information about oral health in children, adults, elderly, special needs?
Is oral health a good topic for community-level health promotion?

27. Questions? Website Resources https://oralhealthamerica.org/resources/