rural ecoh oral health training swan hill, september 18 2015
TRANSCRIPT
RURAL ECOH ORAL HEALTH TRAINING
Swan Hill, September 18 2015
OBJECTIVES FOR THIS SESSION
DISCUSS IMPORTANCE OF ORAL HEALTH
THREE COMMON DENTAL DISEASE- Dental caries- Periodontal disease- Oral cancer
PREVENTION - General advice to reduce dental caries
and periodontal disease
WHY ORAL HEALTH?
“Oral health is fundamental to overall health, wellbeing and quality of life. A healthy mouth enables people to eat, speak and socialise without pain, discomfort or embarrassment. The impact of oral disease on people’s everyday lives is subtle and pervasive, influencing eating, sleep, work and social roles. The prevalence and recurrences of these impacts constitutes a silent epidemic.”
Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2004–13 (2004). Prepared by the National Advisory Committee on Oral Health.
POOR ORAL HEALTH IS LINKED WITH…
HEART DISEASE
STROKE
DIABETES
POOR MENTAL HEALTH
RESPIRATORY DISEASE
MANY OTHER ILLNESSES
IMPORTANCE OF ORAL HEALTH
1 in 7 people aged 15 years and over had toothache in the last year
1 in 2 12 year olds had tooth decay in their permanent teeth
3 in 10 adults aged 25-44 had untreated tooth decay
WHAT DETERMINES ORAL HEALTH?
Figure 4 – Determinants of oral health
Draft National Oral Health Plan 2013-2017
THE ORAL CAVITY
COMMON ORAL HEALTH PROBLEMS
DENTAL CARIES
PERIODONTAL DISEASE
ORAL CANCER
DENTAL CARIES (TOOTH DECAY)
• is a diet related chronic/ infectious disease which affects the teeth.
• It is multifactorial in nature, resulting from a disturbance in the homeostasis of the normal oral microflora in healthy humans.
• A diet rich in fermentable carbohydrates [sugars (including natural sugars) and cooked starch (bread, potatoes, rice and pasta)] results in pathological changes in the normal physiological oral microflora favouring cariogenic bacteria.
• It is affected indirectly by environmental and behavioural influences.
• is preventable/manageable.
DENTAL CARIES (TOOTH DECAY)
Caries extensionCaries Inflamed pulp
Abscess
DENTAL CARIES PROCESS• Normal oral microflora stick to the
teeth forming dental plaque.• Increased consumption of fermentable
carbohydrates favours bacteria that produce organic acids (acidogenic) and tolerate the resultant low pH (aciduric).
• Within just a few minutes of eating, or drinking, these microorganisms begin to produce organic acids (acid attack).
• These acids can penetrate into the hard substance of the tooth and dissolve some of the minerals (calcium and phosphate) – demineralisation.
Teeth
Fermentable carbohydrates
Micro-organisms
Saliva
TIME
Caries
No caries
No caries
No caries
Ref: Graham JM, Hume WR. 2005. Preservation and Restoration of Tooth Structure, 2nd Ediction, © 2005 Knowledge books and Software.
Slide with thanks to Hanny Calache (DHSV)
ACID ATTACKS• If the acid attacks are
infrequent and of a short duration, the saliva can help repair the damage by neutralising the acids and supplying minerals (calcium and phosphates) and fluoride that can replace those lost from the tooth [remineralisation].
• Frequent acid exposures to the teeth will lead to loss of calcium and phosphate from tooth enamel [demineralisation].
DECAY
Fluoride(water, toothpaste)
Brushing twice daily
Saliva
Time b/w meals & snacks( acid attack)
Diet( sugar, carbohydrates)
Diet( sugar, carbohydrates)
Bacteria(Plaque)
Reduced saliva flow
Frequent meals and snacks( acid attack)
Protecting(remineralisation)
Decay promoting(demineralisation)
Picture with thanks to Hanny Calache (DHSV)
DECAY
HEALTHY TEETH
Fluoride(water,
toothpaste)
Brushing
twice daily
Saliva
Time b/w
meals &
snacks( acid attack)
Diet( sugar,
carbohydrates)
Diet( sugar,
carbohydrates)
Bacteria(Plaque)
Reduced
saliva
flow
Frequent
meals and
snacks( acid attack)
Protecting(remineralisation)
Decay promoting(demineralisation)
Picture with thanks to Hanny Calache (DHSV)
DENTAL DECAY IN CHILDREN
• 47% of 5-6 year old children have tooth decay• Over 70 per cent of Victorian children under five have
never visited a dentist and yet in a child’s first year of life they see a general practitioner almost 11 times
• Oral health problems are 5 times more likely to occur in children than asthma and hay fever
• The first oral health assessment can be provided by a Dentist or other Oral Health Professional, Maternal and Child Health Nurse or Doctor.
• Having regular check-ups can help to spot problems early. Early stages of tooth decay can be treated – many issues are preventable. (DHSV 2014)
PREVENTABLE HOSPITAL ADMISSIONS 2014-15
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+0
500
1000
1500
2000
2500
3000
Hospital admissions for dental conditions by age groups, 2013/14
Age
Nu
mb
er
of
hosp
ital ad
-m
issi
on
s
Slide from DSHV 2014
HEALTHY PRIMARY TEETH
PREMATURE LOSS OF BABY (DECIDUOUS) TEETH MAY LEAD TO CROWDING
UNTREATED DENTAL CARIES IN THE DECIDUOUS DENTITION MAY LEAD TO:• Toothache• Infection• Dental phobia• Crowding• Caries on adjacent permanent teeth
IF PERMANENT TOOTH IS CONGENITALLY MISSING NEED TO MAINTAIN THE BABY TOOTH AS LONG AS POSSIBLE. Slide with thanks to Hanny Calache (DHSV)
PRIMARY TEETH
EARLY CHILDHOOD CARIES (ECC)
• Early Childhood Caries is a severe form of dental decay that affects the baby teeth of infants and young children.
• When milk (lactose) is allowed to pool over the deciduous teeth during sleep, it may lead to ECC *.
• Children with ECC need significant dental treatment and may require hospitalisation to have the treatment completed.
Ref: Gussy MG, Waters EG, Walsh O, Kilpatrick NM, Early childhood caries: Current evidence for aetiology and prevention, Journal of Paediatrics and Child Health 42 (2006) 37-43 © Paediatrics and Child Health Division (Royal Australian College of Physicians).
IDENTIFYING ECC
HEALTHY TEETH AND GUMS EARLY STAGES OF DECAY
White lines along the gum line
ADVANCED DECAY ADVANCED DECAY AND INFECTION
Brown or yellow spots that don’t brush or wipe off
Blackened areas on teeth with red and inflamed gums
LIFT THE LIP (LtL)
Screening involves ‘lifting the lip’. LtL is a visual check of child's anterior (front) teeth. These particular tooth sites inspected as they are most implicated in oral disease expression in early childhood.
If disease is found then there needs to be a referral pathway
Healthy mouth
Early disease
LtL- DETECTING EARLY SIGNS OF ECC
Important to have a process for referral and information sharing
WHAT DO WE KNOW?
DENTAL CARIES IS PREVENTABLE• Prevention strategies such as fluoridation of water
on reducing dental caries is now well established• More cost effective than treatment• Public health approaches to shifting community and
individual behaviours is also a proven approach to addressing inequities in oral health.
WHAT DO WE KNOW?
THERE ARE SIGNIFICANT OPPORTUNITIES TO IMPROVE ACCESS TO DENTAL SERVICES: • Very few infants see dental professionals specifically, so
non-dental healthcare professionals must be proactive in promoting good child oral health.
• Integrating awareness of oral health into training for other health practitioners who work with children is an important step
• Addressing geographic, financial and cultural barriers to accessing services is an opportunity to ameliorate the dental health impacts of disadvantage on children and young people.
The Royal Australasian College of Physicians, Oral Health in Children and Young People , 2013
WE KNOW THERE ARE FREE AND LOW COST SERVICES AVAILABLE
• Access to public dental services is free for children aged 0-17 years IF you have a Health Care Card or Pension Card.
• Some children under 17 years are also eligible for free dental care under the Child Dental Benefits Schedule (CDBS). In 2014, it was introduced by the Australian Government, to allow children aged 2-17 years who receive Family Tax Benefit Part A access to up to $1000 of free dental care over two years.
• Those who are not eligible for CDBS are required to pay a minimal co-payment for a course of care unless they identify as Aboriginal or Torres Strait Islander, a refugee or asylum seeker.
• Ask your local clinic to check eligibility.• Access to private dental services vary in cost so ask how much
the services will cost you before treatment.• Public and private services available
HEALTHY PERIODONTIUM
GINGIVITIS
• Gingivitis is early gum disease• Signs of gingivitis are bleeding, redness and swelling
GINGIVITIS
• Gingivitis is the inflammation of the gingiva
• The primary cause is the build up of plaque
• It is painless
• Improved oral hygiene practices may reverse gingivitis
PERIODONTITIS
• Periodontitis is advanced gum disease that may occur if gingivitis is not treated
• Signs of periodontitis include bleeding, swelling and receding gums together with bad breath, a bad taste in the mouth and loose teeth.
PERIODONTITIS
• Periodontal pockets form- Bacteria and their products
become trapped in these spaces between the tooth and the gum causing further inflammation
• As the disease progresses and bone is lost, larger spaces begin to form between the tooth and the gum.
Healthy state Diseased state
ORAL CANCER
• Main risk factors are smoking and excessive alcohol consumption
• Other factors include sun exposure, age, human papilloma virus, nutritional deficiencies, genetic predisposition
• In Victoria, oral cancer is the sixth most common cancer in men and eleventh in women
Incidence of oral cancer by age group, by sex, Victoria 2013
SYMPTOMS OF ORAL CANCER
• A visible mass or lump that may or may not be painful.
• An ulcer that won’t heal. • A persistent blood blister. • Bleeding from the mass or
ulcer. • Loss of sensation
anywhere in the mouth. • Trouble swallowing.
• Impaired tongue mobility. • Difficulty moving the jaw. • Speech changes, such as
slurring or lack of clarity. • Loose teeth and/or sore
gums. • Altered taste. • Swollen lymph glands.
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Brush teeth and
gums twice a day
With an appropriate fluoride toothpaste
Eat a healthy
diet
Have a regular dental
check-up
Drink tap water and
avoid sweet drinks
Chew sugar-
free gum after
meals
Quit smoking
Take extra precautions if
taking medication that causes dry mouth
Interdental cleaning
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• Limit the amount and frequency of sugary foods
• Choose healthy snacks
• Think about the texture of sugary foods (sticky or soft food)
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• Brush teeth along the gum line twice a day with a soft toothbrush
• People over 18 months should use appropriate fluoride toothpaste
• Brushing should commence when the first tooth erupts into the mouth
• Children should be assisted with brushing until the age of 8 years
• The most important time to brush is at night time
Brush teeth and
gums twice a
day
ORAL HYGIENE PRODUCTS
For children 0 to 18 months of age
For adults and children 6 years of
age and over
For children 18 months to 6 years of
age
FLUORIDE PRODUCTSTOOTHPASTE• No fluoride toothpaste until 18 months• Low fluoride toothpaste for children 18 months to 6 years• Standard fluoride toothpaste from 6 years of age• Dentist may prescribe a higher strength fluoride toothpaste for those at
elevated risk ( for those > 10 years of age) • Should not rinse with water after using fluoride products
FLUORIDE MOUTH RINSES• Children under six years should not use mouth rinses• Alcohol v non-alcohol
Refer to fluoride guidelines for Australia (2006 and 2012) for more detailed information
– adelaide.edu.au/arcpoh/downloads/publications/journal/2006-spencer-aj.pdf– adelaide.edu.au/arcpoh/dperu/fluoride/Outcome_of_fluoride_consensus_workshop_2012.pdf
TOOTHBRUSHES
• Small-headed brushes are best for reaching all areas of the mouth.
• Soft bristles are best so as not to damage gums or tooth enamel
• People should choose a brush with a handle that allows them to reach all teeth easily.
• Evidence shows there is no significant difference between electric and manual toothbrushes in terms of cleaning teeth. - Powered toothbrushes may be useful for children or people with
limited strength or control in their hands
• Change your toothbrush when the bristles become shaggy.
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• Drink plenty of tap water
• Avoid sugary drinks and fruit juice
• Sugary fluids should not be placed in infant feeding bottles
Brush teeth and
gums twice a
day
Drink tap water and
avoid sweet drinks
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• Age of first dental visit; it is recommended that children have an oral health assessment by the age of two
• Frequency of visits depends on risk so a dentist or oral health professional will advise how often
Brush teeth and
gums twice a
day
Drink tap water and
avoid sweet drinks
Have a regular dental
check-up
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• Smoking results in more disease and injury than any other single risk factor
• Smoking is a causative factor for periodontal disease and oral cancer
• Quit smoking to improve oral and general health
Brush teeth and
gums twice a
day
Drink tap water and
avoid sweet drinks
Have a regular dental
check-up
Quit smoking
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• Cleaning in between teeth is important, but differs between individuals
• People should seek advice from dentist or other OHP about what is best for them
Brush teeth and
gums twice a
day
Drink tap water and
avoid sweet drinks
Have a regular dental
check-up
Quit smoking
Interdental cleaning
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• There is good evidence to support the use of sugar-free chewing gum as a decay preventive measure as part of normal oral hygiene to prevent dental caries.
• No guidelines on frequency of use but:- A number of studies reported use of gum
around/after mealtimes- Manufacturers suggest chewing gum for
20 minutes 4 times per day especially after eating or drinking acidic or high sugar foods/drinks.
Brush teeth and
gums twice a
day
Drink tap water and
avoid sweet drinks
Have a regular dental
check-up
Quit smoking
Interdental cleaning
Chew sugar-free gum
after meals
GENERAL ADVICE FOR ORAL HEALTHPREVENTING TOOTH DECAY AND GUM DISEASE
Eat a healthy
diet
• Emphasis importance of oral hygiene
• Salvia substitute (doctors or dentists can prescribe)
• Refer to a dental professional
• Increase water intake
• Restrict sweet food and drinks
• Use dry mouth products (toothpastes, mouthwash and topical gels)
Brush teeth and
gums twice a
day
Drink tap water and
avoid sweet drinks
Have a regular dental
check-up
Quit smoking
Interdental cleaning
Chew sugar-free gum
after meals
Take extra precautions if
taking medication that causes dry
mouth
ADVICE (BABIES AND TODDLERS)ADVISE ABOUT SAFE USE OF BOTTLES• During sleep saliva flow decreases, milk (lactose) pools in the mouth
around teeth increasing risk of tooth decay• Don’t put baby to bed with a bottle. Falling asleep with the bottle increases
the risk of choking, ear infection and tooth decay• Prolonged use of bottles increases risk of tooth decay
PACIFIERS • Don’t dip dummies in anything sweet. Encourage weaning from dummy at
12 months• Can affect teeth if still used when permanent teeth are erupting
INTRODUCE A CUP AT 6 MONTHS AND PHASE OUT BOTTLES BY 12 MONTHS OF AGE• Sippy cups are a transitional tool and should not be used for prolonged
periods of time.
WHERE TO FROM HERE AND WHAT ROLES CAN HEALTH PROFESSIONALS PLAY?
• Oral health promotion is important and everybody’s business across the lifespan
• Raise awareness of the services available, particularly low and no cost for disadvantaged families
• Training for all health and community workers is needed
• Referral pathways are important
WHERE CAN I GET MORE INFORMATION?
Dental Health Services Victoria
www.dhsv.org.au
Department of Health and Human Services Oral Health Promotion Evidence Review
www2.health.vic.gov.au
Rural ECOH
http://ruralecoh.com/
CONTACT DETAILS
Ms Stacey Bracksley-O’Grady
La Trobe Rural Health School
Further information about the Rural ECOH program
Dr Virginia Dickson-Swift
La Trobe Rural Health School