The Oral-Systemic Link

Sarah Eakin, RDHKatie Jackman, RDHSarah Lyons, RDH

How Licensed Practical Nurses (LPN) and Registered Dental Hygienists (RDH) Can Work

Together

The oral cavity is linked to the rest of the body via the cardiovascular system and lymphatic system.

http://www.cvillesmile.com/blog/post/oral-systemic-updates.html

Basic homecare on patients including brushing, flossing, and dental prosthesis care.

http://www.eurekalert.org/multimedia/pub/31849.php?from=184295

Basic oral cancer screenings and when to refer patients for further diagnostics and care.

http://fightoralcancer.org/oral-cancer-screening-reviewing-the-new-technologies/

Lesson Objectives•After the presentation, the students will

be able to complete the posttest about the oral-systemic link with 90% accuracy.

•After the demonstration, the students will be able to perform basic homecare procedures as shown in the presentation and demonstration.

Lesson Objectives•During the presentation, the students will

be able to differentiate between normal oral anatomy and possible abnormal oral conditions through group discussion and picture identification.

•After the presentation, students will be able to appropriately refer patients out when necessary as defined by the criteria in the presentation.

Oral-Systemic Link•Linked via

cardiovascular system and lymphatic system

•Traditionally, oral cavity was thought of as separate from rest of body http://www.studiodentaire.com/en/glossary/pulp.php

Transfer of BacteriaBacteria, viruses, etc.

Teeth and periodontal

tissuesBlood & lymph

fluidHeart, lungs, & rest

of bodyhttp://en.wikipedia.org/wiki/Head_and_neck_anatomy

Xerostomia (Dry Mouth)•Increased plaque = increased periodontal

disease•Difficulty swallowing/sore throat•Increased cavities•Decreased taste•Uncomfortable•Difficulty talking•Oral Candidiasis

(Thrush)http://www.studyblue.com/notes/note/n/physical-and-chemical-injuries/deck/850913

Xerostomia Caused by Medications•Over 1,800 drugs can cause xerostomia

▫Anti anxiety and anti depressants ▫Blood pressure▫Antihistamines▫Muscle relaxants▫Parkinson’s Disease▫Urinary Incontinence

http://www.doversherborn.org/index.cfm/page/Medication-Administration-Policy/pid/10371

Other Causes of Xerostomia•Aging

▫Medications & other health factors•Cancer Therapy

▫Radiation of the head & neck•Nerve damage of the head & neck

▫Stroke patients•Mouth breathing/snoring•Smoking

Systemic Diseases, Conditions & Oral Health

•Diabetes Mellitus

•Cardiovascular Disease

•Smoking

Diabetes Mellitus•Two-way street

▫Diabetes immunosuppression and increased blood sugar

▫Periodontal Disease affects blood glucose control

http://www.palmharbordentistry.com/GumDisease/Diabetes.aspx

Diabetes Clip

Cardiovascular Disease•Direct cause and effect relationship is still being

studied•Periodontal disease = risk of cardiovascular

disease due to inflammation markers released into the blood stream

•Antibiotic pre-med for some heart conditions (infective endocarditis)

http://www.perio.org/consumer/heart_disease

Smoking•Dry mouth• Immunocompromised due to constriction of blood

vessels • Increases risk for oral cancer and lung cancer

Smoking Link

http://www.live-in-green.com/health_info/problematic_products/smoking.html

Case Study: Gingivitis increases systemic inflammatory markers

•Objective: investigate if gingivitis increases systemic markers of inflammation related to atherosclerotic plaque development

•37 subjects, non-smokers, no inflammatory or cardiovascular disease/risk factors

Case Study (cont.):Gingivitis increases systemic inflammatory markers

•Methods: Cessation of oral hygiene for 21 days

•Results: Gingival bleeding and Inflammation Systemic inflammatory markers

▫Reactivation of oral hygiene measures completely eliminated these responses

Importance of Home Care• It is important that

patients receive daily oral care

•A healthy mouth is crucial for speaking, chewing and overall health

http://www.1dental.com/blog/2011/06/17/dental-care-dementia/

Techniques •Approach patients in an gentle and caring manner.•Remember many older adults or patients are

sensitive to having their mouths or head touched.• Always move slowly and explain exactly what you

are going to do •While you work speak in a soft and friendly voice to

put them at ease.

Patients with physical disabilities•Some patients may be independent and you can

utilize tooth brushing aids to allow them to brush their own teeth

•You can enlarge the handle by attaching it to a bike handle grip, rubber ball or large marker

•Strongly encourage an electric brush

Tooth brushing basics•Utilize a soft bristle brush•45° angle with gentle circular motions•Biting surfaces of teeth •2 minutes•Tongue

http://www.drchetan.com/bass-technique-of-toothbrushing.html

Don’t forget to floss•Many patients you will be taking care of will not be

independent enough to do this on their own•Use 18 inches of floss and use index fingers to guide

floss between contacts of the teeth (Do not snap)•Use a “C” shape to contour between each tooth •Floss each tooth with a clean section of floss

Denture Use• It is recommended to

rinse dentures after every meal

•Remove at night•Tissue needs to

breathe

http://blog.charlottedentistry.com/2011/07/08/perfect-fit-dentures-bring-comfort-success/

Denture Care •Clean dentures X2 daily with

a denture brush and a non-abrasive denture cleanser

•Regular toothpaste is too abrasive for denture care

•Remain moist •Dentures are fragile

http://www.heritagecreekdental.com/des-moines-dentures.htm

Conditions that require a closer look by a Dentist

•Bleeding gums •Change in how their teeth fit together •Red, swollen or tender gums •Discharge at the gumline of a tooth •Change in the fit of their dentures or partials •Very bad breath • Loss of taste and weight loss • Loose or chipped teeth

Not Oral Cancer! But need to be seen by a DDS!

http://smilekraft.blogspot.com/2012/03/preventing-formation-of-dental-plaque.html

Oral Cancer Screenings•A thorough examination of the oral cavity

is essential to the total care of the patient

•Goal: Identify suspected lesions that require additional testing and refer for medical evaluation

Oral Cancer•Survival rate of oral cancer is very low

•Key risk factors: Smoking and alcohol consumption

What to look for•Mouth sore that doesn’t heal quickly

•A change in color or texture of the oral tissue

Appearance •Size and shape- varies. Can be flat or

raised

•Color- red and white are most common. Can be blue, purple gray, yellow, black or brown.

•Surface texture- May be smooth or irregular

•Consistency- soft, spongy, hard or indurated

Most Common Sites •Floor of the mouth

•Lateral part of tongue

•Lower lip

•Soft palate

Floor of the mouth•Have the patient raise their tongue to the

roof of their mouth- look for white and red patches

•Using bimanual palpation, feel for lumps

Floor of the mouth•Normal

• Tori- hard bilateral- OK

• Refer

Lateral border of tongue•Have the patient stick out their tongue,

grab with gauze.•Examine the sides and underside of the

tongue for white and red patches, feel for lumps

Lateral border of the tongue• Healthy

• Geographic tongue- OK

• Refer

Lower Lip•Gently pull the lower lip down to view the

inside tissue. Be sure to look in the vestibule.

•Palpate the lip to feel for any lumps while looking for white or red patches.

Lower Lip

http://www.skinsight.com/adult/oralMucocele.htm

• Mucocele- fluid buildup- OK

http://www.dentalcare.com/en-US/dental-education/continuing-education/ce348/ce348.aspx?ModuleName=coursecontent&PartID=1&SectionID=-1

• Refer

Soft Palate

•Have the patient open wide and say “Ahh”.

•Observe the area between the roof of the mouth and the uvula.

www.healthhype.com

Soft Palate• Healthy

• Strep Throat

• Refer

www.meduweb.com

www.rightdiagnosis.com

www.cleft.org

Screening•Explain the

procedure to the patient

•You will be using different kinds of palpation

In Clinic •Tell, show, do• Oral Cancer Screen•TB and Floss•Denture Care

Questions about Clinic •Aha moment?

Summarize•Oral cavity is connected to the entire

body•2 way street!•Home care is crucial•Catching oral cancer early is important

Questions

What is your muddiest point?

ReferencesAmerican Academy of Periodontology (2012). Gum disease and cardiovascular disease. Retrieved

from http://www.perio.org/consumer/heart_diseaseCaesy Education Systems (Producer). (n.d.). Periodontal disease systemic effects diabetes. [Online

video]. Retrieved from http://www.youtube.com/watch?NR=1&v=0KDQp8OVICQ&feature=endscreen

Colgate (2013). Take charge of your diabetes and oral health: Learn about the connection between gum disease and diabetes. Retrieved from http://www.colgate.com/app/ColgateTotal/US/EN/Diabetes.cwsp?cid=ppc_gg_nb_stan_diabetes+oral+health_broad&kw=gum+disease+and+diabetes

Eberhard, J., Grote, K., Luchtefeld, M., Heuer, W., Schuett, H., Divchev, D., Scherer, R., Schmitz-Streit, R., Langfeldt, D., Stumpp, N., Staufenbiel, I., Schieffer, B., & Stiesch, M. (2013, February 7). PubMed: Experimental gingivitis induces systemic inflammatory markers in young healthy individuals. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23408963

Mayo Clinic (2011, April 7). Dry mouth. Retrieved from http://www.mayoclinic.com/health/dry-mouth/HA00034/DSECTION=symptoms

Thank you!