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Chronic Disease and Oral Health Care Presented by Margaret Pukallus & Andrea Maguire [email protected] [email protected] Our purpose • Increase awareness and understanding of oral health issues particularly in regard to people with chronic conditions in particular diabetes and heart conditions. • Uniting general health and oral health • Increase knowledge of the management and care of the oral cavity. Oral health • Fundamental to overall health, wellbeing and quality of life. • A healthy mouth enables people to eat, speak and socialise without pain, discomfort or embarrassment. • Oral diseases, particularly affecting teeth and gums, are among the most common health problems experienced by Australians Impact of oral disease Burden of oral disease • Tooth decay a ‘silent epidemic’ • 2nd most costly diet-related disease in Australia • economic impact comparable with heart disease and diabetes. • Oral Health $7.1 billion = 10% of total health expenditure • Public funding in QLD is around $78 million / year Burden of oral disease cont/ • Demand far outstrips capacity to supply treatment Current high waiting list for public of oral health services – most vulnerable in our community Demand far beyond resources – drill and fill emergency service worsening national shortage of dental providers. • Ageing population increasing costs and complexity of services. • Growing population 4,826,966; 14.4% aged 65 years+ 1528046; 28% aged 65 years+ (MSOH) • Refugees Metro South Oral Health currently see 51% of the States refugee and asylum seeker populations 76% of States interpreter services • 1.5 million Queenslanders eligible for public dental care 40% are school children. Eligible population in MSOH is 480,000 and currently reach only 20% • Timely care often unavailable due to long waiting lists result is rapid oral health deterioration Inequalities in oral health status • Poor oral health is most evident among: Aboriginal and Torres Strait Islander people people on low incomes rural and remote populations some immigrant groups from non-English speaking background – particularly refugees residents of aged care facilities and the elderly population people with special needs and/or long term health conditions. What determines oral health? • • • • • biological social economic knowledge and attitudes to health learned behaviours – personal health practices and individual capacity • cultural and environmental factors • access to and availability of oral health services. Common risk factors Common risk factors • Shared risk factors leading to tooth decay, gum disease and oral cancer include: tobacco smoking, inappropriate diet, alcohol consumption, injuries, poor hygiene, exposure to ultraviolet radiation, illicit drug use. • Risk factors for oral health in people with CVD & Diabetes: smoking high blood pressure high blood cholesterol inappropriate diet including obesity alcohol consumption Type II diabetes presence of dental plaque. How does oral health affect cardiovascular health? • Growing recognition of the link between cardiovascular disease and periodontal disease. • Periodontal disease may increase risk of heart diseases including: coronary heart disease – heart failure and angina stroke peripheral vascular disease. • Some conditions place the person at higher risk of infection through dental treatment: rheumatic fever and rheumatic heart disease congenital heart diseases. Infective endocarditis • • • Certain dental treatment can produce a transient bacteremia Infective Endocarditis (IE). Untreated, the infection may severely harm or even destroy the heart valves. Increased risk associated with: congenital or diagnosed cardiovascular disease (heart defects, heart murmurs, rheumatic fever, etc) recent heart surgery (within last 6 months) history of infective endocarditis acquired valvular dysfunction diagnosed with other heart ailments artificial valves recent vascular surgery (within last 6 months) pacemaker congenital heart defect. How does diabetes affect oral Health? • People with diabetes have narrower then normal blood vessels, as a result the gums receive decreased oxygen & nutrients. • An altered immune system makes diabetics more susceptible to infections & disease. • Diabetics may suffer decreased saliva flow, which in turn leads to an increase in plaque build up. How does diabetes affect oral health? • Compromised immune systems mean people with diabetes are at greater risk of developing gingivitis periodontitis (gum disease) oral infections (thrush). • Infections and wounds take longer to heal. • Build-up of plaque and calculus leads to increased risk of periodontal disease and tooth decay. Inadequate care can cause a range of dental problems Dental plaque • A thick sticky matrix, produced by bacteria within the mouth. • Plaque protects the bacteria from our natural body defences. • Mature plaque (more than 12 to 24 hours old) is responsible for and common to tooth decay and gum disease. Dental caries • Tooth decay occurs when bacteria and sugar are left in contact with the tooth surface. • Appears as white or dark patches on the tooth or as a hole or cavity. • Toothache occurs when the pulp of the tooth is irritated by the decay process. • Decay can occur on the tooth enamel or root surface. • Refer to a dental professional Aetiology of Caries NSW Government, 2016 Calculus • • • • • Also known as tartar. Hard cement like deposit. Formed from minerals in saliva bound to plaque. Causes gingivitis and gum disease. Must be removed by a dental professional Gingivitis • Reversible condition. • Inflamed gums. • Caused by plaque left along the gumline for more than 24 hours. • Signs are red, swollen, sensitive, bleeding gums. Periodontal disease (periodontitis) • True gum disease. • Painlessly damages gums, ligaments and supporting bone. • If untreated, it is progressive until the tooth becomes mobile. • Plaque toxins are the major cause of gingivitis and periodontitis calculus should be removed as it traps plaque bacteria and their toxins. Periodontal disease • • • • Infection of gums, ligaments and surrounding tooth bone. Caused by bacterial plaque. Genetic marker (crucial). Modifying factors: diabetes heart disease smoking hormonal changes/pregnancy stress medications poor nutrition immune disorders poor fillings. Common signs of periodontal disease • Bleeding gums on brushing, flossing or eating not a strong sign in smokers. • Red and swollen, puffy, uneven gums. • Sensitivity. • Recession of gums. • Stale taste, bad breath. • Tooth mobility when advanced, loose or drifting teeth. • Seek professional dental care to halt the progress of periodontal disease. The Importance of Saliva • • • • • • Lubrication for swallowing & speech Assisting taste Maintaining the health of the oral soft tissues Assisting digestion Dilution & clearing material from the mouth Buffering acids from plaque, food & drinks, internal acids (reflux & vomiting) • Reservoir for ions – remineralisation A good saliva flow is important! • A lack of saliva causes: Increase in tooth decay Increase in gum problems Discomfort on eating Irritations of the soft tissues Impaired retention of dentures Increase in sensitivity Salivary Dysfunction • Diabetics with poor glycaemic control may experience dry mouth caused by increased in urination or alterations in the salivary glands. • Other health complications in conjunction with the diabetes and CVD can have an affect on saliva flow, as well as many of the medications used to treat these complications. • Any “Anti” medication, along with many others can cause a dry mouth. (e.g. anti – hypertensives, anti – depressants etc.) Candidiasis • Fungal infection more commonly known as ‘thrush’. • Initially presents as red areas • More progressive forms appear as a white flaky layer over the red underlying tissue. • Very contagious. • Can be quite painful. Dental Appointments for Diabetic patients • • • Advise the dental practitioner about your condition. Book appointments in the morning when insulin levels are more stable, and your less likely to be kept waiting. Monitor blood glucose levels prior to surgical treatments & advise dental practitioner • • Treatment of periodontal disease can be successful in patients with well controlled diabetes. Good Oral Health assists people with diabetes to control their diabetes! Dental Appointments for CVD patients • • The main dental issues relating to cardiovascular conditions are prevention of endocarditis and potential problems with anticoagulant and antiplatelet drugs in patients undergoing dentoalveolar surgery (including extractions). Cardiac conditions that may require antibiotic prophylaxis: extraction periodontal procedures including surgery, subgingival scaling and root planning replanting avulsed teeth • • • • Patients may also have a history of coronary heart disease, heart failure or hypertension, which can affect dental treatment. Optimal blood pressure is less than 120/80 mm Hg Treatment of periodontal disease can be successful in patients with well controlled CVD. Good Oral Health assists people with diabetes to control their CVD Infective endocarditis Therapeutic Guidelines Limited 2016. Home care and oral health Oral health care for CVD & diabetes • Treatment and prevention: healthy eating and regular exercise limit consumption of food and drinks that contain high levels of sugar/acids. monitor and control blood glucose levels QUIT smoking brush twice daily with fluoride toothpaste and a soft brush clean between teeth daily clean dentures and remove overnight look for early signs of gum disease seek regular professional dental care Saliva Flow = Healthy teeth and gums • • • Natural protector against decay dilutes and neutralises acids in the mouth contains minerals which help repair damage caused by acids. Diet, some diseases and medications affect saliva flow Reduce caffeine (cola soft drinks, coffee, tea, alcohol). more prone to tooth decay, gum disease and digestive problems. To increase saliva flow: drink water reduce consumption of caffeine and acidic foods and drinks chew sugar-free gum or suck hard sugar-free sweets QUIT smoking Fluoride toothpaste on a small soft brush, twice daily! Flossing technique Floss daily, prior to brushing. 40cm of floss, wrapped around the 2nd finger of each hand. • With one finger in the mouth, gently draw the floss between the teeth until it slips just slightly under the gum level Mouthrinses • Chlorhexidine based rinses or gels short term (approx. 2 weeks) only use must be recommended by a dental professional. • Fluoride mouthwash daily or once per week depending on decay risk or sensitivity level appropriate for continual use. Interdental tools Modified toothbrush handles • Useful for independent or partially dependent people. • Allows for greater degree of control. • Suction brushes are more appropriate for dependent people. Oral health is part of general health • Health practitioners therefore have an important role in ensuring that oral disease does not contribute to systemic disease in any individual. Collaborative patient care is essential • Patient education • Diabetes educators/nurses/screening for poor oral health THANK YOU!