Download Chronic Disease and Oral Health Care

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/
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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.
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Ageing population
 increasing costs and complexity of services.
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Growing population
 4,826,966; 14.4% aged 65 years+
 1528046; 28% aged 65 years+ (MSOH)
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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%
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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?
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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:
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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
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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
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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
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Infection of gums, ligaments and surrounding tooth bone.
Caused by bacterial plaque.
Genetic marker (crucial).
Modifying factors:
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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
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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
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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
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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
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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
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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
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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!