Download Oral, Vision, Hearing

Dental Health &
Prevention
 Teach children to brush early
 Take children to the dentist by 1 years old
 Consider Fluoride Varnish when teeth first appear
Fluoride Varnish
 All solutions Fluoride Varnish
 Cavity Shield Varnish
 Duraflor
 Enamel Pro Barnish
 Lor-Opal Varnish
 Vanish
Dental Health &
Prevention
 Fluoride Varnish
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Inform any discoloration will be gone in 8 hours
Apply varnish 2 – 4 times a year
No food or drink 60 minutes after application
No brushing for 12 hours after application
Remove plaque and debris from teeth with gauze
But don’t dry , salvia needed set properly
Pain on the varnish on all sides of the teeth
Fine thin film
Billable 99211
Oral Health
 Taking an oral history
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Who is your dentist?
When was your last visit?
What did the dentist do for you?
How often do you brush/floss?
Are you having any problems with your teeth, chewing,
tasting, swallowing
Oral Health
 Taking an oral history
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Do your gums bleed when you brush?
Do you find blood on the pillow case?
Do you smoke, or chew tobacco?
So you use sun screen on your lips?
Do you have any sores/lumps in your mouth?
Oral Health
 Taking an oral history
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Do you engage in contact sports?
Do you (children) use fluoride?
Does your mouth hurt?
Do you have any questions about your oral health?
Oral Health
 A complete oral exam is recommended
 Prompt referral
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Bleeding gums
white spots lesions along the gum line
Decayed or loose teeth
Ulcerations
Leukoplakia or Erythroplakia
Lumps or Swelling
Hairy Leukoplakia
 Oral hairy leukoplakia
may look like oral
candidiasis (thrush).
Thrush can be scraped
off.
 The white ridges of oral
hairy leukoplakia do not
scrape off.
 Occurs in people who
have HIV and who have
moderate to severe
immune system damage.
Erythroplakia
 Also called
Speckled
Leukoplakia
 More predictive of
neoplasm than
Leukoplakia
 90% of early
carcinomas appear
as erythroplakia
What about Fluoride?
 Dental fluorosis is an irreversible condition caused by
excessive ingestion of fluoride during the tooth
forming years.
Mild Fluorosis
 The white opaque
areas in the enamel of
the teeth are more
extensive but do not
involve as much as 50
percent of the tooth."
Severe Fluorosis
 All enamel surfaces are
affected and hypoplasia is
so marked that the
general form of the tooth
may be affected.
 The major diagnostic sign
of this classification is
discrete or confluent
pitting.
 Brown stains are
widespread and teeth
often present a corrodedlike appearance.
Oral Health
 Dietary fluoride:
 Liquid form with and without vitamins and in chewable
tablets, dosed by age range.
 Additional topical fluoride in toothpaste: age 2 –3 yrs
(a pea size amount) until age 6
 Parents should assume primary responsibility for
brushing until child has enough dexterity to do it on
their own
 Age 7 begin dental flossing under supervision
Oral
 Major risk factors
 Use of tobacco (increases risk 6-28 times)
 Tobacco and alcohol account for 90% of cases
 Age
 Screening for oral cancer
 Lip, tongue, pharynx, oral cavity
 30,000 cases per year
 5 year survival 52%
Oral Cancer
 Oral leukoplakia
 Needs biopsy
Recommendations
 Early detection has better prognosis ?
 No proof better outcomes
 Oral leukoplakia: form of premalignancy
 ACS:oral exam every 3 years after age 40
 Canadian task force: annual exam by provider or
DDS over age 60 with risks
 Counsel regarding risks of tobacco and alcohol
 Patients undergoing cancer tx can benefit by
seeing a dentist before tx begins.
Dental Prevention
 Visit a dental care provider regularly, floss & brush
daily, brush with a fluoride toothpaste
 Use mouth rinses for plaque prevention
 Don’t put infants to bed with a bottle
 Fluoride supplements for children in communities
without adequate fluoridation
Older Adults – Oral Care
 Risks:
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Poor oral hygiene
Decreased salivary flow
Lack of professional care
Dentures
Older Adults – Oral Care
 Brush and floss
 See the dentist (cost, transportation)
 Use soft toothbrush with light pressure
 Implanted joints, valves, some murmurs
antibiotic Rx for dental repair
 Diabetes need special care
 Dentures are not to be worn continuously
 It is better if they fit
Vision Screening
Visual Impairment
 Undetected visual problems
 Common in preschool children
 Estimated prevalence of 5-10%
Risk Factors
 Risk factors in newborns
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Family History of ocular malformations
Congenital cataracts
Ocular tumors
Premature birth
Birth to mother who suffer from
 rubella herpes or toxoplasmosis
Amblyopia
 Amblyopia
 reduced vision in an eye
that has not received
adequate use
Strabismus
 Strabismus
 crossed-eyes, is a vision
condition in which a
person can not align both
eyes simultaneously
under normal conditions
Screening
 Stereoacuity testing more effective than visual acuity
for these conditions
 (random dot sensitivity 54-64%, specificity of 87-90%
PPV 57%, NPV 93%)
 Snellen, Landolt C, tumbling E, Allen picture cards,
grating cards
 Snellen letters sensitivity of 25-37%
 Early detection and treatment improves prognosis
for normal eye development
Visual Impairment
 Elderly
 Snellen visual acuity
 Causes: presbyopia, cataract, age-related macular
degeneration, glaucoma
 >75 yo have 5% MD & 5% glaucoma, 40% cataract
 Routine screening for acuity is recommended
 Frequency left to clinical discretion
 No routine rx for ophthalmoscopy if symptomatic
Cataracts
 Prevention
 Sun Glasses
 Risk
 Genetic
 Blue Eyes
 Corticosteroids
Vision through a Cataract
Recommendations for Adults
 There is no data to determine the incremental
benefit of routine screening of asymptomatic adults
to detect early refractory errors compared to
waiting for patients to present with complaints of
visual problems
Glaucoma
 Slowly progressive loss of vision associated
with damage to the optic nerve
 Inc IOP common, but not diagnostic criterion
 Visual fields and fundoscopic/slit lamp
examination
 2nd leading cause of irreversible blindness in
the US
 Congenital; Open-angle: most common;
Closed –angle; Secondary
Screening
 Tonometry
 Schiotz, applanation, air puff devices
 Measures IOP
 Accuracy and reliability
 varies by device
 Experience of examiner
 Physiologic variations in the patient
Tonometry
Slit Lamp Exam
 Ophthalmoscope
 Detects changes in the optic nerve head that often
precede visual deficits
 pallor, cupping, hemorrhage
 Interobserver variation
Slit Lamp Exam
Screening
 Perimetry: gold standard
 Visual stimuli varying brightness throughout visual field
 Takes 45 min, not feasible for screening
 Sensitivity in excess of 90% with specificity of 70-88%
Perimetry
Early Detection
 Visual deficits from glaucoma generally not
reversible
 Early treatment can prevent or delay progression
 Controversial role of increased IOP
 High risk patients: blacks over 40yo, whites over
65yo; Diabetics; Severe myopia
Recommendations
 American academy of Ophth
 Comprehensive eye exam by ophth all adults 40yo;
Younger for blacks
 Canadian task force
 Insufficient evidence to recommend for against
screening
 Guide to Clinical Preventive Services:
 insufficient evidence for or against routine screening
by primary care clinicians: effective screening best
done by specialists with specialized equipment to
measure visual fields and evaluate the optic disc
Hearing
Hearing
 School aged children and adults
 Pure-tone audiometry
 Problems
 Improper technique
 Background noise
 Unintentional or intentional misreporting by subject
Hearing
 Older adults
 Questioning them about their hearing, counseling
about the availability of hearing aid devices, and
making referrals.
 Pt inquiry or evidence of impairment:
 audiometric testing and otoscopic examination.
Hearing
 Screen high risk infants
 evoked oto-acoustic emission
 auditory brainstem response
 High risk:
 Risk for congenital or parentally acquired hearing loss:
herpes, syphilis, rubella, CMV, toxo, low birth weight,
meningitis,….).
Evoked Otoacoustic Emission Test
 Measures an acoustic response produced in inner ear –
bounces back out of ear in response to sound stimuli
 Place small probe with microphone and speaker in
infant’s ear
 With infant resting quietly, sounds are generated and
responses that come back from cochlea are recorded.
 Cochlea processes sound – electrical stimuli sent to
brainstem
 Second separate sound comes back out into canal –
otoacoustic emission
 If there are emissions for those sounds critical to speech
comprehension, then infant has “passed” hearing screen.
Auditory Brainstem
Response
 ABR test is reliable, objective, noninvasive and
painless.
 Brain wave activity in the auditory centers of the
brain is recorded in response to a series of clicks
presented to each ear
 Measures readiness for language development.
Auditory Brainstem Response
Testing