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The Integration of oral health for hospitalized patients Lynn Stedman, RDH Director/Associate Professor Columbia Basin College c How does it begin? Red Zone Bacteria • The 3 most destructive oral bacteria are: – Porphyromonas gingivalis – Treponema denticola – Tannerella forsythia The body’s immune system is activated . . . Bone loss and calculus buildup This is what the RDH is measuring with a periodontal probe ORAL DNA Where does the inflammation go? Inflammation occurs on the inner surface of the intima – the inside layer of the artery wall Formation of plaque causes narrowing of artery and turbulent blood flow – this can lead to rupture of the atheroma = heart attack or stroke. Esophageal Squamous Cell Cancer Link found in a recent study between P. Gingivalis and Esophageal Squamous Cell Cancer – 61% of cancerous tissues and 12% of adjacent tissue had P. Gingivalis present– it was not detected in normal esophageal tissues. The Oral Systemic Link • How did we get started? • Sam Barry, retired DDS who is a Representative for Henry Schein • Lee Ostler, DDS – Richland dentist – guest speaker for Periodontal class at CBC • AAOSH = American Academy of Oral Systemic Health – Dr. Ostler = a founder – Scientific Session #2 Las Vegas, NV – Scientific Session #3 St. Louis, MO “Say Ahh – The Movie” premiered at AAOSH in Las Vegas “Say Ahh” • Clip #1 Clip #2 Pre-term birth • Any birth that occurs prior to 30 weeks • Average cost of uncomplicated birth to a hospital = $1700 • Pre-term births cost an average of $77,000 • It would be worth it to determine as many risk factors as possible to drive down these costs. • Periodontal disease in the mother is a RISK FACTOR • P.Gingivalis and Fusiform nucleatum are both elevated in Periodontal disease Medical – Dental Summit I • Oral Health Coalition and Community Partners for Health joined efforts to create the Summit • Several of the national presenters came to the first Summit to promote our grass roots efforts • High Obesity and rates of Type II Diabetes • One of the highest rates of childhood and adult caries in the state -- a designated underserved area • In need of innovative and effective solutions = OUT of the BOX THINKING! The reality of dental care . . . • Patients without some ‘dental IQ’ need to be educated to value their oral health • Private dental offices provide excellent care for the insured with resources • Uninsured people with limited resources do not seek preventive dental care • Diverse cultures do not have a concept of ‘prevention;’ care = “I am in pain.” • Hospital ERs are seen as their resource to alleviate pain Utilization of ERs is costing all of us • In one 18 month period in WA state dental visits to the ERs cost taxpayers $36 million. • For our local area: 3/1/13 through 2/28/14 – – – – – Trios Hospital = 298 Lourdes = 227 Prosser = 52 Kadlec = 713 Total = 1,290 Average cost of an ER visit is $500 - $700 Where did we start? • Decision to utilize Dental Hygiene students • New work venues needed other than private dental practices • Education is thorough and rigorous and can be used to fill in the gap of health care in hospital settings Clinical Rotations at Kadlec Students from Class of 2015 And Ian Corbridge, RN, Policy Director of Clinical Issues, from WA Hospital Association Rotation on OB Floor Kadlec Instructor Mellisa McGlinn Students from Class of 2016 Oral exam being done on Patient. Evaluation of Hospitalized Patients’ oral health • Director of Nursing is now Dean of Health Sciences • Director of Nursing Services at Kadlec Regional Medical Center = a CBC graduate • Meeting facilitated with Medical Director to discuss the feasibility of a dental hygiene student rotation in the hospital • Goal = to determine how many hospitalized patients had signs/symptoms of periodontal disease or past evidence of periodontal disease Goals of Rotation • Identify patients with no regular dental care • Give them information regarding community resources • Teach them how their oral health may be impacting their general health • Encourage seeking dental evaluation ASAP following discharge What if . . . • Medical problems had a dental component that was being ignored or failing to be evaluated? • What if many medical problems had a dental related solution? • What if, by addressing the dental aspect of patients’ health there could be better outcomes in achieving health before or after hospitalization? • What if addressing the dental needs could reduce the number of patients who are now hospitalized? Where’s the mouth? • Assumption = that’s the job of the dentists or the dental community • Private, fee for service dental practices are serving a smaller and smaller % of the population • Community based clinics are often plagued with business challenges . . . • Too many people are using the ER for their dental pain and needs – with no real solutions (antibiotics or pain meds only) The role of an RDH in the hospital • Currently the student rotation consists of – Extra and Intra oral exam/cancer screening – Looking for Decayed, Missing or Restored teeth; areas that are painful – Checking edentulous areas for sores and the fit of partial or full dentures – Cleaning these appliances – Providing oral hygiene instructions and brushing and flossing patients’ teeth – Second student does a screening interview including information regarding periodontal disease Screening Forms Summary of Initial Rotation of CBC Dental Hygiene students are in your handout packet Cardiac Floor . . . • FINDINGS: • Many edentulous patients are not aware of why they lost their teeth. • No patient awareness of the oral-systemic link • No dental care due to lack of dental insurance or resources • Limited knowledge of local resources • Patients and family members were receptive to the care provided by students • Nursing team was positive and receptive to the rotation • There is a lack of awareness of the education and role of a Dental Hygienist Obstetrics . . . • Are babies born with the bacteria that causes decay? • Can a family member pass bacteria to a baby that causes decay? • Should a baby be nursed to sleep or given a bottle at bedtime after age 1? • At what age should a baby see a dentist for the first time? • Is it normal for your gums to bleed during your pregnancy? Start them early . . . To avoid this . . . White spot lesions Baby Bottle Mouth Rampant Childhood Caries (cavities) Gingivitis = Reversible Periodontal Disease = Treatable Gingivitis Periodontal Disease Conclusions . . . • Early prevention, identification and treatment of caries and periodontal disease can present a significant difference in long term health outcomes. • It is both a financial and educational endeavor. • Dental hygienists can be utilized to deliver oral assessments in medical settings. • Early identification and treatment or referral for dental problems can remove oral inflammation as a risk factor for systemic illness.