Oral Health for Medical students Dr. Zahra Saied - - PDF document

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Oral Health for Medical students Dr. Zahra Saied - - PDF document

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2/25/2013 Oral Health for Medical students Dr. Zahra Saied Moallemi DDS, PhD, Head of department

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2/25/2013 1

Oral Health

for Medical students

  • Dr. Zahra Saied Moallemi

DDS, PhD, Head of department Oral Public Health Dept., Dentistry Inst., IUMS 1391 رﺗﮐد ﯽﻣﻠﻌﻣ دﯾﺳ ارھز ﯽﺻﺻﺧﺗ یارﺗﮐد ،ﮏﺷزﭘ نادﻧد تﻼﯾﺻﺣﺗ تﺳرﭘرﺳ و هورﮔ رﯾدﻣ ﯽﻠﯾﻣﮑﺗ ﯽﮑﺷزﭘ نادﻧد و نﺎھد تﻣﻼﺳ هورﮔ رﮕﻧ ﮫﻌﻣﺎﺟ

Why we should know about

  • ral health?

Dr . Z. Saied-Moallemi

  • a fever of unknown origin that got all sorts of

workup because it never occurred to the physician team that it might be a dental issue.

  • an elevated white blood cells in a patient

indicating an infection: an abscess in the mouth

Dr . Z. Saied-Moallemi

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  • What is the most prevalent infectious

disease worldwide?

– Influenza? – HIV? – ….?

Dr . Z. Saied-Moallemi

Dental caries

Dr . Z. Saied-Moallemi

  • Everybody
  • Gender
  • Age
  • Race
  • Everywhere
  • Every time

Dr . Z. Saied-Moallemi

  • Your recommendations for a pregnant woman

with vomiting?

  • Which are threatening the oral health of

pregnant mother during pregnancy?

– Dental erosion – Dental caries – Gingivitis – Periodontitis – Pregnant tumor

Dr . Z. Saied-Moallemi

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2/25/2013 3 Why we should know about oral health?

– General diseases with oral origin – General diseases with signs in oral cavity – Common risk factor approach – YOU are the HEAD. You are RESPONSIBLE for the OVERALL health of individuals – For your personal health

Dr . Z. Saied-Moallemi

Oral disorders due to systemic diseases

Oral disorders from diabetes:

  • Gingivitis and periodontitis
  • Neuro-sensory disorders, burnt mouth, taste

disorders

  • Fungal infectious, unhealed wounds
  • Halitosis, dry mouth: dental caries

Dr . Z. Saied-Moallemi

Uncontrolled diabetes Uncontrolled Periodontitis

  • Type 2 diabetes: increased incidence of

periodontitis

  • Periodontitis: increase two fold risk of

developing diabetes

Dr . Z. Saied-Moallemi

  • Respiratory dis., inhalers may make fungal dis.
  • r dry mouth
  • Systemic diseases or medication:

– Low saliva flow xerostomia (anti-colinergic medicine) – Change in taste or smell – Oro-facial pain – Gingival fibrosis – Bone loss – Tooth mobility

Dr . Z. Saied-Moallemi

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Dr . Z. Saied-Moallemi

  • Poor oral hygiene is a risk factor for some systemic

diseases.

  • Periodontal diseases in linked to:

– Diabetes – Cardiovascular diseases (due to increased systemic inflammation) fragments of periodontal bacteria found at atherosclerotic blood vessels. aggressive treatment of gum disease reduces the incidence of atherosclerosis within six months – Arthritis rheumatoid (increased systemic inflammation) – Pneumonia, especially in high risk groups like elderly people: pneumonia was 3.9 times higher in

patients with periodontal infection than healthy mouth

– COPD: 3 times more in perio. dis. – an improvement in oral health can lead to a reduction in respiratory infection. – Pancreatic cancer: increased risk in perio. dis. (systemic inflammation or increased levels of carcinogenic compounds) (type 2 diabetes points to damage to the pancreas)

Dr . Z. Saied-Moallemi

  • Pregnancy:

– fluctuating hormone levels – neglected oral care

  • Pregnant mother with periodontal dis.:

Premature delivery: (inflammation in the mouth possibly triggers an increase in prostaglandin) – pregnant women with gum disease between weeks 21 and 24: 4-7 times more likely to give birth before week 37. LBW baby

Dr . Z. Saied-Moallemi

Oral cancer

– Prevalence?

Dr . Z. Saied-Moallemi

  • The 8th most common cancer in the world. (Petersen et al, 2005)
  • sixth most common cancer in men (Parkin et al, 2005)
  • 40% of head and neck cancers occur in the oral cavity.
  • 700,000 death annually (Moore et al, 2000)
  • Oro-pharyngeal cancers = 3% of all diagnosed cancer in

Iran (MOHME,2003) and in the U.S. (Day et al, 2003)

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60% of oral cancers are in an advanced stage by the time of detection In Iran, most of diagnosed cancer were in advanced stage (Sargeran et al, 2006) – Diagnostic delay [time elapsed between the onset of

symptoms and diagnosis]: 7.2 months

– Treatment delay [time from diagnosis to the beginning

  • f treatment]: 1.3 months

[Sargeran et al, 2006]

– 60% five-year-survival rate, increase with early detection

Dr . Z. Saied-Moallemi

  • Oral cavity (i.e., lip, tongue, floor of the

mouth, gums, and soft palate).

  • The most common sites for oral cancer are the

tongue and floor of the mouth.

Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi

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Risk Factors

  • Cigarette Smoking: risk for 75% of oral cavity and

pharyngeal cancers, six times more than non-smokers

– Pipe smokers have an especially high risk for lip cancer

  • Smokeless Tobacco (Chewing Tobacco): 50 times

more likely to develop cancers of the cheek, gums, and lining of the lips.

  • Marijuana
  • Alcohol Abuse: six times more
  • Age: older than 40, average age 63 year
  • Gender: Men have twice the risk of oral cancer as

women

Dr . Z. Saied-Moallemi

  • Mouth Rinses: Ethyl alcohol insufficient clinical evidence
  • Ultraviolet Light: Excessive exposure to solar radiation

(sunlight) especially at a young age

  • Irritation: chronic irritation- complete dentures
  • Human Papillomavirus Infection: Infection with human

papillomavirus (HPV) = increased oral squamous cell carcinoma (still in question)

(Viruses cause proto-oncogenes to become oncogenic, which can cause altered expression of their products and lead to cancer)

  • Poor Nutrition

Dr . Z. Saied-Moallemi

  • Family history of cancer
  • A weakened immune system: HIV/AIDS, or

who are taking medicines that suppress the immune system

Dr . Z. Saied-Moallemi

Do “90-second oral cancer examination”

  • Symptoms of Mouth Cancer (Oral Cancer)
  • no early symptoms
  • an ulcer in the mouth or on the lip that won’t heal
  • constant pain or soreness
  • red or white patches in the mouth
  • a lump on the lip, tongue or in the neck
  • bad breath
  • unexplained bleeding in the mouth
  • numbness in the mouth
  • loose teeth
  • Difficulty swallowing or speaking

Dr . Z. Saied-Moallemi

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Extra-oral assessment

  • Face, head, and neck, ears,

– Asymmetry – changes on the skin such as crusts, fissuring, growths, and/or color change.

  • bilaterally palpated on regional lymph node
  • enlarged nodes
  • If enlargement is detected, should determine the mobility and

consistency of the nodes.

  • A recommended order of examination:
  • Pre-auricular,
  • Sub-mandibular,
  • Anterior cervical,
  • Posterior auricular,
  • Posterior cervical regions

Dr . Z. Saied-Moallemi

Lip

  • Observing the lips

– closed and open patient's mouth – Note:

  • the color,
  • Texture
  • surface abnormalities

Dr . Z. Saied-Moallemi

Labial mucosa and sulcus

  • With the patient's mouth partially open,

visually examine the of the maxillary vestibule and frenum and the mandibular vestibule.

  • Observe

– color, – texture, – any swelling – other abnormalities

Dr . Z. Saied-Moallemi

Buccal mucosa

  • Retract and Examine right then left buccal

mucosa (from the labial commissure and back to the anterior tonsillar pillar)

  • Note:

– change in pigmentation, – color, – texture, – mobility, – other abnormalities

Dr . Z. Saied-Moallemi

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Gingiva and alveolar ridges

  • First, examine the buccal and labial aspects
  • Second, examine the palatal and lingual

aspects

Dr . Z. Saied-Moallemi

Tongue

  • the dorsum and tip of the tongue (patient's

tongue at rest, and mouth partially open)

  • inspect:

– swelling, – ulceration, – coating, – variation in size, color, or texture. – change in the pattern of the papillae covering the surface of the tongue and examine the. – The patient should then protrude the tongue, and note any abnormality of mobility or positioning

Dr . Z. Saied-Moallemi

Tongue

  • lateral margins of tongue (with mouth mirror)

Dr . Z. Saied-Moallemi

Tongue

  • more posterior aspects of the tongue's lateral

borders (grasping the tip of the tongue with a piece of gauze)

Dr . Z. Saied-Moallemi

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Tongue

  • Examine the ventral surface
  • Palpate the tongue to detect growth

Dr . Z. Saied-Moallemi

Floor

  • floor of the mouth (with tongue elevated)
  • Inspect changes in:

– color, – texture, – swellings, – Other abnormalities.

Dr . Z. Saied-Moallemi

Palate

  • hard and soft palate (with the mouth wide
  • pen and the patient's head tilted back, gently

depress the base of the tongue with a mouth mirror

Dr . Z. Saied-Moallemi

Soft palate and oropharyngeal tissues

  • Examine all soft palate and oropharyngeal

tissues

Dr . Z. Saied-Moallemi

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Palpation

  • Bimanually palpate the floor of the mouth for

any abnormalities.

  • All mucosal or facial tissues that seem to be

abnormal should be palpated.

  • http://www.nidcr.nih.gov/imagegallery/oralhealth/O

ralCancerExam.htm

Dr . Z. Saied-Moallemi

Overall …

Dr . Z. Saied-Moallemi

Elderly people

  • Periodontitis and receding gums,
  • Root caries

Dr . Z. Saied-Moallemi

Root caries

Dr . Z. Saied-Moallemi

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Dr . Z. Saied-Moallemi

What you can do ...

  • Do a good oral exam, especially in those with risk

factors such as smoking and drinking

  • Ask about last dental visit of your patients, and

whether they’re experiencing any dental problems

  • Consider the medications your patients prescribe: dry

mouth, results in other dental problems.

  • Discuss with your patients the importance of

preventive measures for good oral hygiene: fluoride toothpaste and varnish, electric toothbrushes, and flossing

  • weight loss: poor denture

Dr . Z. Saied-Moallemi

  • Go find a dentist! [It is not enough.]
  • Multidisciplinary healthcare professionals:

By treating the mouth we treat the whole body.

Dr . Z. Saied-Moallemi

  • Suggest that patients with limited use of their hands (eg,

rheumatoid arthritis) try adapting their toothbrushes by inserting the toothbrush handle into a rubber ball or sponge hair curler. They can also lengthen toothbrush handles with a piece of wood or plastic such as a ruler.

  • Recommend electric toothbrushes for patients with

dexterity problems who cannot use a manual toothbrush. Studies have shown that electric brushes efficiently remove plaque and aid in gum stimulation.

  • Promote daily brushing and flossing to protect against root

and tooth decay.

  • Recommend that patients with partial or full dentures use a

soft toothbrush or denture-cleaning brush along with a commercially prepared denture powder or paste, hand soap, or baking soda. Dentures should be brushed inside and outside and rinsed with cool water.

  • Remind patients to brush partial dentures, their remaining

natural teeth and gums, and especially the teeth supporting a partial denture.

Dr . Z. Saied-Moallemi

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  • CRFA: Common Risk Factor Approach
  • Cardiovascular diseases
  • Cancers
  • Chronic respiratory diseases
  • Diabetes
  • Periodontal disease
  • Dental caries
  • Oral cancer

(Sheiham and Watt, 2000)

Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi

Common Risk Factor Approach

  • An integrated approach to prevent a range of

conditions

  • Changing a small number of factors that

determine the large number of diseases

  • CRFA vs. disease-specific actions: CRFA is more

effective and efficient

(WHO 2000)

  • Dr. Z. Saied Moallemi
  • Oral health is an integral part of general

health.

  • It significantly impacts quality of life.
  • Oral diseases can lead to:

– irreversible damage, – unnecessary pain, – dental anxiety, – general health problems, – depression, – low self-esteem, – lost school time, and – poor quality of life.

(WHO, 2003)

Dr . Z. Saied-Moallemi

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Dr . Z. Saied-Moallemi

  • Additional slides:

Dr . Z. Saied-Moallemi

The ultimate goal of Health is to reach Quality of Life: PRECEDE-PROCEED MODEL

Quality of life Phase 1 Social assessment Health Phase 2 Epidemiological assessment Health education Policy regulation

  • rganization

Health Program*

Phase 5 Administrative & policy assessment Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Predisposing Reinforcing Enabling Phase 4 Educational & ecological assessment Behavior Environment Phase 3 Behavioral & environmental assessment

*New in 4th ed., Green & Kreuter, Health Promotion Planning.

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Milk (Primary) teeth Primary and Permanent teeth

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Healthy gingiva

Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi

Gingivitis and periodontitis Gingivitis and periodontitis

Dr . Z. Saied-Moallemi

Gingivitis and periodontitis

Dr . Z. Saied-Moallemi

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Microbial plaque

Dr . Z. Saied-Moallemi

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Dr . Zahra Saied Moallemi