Lecture 1 20231.pptx

Primary Preventive Dental Concepts Chapter 1: Primary Preventive Dental Concepts Past as Prologue: What has changed in 100 years? Founder of Preventive Dentistry & Dental Hygiene “…the mouth is the show window in which the body displays its physical wares.” (preventive dentistry research should...

Primary Preventive Dental Concepts Chapter 1: Primary Preventive Dental Concepts Past as Prologue: What has changed in 100 years? Founder of Preventive Dentistry & Dental Hygiene “…the mouth is the show window in which the body displays its physical wares.” (preventive dentistry research should focus on) “….causes related to systemic diseases, which affect one or more organs, or the whole body; these diseases are believed to have an influence on the general health and, consequently, on dental health.” Courtesy of National Library of Medicine & Michigan Univ. Another notable historical dentist… Surgeons General & Oral Health Reports: 2000 & 2020 Oral Health In America An Atlas of 20 Years of Research Call to Action: • Policy changes needed reduce or ameliorate oral health inequities that affect behaviors & access to care • Dental & other providers must work together to offer integrated care in a variety of settings: schools, FQHCs, nursing homes, medical & dental clinics • Strengthen the workforce through diversification, reduce education costs, and a strong research enterprise dedicated to improving oral health. Dental Diseases, Systemic Health & Policy Alignment • Oral health is a major unmet • • need Pronounced inequities, especially among certain demographic subpopulations Access to care linked to disease burden Health Defined & Primary Preventive Care WHO defines health as the state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. Levels of Prevention • Primary Prevention – prevent onset of • • disease, reverse or arrest disease progression prior to secondary prevention. Often called dental hygiene. Secondary Prevention – routine treatment to terminate disease or restore tissue. Often called restorative care. Tertiary Prevention – Lost tissue replacement and rehabilitation. Often called reconstructive care. Categories of Oral Diseases 1. Acquired Conditions (ACs) – Caries & periodontal disease 2. Opportunistic Infections – also acquired but excludes caries & periodontal disease. Usual harmless microorganisms become disease-causing when the host is impaired. 3. Craniofacial Disorders – disorders of cranium and skull and can include genetic conditions and accidents Feasibility of Plaque Biofilm Prevention 1. Exposure Time: ACs result from prolonged presence of pathogenic plaques affecting: › › › Enamel Cementum Contiguous gingiva 2. Effective Removal: ACs can be controlled mechanically & chemically 3. Reversibility Continuum: ACs must go through a continuum of two reversible interim stages › › Histological normalcy (normal tissue structure/organization) Clinical pathology (structural & functional deviations) Stages of Plaque - in situ (earliest stage) • Plaque involvement limited to the site of • • origin Microscopic demineralization in enamel (Perio) Early infiltration of inflammatory cells beneath the sulcular epithelium (lines the gingival sulcus https://www.behance.net/gallery/36102789/ Tooth-Anatomy-Poster Stages of Plaque – Incipient Lesion • “White spot” visible on enamel – due to subsurface demineralization of the enamel • “Precaries” lesions: • • • • • • Interproximally (between teeth) Apical to the contact point (near the end of the root) Cervical (junction of crown and root) Deep occlusal fissures (grooves on surfaces of posterior teeth) Buccal surfaces (adjacent to inside of cheek) Lingual surfaces (adjacent to tongue) • Gingivitis – the incipient lesion for periodontal disease • Gingival bleeding first symptom • Incipient lesions for both caries and gingivitis can be cured! Stages of Plaque – Overt Lesions • Caries: Cavitation with bacterial infiltration • Periodontal Disease: irreversible changes in the periodontium; untreated leads to • bone loss Treatments: • • Use of antibacterial agents and/or remineralization therapy to arrest root decay Sealants for pit-and-fissure caries • Prevention goal should always be early identification & reversal of in situ or incipient stages of plaque disease. Risk Assessments Summary Risk identification & management Disease is progressive & reversible….to a point Non-invasive remedies are available Chapter 2: Cultural Health Influences What is Culture? Conceptual framework operationally defined according to characteristics or behaviors associated with individuals, groups, or organizations. Functionally defined as integrated patterns of human behavior that include language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups. Population Changes Cultural Diversity & Beliefs • Dental & hygiene training programs • How do you build trust that is patient• centered? Adaptation Theory & Explanatory Model Cultural Beliefs & Preventive Dental Care • Concept of self-care derived from notion of individualism • Adaptation theory Special Considerations for Patients with LEP • • • • • • Difficulty using the telephone to schedule appointments. Asking for and understanding directions to the practice. Providing incomplete/inaccurate information on health histories Being unable to understand informed consent Misunderstanding need for follow-up care or referrals Having problems with specialized care instructions LEARN Listen with sympathy and understanding Explain your perception of the problem Acknowledge and discuss the differences and similarities Recommend treatment Negotiate agreement Summary Attention to cultural competency is a lifelong commitment requiring self-reflection, listening to others, and investing in continuing education. Always check yourself for your own biases and resist the temptation to compare someone else’s lived experiences to your own. Patient populations are exceedingly more diverse than the profession of dentistry. In order for the profession to be impactful at a population-level, patient-centered care that is respectful and culturally sensitive is essential. What can you do practically, as a clinician, to address your culture and inclusion in your practice? Chapter 3: Primary Preventive Dental Concepts Dental Hygiene Dental hygiene: the practice of preventive oral health care and education provided by a dental hygienist • Includes: • • • • • assessment dental hygiene diagnosis planning Implementation, and evaluation. The practice of dental hygiene is inherent in the primary prevention of dental diseases You, as the dental leader, are ultimately responsible for the quality of dental hygiene services provided to your patients. Hygiene services are billed under the dentists’ NPIs in most states. Dental Hygiene vs. Dental Public Health Interdependent relationship Dental Public Health: • The science & art of preventing & controlling dental diseases & promoting dental health through organized, population-based approaches. • Serves the community as patients rather than individuals • It is a dental profession specialty for which residency is required. Did you know? Evidence-Based Care • Dental practice is based on independent research done by practitioners and scientists as reported in peer-reviewed journals. • • • • Fluoride Sealant ‘believers’ SDF and its role as a medicament Others Hygiene Process of Care Model • What are the most appropriate products and practices in preventive dental care? • Understanding the risk for oral diseases • Identifying risk factors Dental Hygiene Appointment • Provides patient services that support total health through the promotion of optimal oral health. • May include: - assessments, diagnoses, preventive oral prophylaxis, therapeutic scaling and root planing, periodontal debridement, education and counseling, preventive and therapeutic modalities, and/or supportive care. Assessment Assessment • Systematic collection and analysis drive appropriate care plans • Identifies individual patient needs • Allows recognition of deviations from health  CDT  ADA’s set of codes and definitions of dental procedures  Billing codes  Not to drive hygiene treatment recommendations       Comprehensive Oral Evaluation (COE – D0150) - Establishes a baseline Periodic Oral Evaluation (POE – D0120) - Established dental patient to determine changes Health & Dental History Vital Signs Extraoral/Intraoral Evaluation Dental/Periodontal Evaluation Diagnosis The determination of the nature of disease made from the study of the signs and symptoms. Most common - Dental caries and periodontal disease Dental Hygiene Diagnosis • Necessary for the development, implementation, and evaluation of the dental hygiene treatment plan • Derived by the hygienist using information from the assessment • Specificity that implies the treatment is limited to that which can be accomplished by qualified and licensed hygienists Patients should be informed Planning • Dental hygiene therapy must be determined along with the establishment of realistic patient goals. • The dental hygiene care plan serves as a component of the dental treatment plan (Figure 3–3). • It should be unique Implementation • • • Occurs when treatment begins. Includes preparing the operatory for the treatment, using proper infection control procedures, and selecting the materials, instruments, and equipment to be utilized. The treatment is then performed by providing oral prophylaxis, pain management, periodontal debridement, patient instruction, selective coronal polishing, and/or other procedures identified in the planning phase (Figure 3–4). 50 to 60-minute patient encounter 1. 2. 3. 4. Assessment (15 minutes) Diagnosis/planning/implementation (30 minutes) Evaluation (5 minutes) Disinfection (10 minutes, pre-COVID) Evaluation • Outcomes-focused & Patient-centered • Are modifications needed to the previously defined strategies? • Continuous over the patient’s life span • Dentistry is a relationship-based profession. Is that different from medicine, and if so how? Dental Public Health The American Board of Dental Public Health (ABDPH) Dental Public Health The goal of public health is to protect and promote the health of the public across three essential domains: health protection, disease prevention and health promotion Population Assessment Tools ….a primer for Dental Public Health Cancer Registries Vital Statistics Clinical Surveys › › › › › NHANES - NCHS BSS - ASTDD MEPS NSCH & NSCHC NHIS Nonclinical Oral Health Surveys › NOHSS NOHSS Oral Health Indicators 1. Dental visit: adults aged 18+ who have visited a dentist in the last year 2. Teeth cleaning: Adults aged 18+ who have had their teeth cleaned in the past year (among 3. 4. 5. 6. 7. 8. 9. that with natural teeth and have visited a dentist) Complete tooth loss: Adults aged 65+ who have lost all natural teeth due to decay or gum disease Loss of six or more teeth: Adults aged 65+ who have lost teeth due to decay or gum disease Fluoridation status: Percentage of people served by public water systems who receive fluoridated water Dental sealants: Percentage of third grade students with sealants on at least one permanent molar tooth Caries experience: Percentage of third grade students with caries, treated and untreated Untreated tooth decay: Percentage of third grade students with untreated caries Oral cavity and pharynx cancer: incidence and mortality rates, survival rates, and stage at dx for oral and pharyngeal cancer. Did you know? Population-Based • • • • Diagnosis - generalized Planning – how and how to measure effectiveness Implementation Evaluation – Is the program successful Summary • Assessment, diagnosis, planning, implementation, and evaluation are the essential • • • elements of the dental hygiene process of care A successful practice that prioritizes preventive dentistry has a strong dental hygiene team. Knowledge of your community’s oral health status better positions your leadership role in the healthcare system. Hygiene care is a partnership.