for Registered Nurses for Registered Nurses

Oral Health Screening TrainingOral Health Screening Training for Registered Nursesfor Registered Nurses

Georgia Oral Health Prevention Program

““YouYou’’re re not healthy without good oral healthnot healthy without good oral health””Surgeon General 1982-1989:

C. Everett Koop, MD

“Tooth decay is currently the single most common chronic childhood disease –

5 times more common than asthma……

The burden of disease restricts activities in school, work, and home, and often diminishes

the quality of life.”

“Oral health must bea critical component

of the provision of health care and the design of community programs.” Surgeon General’s Report on Oral Health:

May 2000, S.G. David Satcher, M.D., Ph.D.

The mouth is a mirror of general health, wellThe mouth is a mirror of general health, well--being.being.

•Diagnostic role•Barrier, as well as portal, for infections •Additional diagnostic potential of saliva, buccal mucosa, and other oral components

ObjectivesObjectives

I. Oral Health Screening– Recognize normal from abnormal– Classify the screening– Refer appropriately– Know who can perform OH screening in GA

II. Dental Emergencies– Recognize common dental emergencies– Respond appropriately

Note: **An oral health screening is not a diagnosis and does not take the place of regular dental care.

REGISTERED NURSES ROLE IN ORAL HEALTH SCREENING

GREENGREEN

YELLOWYELLOW

REDRED Stop

Caution

Go

ORAL HEALTH SCREENING: Classify the Patient

REDRED -- EMERGENCY– Immediate dental

care

YELLOWYELLOW -- Caution– Early dental care

needed– Non-urgent

preventive

GREENGREEN –– Go -Routine care

•• Pain, infectionPain, infection, swelling, , swelling, ulceration > 2 wks durationulceration > 2 wks duration

•• Cavities Cavities w/ow/o Pt. complaintPt. complaint-- spontaneous bleeding, spontaneous bleeding, suspicious white or red soft suspicious white or red soft tissue lesions, poor fitting tissue lesions, poor fitting appliancesappliances

•• Normal, No Apparent NeedNormal, No Apparent NeedNo obvious problemsNo obvious problems–– Continue regular careContinue regular care

Good Oral Health is for Everyone

Recognize Normal From Abnormal

Clinical Dental Examination Diagnostic – Treatment Planning Form

To be completed by a licensed dentist

Georgia Department of Human Resources CERTIFICATE of EAR, EYE AND DENTAL EXAMINATIONSTO BE FILED WITH SCHOOL AT TIME OF CHILD’S ENROLLMENT

This is to certify that the child identified here has received or been excused for special or provisional reasons from receiving EXAMINATIONS, TESTS or INSPECTIONS.

CHILD’S NAME First Middle Last DATEMo. Day

OF BIRTH

Yr.

SEX LOCAL RESIDENCE (Street & Number, P.O. Box, Route, Etc.) SCHOOL

Male Female CITY STATE & ZIP CODE COUNTY RACE

White Black Other

PARENT’S NAME ADDRESS (Street or R.F.D. No., City or Town, State)

EYE-VISION

Screening Test Passed Needs Further Professional Examination Special Certificate Provisional Certificate

Examination Done By

County Health Volunteer Organization Private Practitioner

Date

Examiner’s Signature Title

EAR-HEARING

Screening Test Passed

Needs Further Professional Examination Special Certificate Provisional Certificate

Examination Done By

County Health Volunteer Organization Private Practitioner

Date

Examiner’s Signature Title

DENTAL Normal Appearance (Green)

Needs Further Professional Examination (Yellow) Emergency Observed Problem (Red)

Special Certificate Provisional Certificate

Examination Done By Public Health: Dentist, Hygienist, PH/School R.N. Private Practitioner: Dentist, Physician

Date

Examiner’s Signature Title

Form 3300 (Rev. 6-98)

FOR INFORMATION: CONTACT YOUR COUNTY HEALTH DEPARTMENT, OR YOUR PRI-VATE PRACTITIONER

FOR INSTRUCTIONS: SEE REVERSE SIDE OF THIS PAGE.

http://health.state.ga.us/programs/oral/publications.asphttp://health.state.ga.us/programs/oral/publications.asp

Screening data reporting form for assessments by registered nurses. Please fax or mail to your health district dental contact found at http://health.state. ga.us/pdfs/family health/oral/oralhe althcontacts.pdf

PRIMARY ERUPTION SCHEDULE

20 Primary (Baby) Teeth

PERMANENT ERUPTION SCHEDULE

Who can perform an oral health screening in GA?

•• Georgia licensed Dentists, Dental Georgia licensed Dentists, Dental Hygienists, Physicians, or Registered Hygienists, Physicians, or Registered NursesNurses

• Not Dental Assistants or LPNs• Not lay persons who are trained

“Lift the Lip and Take A Look”Parent’s Position

Lift the Lip

Knee to Knee Position

Check for normal healthy teethWHAT TO LOOK FOR

Definition of tooth decay:Definition of tooth decay:• ½ mm loss of enamel

• Staining of walls might not be present in young children (at cervical 1/3 might not be present)

• Broken/chipped teeth with visible decay

• Retained roots of decayed teeth

• Temporary fillings presentLook for Normal or Abnormal when screening.Look for Normal or Abnormal when screening.

White Spots LesionsWhite Spots Lesions 6 Max Anterior teeth at cervical 1/3 of tooth only (gum line) - w/ or w/o break in enamel or staining “at risk for ECC”

Early Childhood Caries (ECC)Early Childhood Caries (ECC) (< age 6: ) Any decayed, filled or missing tooth due to caries Severe ECC: *At least 1 of 6 maxillary anterior teeth decayed, filled or missing due to caries

Rampant DecayRampant Decay Treated or untreated decay on > 7 teeth (>age 5)

* Definition of ECC used for statewide surveys

Check for early signs of ECC: White Spot LesionsWhite Spot Lesions Identifies children at risk for ECC or Rampant Decay

WHAT TO LOOK FOR

Check for later signs of ECC: brownbrown areasWHAT TO LOOK FOR

Check for advanced severesevere ECCWHAT TO LOOK FOR

SMOOTH SURFACE DECAY

RED RED YELLOW YELLOW GREENGREEN

PIT & FISSURE DECAY

RED RED YELLOW YELLOW GREENGREEN

TOO MUCH FLUORIDE

Can cause fluorosis

Goal is to recognize Normal and Abnormal Goal is to recognize Normal and Abnormal when screeningwhen screening

SEALANT: BEFORE and AFTER

RED RED YELLOW YELLOW GREENGREEN

Flat, dark grey/black, asymptomatic, unknown duration.Amalgam tattoo.

http://www.oralcancerfoundation.org/

Clinical Diagnosis = Multifocal, Nodular LeukoplakiaMicroscopic Exam = Well Differentiated Squamous Cell

Carcinoma.

Clinical Diagnosis = Erythroplakia (red) Microscopic Examination = Squamous Cell Carcinoma

EXTENSIVE DENTAL DECAY

– RAMPANT (>7 TEETH)

RED YELLOW GREEN

DENTAL ABSCESS A localized collection of pus, formed by tissue

disintegration and surrounded by an inflamed area.

RED RED YELLOW YELLOW GREENGREEN

Abscess (circumscribed area of pus)and Fistula (an abnormal passage directing or draining pus to

surface)

Recent Electrical Burn

Laceration of Tongue

Injury to Primary Incisor

Fractured Primary Tooth

1- 3 million teeth/yr in US, mostly young children > 90% can be saved

Re-implant 15-30 min > 90% chance retained for life. Practical experience indicates this may be unrealistic.

Place in cold milk, Place in cold milk, isoiso saline, water, or saline, water, or saliva saliva -- Refer to dentist ASAP.Refer to dentist ASAP.

What to What to do...do... Fights,

Sports Injuries, Accidents

Screen & ReferScreen & Refer•• RedRed, YellowYellow and GreenGreen

– Red: Emergency Care - immediately – Yellow: Early Care -as soon as possible,

within 1-3 months– Green: Routine Care – every 6 months

• Medicaid/PeachCare, Community DDS, Public Health Providers

(678) 578-2920 (client line) 1-800-982-4723 if outside of metro Atlanta

(678) 578-2931 (provider toll-free) 1-888-473-2444 if outside of metro Atlanta

Monday–Friday 8:30 AM- 4:30 PM

GEORGIA PARTNERSHIP FOR CARINGhttp://www.gacares.org/how_to_qualify.htm

The Healthy Mothers, Healthy Babies Coalition of GAPower Line. Metro Atlanta 770-451-5501

Statewide 800-822-2539 http://www.hmhbga.org/index.html

Select “Resources” - has links to Medicaid/PeachCare health plans & providers: Amerigroup | PeachState | Wellcare

DENTAL PROVIDER REFERRAL RESOURCES

To locate a Medicaid or PeachCare Dental Provider go to the Georgia Health Partnership web site at

https://www.ghp.georgia.gov/ and

select “Provider Information”

Under “Find Health Care Resources”Select “Search for Medical Services”

Enter your city, state & zip code,Click on “Select Specialty” in the blue box

Choose “D-G” from the alphabetical list at the bottom of the page to search for “Dental”

Check the “Dentistry, General Practice” box, Click on “Select Specialty” in the blue box,

you will be returned to the address entry screen

Click on “Select Organization” in the blue box

Choose the insurance organization that provides your coverage;

Then click on “Select Organization” in the blue box

Peach State-Atlanta is used for illustration only

Select the number of miles of radius you are willing to travel, Click on “Search” in the blue box

A list of dental providers who accept your insurance is displayed.

List of Public Health Dental Providers for each health district.

http://health.state.ga.us/programs/oral/index.asp

http://http://health.state.ga.us/programs/oral/index.asphealth.state.ga.us/programs/oral/index.asp