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Pneumonia in dependent adults is pervasive. Many are suffering needlessly because their oral health is contributing to all respiratory diseases. Dental hygienists in most states are unable to care for these people without a prescription from a dentist. It's an unnecessary hurdle.
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Pneumonia
Oral biofilm management for
health
1998
Average cost for people over age 65 with community acquired pneumonia is $7166.
Clin Ther. 1998 Jul-Aug;20(4):820-37.The cost of treating community-acquired pneumonia.
2004
Roughly 915,900 cases of community-acquired pneumonia occur annually among seniors in the United States.
2004
Approximately 1 of every 20 persons aged 85 years or over will have a new episode of community-acquired pneumonia each year
2006There is good evidence to show that improved oral hygiene and frequent professional oral health care reduces the progression or occurrence of respiratory diseases among high-risk elderly adults living in nursing homes…
J Periodontol. 2006 Sep;77(9):1465-82.Systematic review of the association between respiratory diseases and oral health.
Immunocompetent Seniors
cardiopulmonary disease
poor functional status
low weight
recent weight loss
Higher risk for Community-Acquired Pneumonia
cardiopulmonary disease
poor functional status
low weight
recent weight loss
Nursing Home Acquired Pneumonia
30-day mortality rates ranging from 10 to 30%
A study looking at the charts of 528 persons with NHAP transferred to acute hospitals for treatment found that advance directives were present only 6.4% of the time.
Given the high 1-year mortality rate forNHAP, clinicians caring for nursing home residents should make it a priority to ensure that advance directives are in place. These should be readily available to help with the decision on whether or not the residentshould be transferred to a hospital, and must also accompany the patient to the acute care facility.
You know when you hear it.
All Due to Biofilm
Typical bacterial pathogens
Streptococcus pneumoniae (penicillin-sensitive and-resistant strains)
Haemophilus influenzae (ampicillin-sensitive and -resistant strains) Moraxella catarrhalis (all strains penicillin-resistant).
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Typical bacterial pathogens attributed to pneumonia
The airway is very close to the mouth – ahem.
Mouth
Lungs
Montana State University Center for Biofilm Engineering used with permission
2005
Calculation of population-based attributable fractions showed that 21% of all cases of pneumonia in our cohort could have been avoided if inadequate oral care and swallowing difficulty were not present.
~ $15,000Per person with NHAP
Contributing to Nursing Home Acquired Pneumonia
Poor oral hygiene
Difficulty swallowing Bedridden
Dementia Diabetes
Contributing to NHAPThese two can be addressed by a licensed
dental hygienist
Poor oral hygiene
Difficulty swallowing Bedridden
Dementia Diabetes
A dental hygienistassisting with oral care can
save thousandsof dollars.
To Summarize
10 to 30
Out of 100,000 people
17%
$15 – 20,000 per
case
21% NHAP can be
avoided with oral
care
Conclusion
Pneumonia is expensiveOral care can decrease incidence by 20%Nursing home acquired pneumonia leads to death.
ConclusionDental hygienists cannot work in Long Term Care facilities unless there is also a dentist there to “oversee” them.
Dental hygienists risk their license if they brush someone’s teeth without a prescription by a dentist to do so.
Call to Action
Find out the limitations of dental hygienists in your state.
Strive for a mandate that all Long Term Care Facilities funded by Medicaid have an independent dental hygienist as the Director of Dental Hygiene, a DDH.
Credits
PowerPoint designed by Cross Link Presentations, LLC
Presentation designShirley Gutkowski, RDH, BSDH, FACE
ScriptShirley Gutkowski, RDH, BSDH, FACE
Photos: Dreamstime, Gutkowski, StoneImages: Montana State University Center for Biofilm EngineeringCharacters: PresenterMedia
Copyright 2011 Exploring Transitions, LLC