Bobbi Jo Muto, MPH, RDH

Gina Sharps, MPH, RDH

Marsha Delancey, RDH

Oral Health Care for People with Diabetes

Marshall University Oral Health Team

AKA The “Toothfairies”

The Toothfairy Team Mission

• Gain fundamental knowledge regarding the relationship between oral health care and diabetes

• Participants will review guidelines and recommendations for

inclusion of oral health messaging into existing diabetes education

• Participants will initiate work on a draft work plan delineating oral health as part of coalition deliverables

• Participants will learn about resources available to them.

Today's Objectives:

Name that Smile!

And you are…???? Name, State

Role within the Coalition

Professional Affiliation and

Experience with oral health (Personal and Coalition)

What’s Your Dental I.Q.?

Answers

“One proven strategy for reaching

individuals at high-risk for dental disease

is” supporting linkages with health care

professionals and other dental partners in

the community”

Grant Makers in Health Issue Dialogue.. (2001, May). Filling the Gap: Strategies for Improving Oral Health. Issue Brief.

Oral Health Problems: A Response

A Healthy Mouth= Healthy You

Oral Health 101

Highlights from the US Surgeon

General’s Report

• Oral health is integral to general health.

• Oral diseases and disorders affect health and well-being throughout life.

• The most common dental diseases (dental cavities and periodontal disease) are PREVENTABLE.

Source: U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General

Highlights from the US Surgeon General’s Report

• Oral Infection is associated with Diabetes, Heart Disease, Stroke, Bacterial Endocarditis, Respiratory Disease and adverse Birth Outcomes

• Psycho-Social Implications: Reduced Self-Esteem, Job eligibility

Oral Health 101

Untreated Dental Disease Can Lead to…. •Extreme Pain

•Spread of Infection

•Difficulty chewing, poor

nutrition, below average weight

•Costly dental treatment

•Additional decay and malocculsion

•Missed School Days/Missed Work Days

•Impaired Speech development

•Reduced Self-esteem

Additional Consequences of Dental Caries

From Healthy to Disease

Healthy Diseased

Gum Disease: Warning Signs

Warning Signs and Symptoms

• Bleeding gums when you brush or floss is not normal; even if your gums don’t hurt, get them checked

• Red, swollen, or tender gums

• Gums that have pulled away from teeth making teeth appear longer

• Pus between the teeth and gums

• Bad breath

• Teeth that are loose or moving away from each other

• Changes in the way you bite

• Changes in the fit of partials, dentures, or bridges

What Does the Research Say ?

• 75% of all adults have at least the early stages of gum disease.

• Children and teens who have diabetes are at a greater risk of developing dental problems than those who don’t have diabetes.

• People who have diabetes are twice as likely to develop gum disease. Poor blood glucose control makes gum problems more likely.

Dental Plaque - What Is It?

• Plaque is a sticky film of food, saliva, and germs.

• Plaque loves to settle at the gum line.

• The goal of your daily tooth brushing and flossing is to clean away plaque.

• When plaque is not removed, it hardens into tartar.

How Many Microbes? (per square centimeter)

Forehead 1 million

Mouth 1 billion

Colon 1 to 100 billion

Feet 10 million

Armpits 1 to 10 million

Hands 2 million

Dental Plaque - What Does It Look Like?

• If plaque and tartar are not cleaned away, even gentle brushing can cause your gums to bleed. This is called ________.

• This is the first stage of gum disease.

• If you ignore gingivitis, it does get worse! It does not go away on its own.

Dental Plaque - What Does It Do?

From Gingivitis to Gum Disease •Bacteria multiply and multiply and multiply some more. •Gums separate from the teeth, forming pockets. •Often, this destructive process has very mild symptoms. •Eventually, teeth become loose, leading to extractions.

Transmission of Gum Disease

Bacteria that cause gum disease can pass through your saliva.

What does this mean?

Brainstorming Session #1

Incorporating Oral Health Into Your Coalitions Activities?

When & Timeframe

Targeted Population- Childs/Adults/Seniors

Health Fair, Screenings, Education

Resources- Free, In-kind, Other

LUNCH BREAK

Welcome Back

Quick Review of Morning Session

• Oral Health is a critical part of overall health and well being

______ % of Adults have periodontal disease ?

Name a sign or symptom of gum disease.

Etiology of Dental Decay

BACTERIA

• Frequency of sugar ingestion is just as important than quantity

• Acids produced by bacteria after sugar intake persist for up to 20 minutes

TOOTH

FOOD

DECAY

Danger Zone

Acid Production

Safe Zone

Breakfast Snack Snack Lunch Snack Dinner Snack

Not just what you eat but

how often you eat

Do you really know how much sugar is in your food?

CHECK FOOD LABELS

Oral Environment

pH or Acidity Coca-Cola Classic 2.53

Pepsi 2.49

Mountain Dew 3.22

Gatorade 2.97

Nestea Iced Tea 3.04

Enamel dissolution 5.50

Saliva 6.30

Baking soda 9.00

Bleach 14.0

Dry Mouth

• Diabetes is one disease that can cause dry mouth.

Saliva • Bathes gum tissues (keeps

them moist)

• Lubricates and breaks food down for digestion

• Prevents tooth decay by washing away food debris/particles

• Limits oral bacterial overgrowth

• Strengthens teeth with its protein

• The protein in saliva called is anti-inflammatory, anti-viral, anti-fungal and anti-bacterial)

Do You Have Dry Mouth?

• Does your mouth feel dry when eating?

• Are dry foods (crackers, dry toast) difficult for you to eat?

• Do you feel a burning or sticky sensation on your tongue?

• Do you often sip liquids or suck on candies throughout the day?

• Do you wake up to drink liquids through the night?

• Is chewing or swallowing difficult?

• Do you breathe through your mouth?

• Does your saliva feel thick, ropey, or even non-existent?

The Magical Properties of Saliva

It’s time to get your SCIENCE on!!!

How To Prevent Gum Disease

• Use a soft toothbrush.

• Angle the brush against the gum line.

• Brush in little circles and then brush down.

• Brush 2 teeth at a time.

• Brush the gums.

• Change your toothbrush every _____ months.

• Use an electric toothbrush if possible.

• Make and keep dental visits (especially cleaning appointments).

Proper Brushing Technique

How Do You Floss ?

• Never snap the floss between your teeth.

• Use a sawing motion to get the floss in between the teeth.

• Take the floss in a C-shape against the tooth and especially underneath the gum.

• Try Glide floss if teeth are hard to floss.

• If you have arthritis or trouble using your fingers try a floss holder, electric flosser, Easy-Slide, or Satin Floss.

Diabetes and The Dental Visit

If you’ve been diagnosed with gum disease your preventive appts may be 3 months or 6 months

When scheduling a dental visit a person with diabetes should remember to:

► tell your dentist and dental hygienist you have diabetes.

► ask for a time when your blood glucose level is in a normal range and your diabetes medicine action is low.

Let’s Review: Recommendations

• Learn how gum problems start.

• Brush your teeth twice a day and your tongue.

• Floss your teeth every day.

• Look for early signs of gum disease.

• Visit your dentist and dental hygienist at least twice a year.

• Chew gum containing Recaldent four times daily (Trident Xtra Care)

• Chew gum containing xylitol four times daily

• Reduce snacking frequency between meals

Practical Tips • Avoid caffeine-containing beverages, alcoholic beverages,

and mouthwashes with alcohol.

• Sip water throughout a meal to help moisten the food.

• Chew sugarless gum or use sugar-free candies to help stimulate salivary flow (sugar-free lemon products are especially effective).

• Use an electric toothbrush (controls bacteria better and stimulates saliva production).

• Use a saliva substitute.

References and Sources

• National Institute of Dental and Craniofacial Research

• Crest (www.dentalcare.com)

• Colgate

• National Institute of Health

• American Dental Association

• Academy of Periodontology

• American Diabetes Association

• U.S. Department of Health and Human Services

Incorporating Oral Health into Your Coalition

Activities & Work Plan

Potential Strategies To Incorporate Oral Health into your ARC Diabetes

Grant/Work Plan

-Dining with Diabetes-WV

-Invited Dental Profession at Coalition Meetings

-Develop a Dental Referral Catalog

-Health Fairs-ensure dental representation

-Educational Outreach

-Health Care Providers, Community, Members

-Others

Possible Barriers • Oral health care is absent from the radar screen of the

Primary Care Provider.

• Oral health care is not a priority for the Primary Care Provider.

• There is confusion about the role of the Primary Care Provider in oral health care.

• There is no reimbursement model to support the Primary Care Providers needed role in oral health care.

• Others

Developing a Work Plan LET'S GET TO WORK!!!!!

* Goals for Work Plan Breakout:

1) Identify your target population-identify needs of your population-what are the recommended interventions for your population

-A point person in your coalition, who will take on the oral health piece, and serve as a liaison to our partners at the state level.

2) Discuss what type of activities you would like to accomplish over the next year i.e. guest speaker at coalition meeting, establishment of a referral system to dentists in your local community, etc

Writing a Work Plan

• For each objective do a brainstorm of all the things that your coalition could do to meet this objective. Use a flip chart to write all of the ideas from the group. This will give you a long list of activities that could be done.

• Decide on the priority activities. Start by putting the ideas on the flip chart in chronological order. What is the first step? What’s next? Weed out non-essential activities. For example: ideas that don’t fit; things that you may not have time to do; activities that you can skip over and still meet the objective. Keep your plan as simple as possible!

• Add dates to the activities. Think about the effects of the seasons, school schedules, etc. Take advantage of activities that already occur such as health fairs, county fairs, football games, etc.

• Use the work plan form on the next page to pull together your goals, measurable objectives and action steps into one document.

Chomp Time! Let’s hear from you …..

• AppalachianDiabetesCoalitions.org