Oral Health Awareness and Disease Prevention Session 3 - Partnerships

1. Oral Health Awareness and Disease PreventionSession 3 - Partnerships Judy Skelton, RDH, PhD University of Kentucky College of Dentistry

2. KY CARATKentucky – ConsortiumforAppliedOral HealthResearch andTreatment

3. Purposes • provide an infrastructure for educating dental professionals • provide state-of-the-art clinical care of patients in these communities • enable the development of outreach research capabilities in rural regions of the Commonwealth.

4. Purposes (cont.) • provide an economic impact by: • decreasing expenditures for “major/heroic” oral health care of children and adults • focusing oral health dollars for regional implementation of preventive and early intervention strategies • providing an economic stimulus to the regional sites through creation of jobs • increasing oral health care access, thus broadening the participation and generating a new funding base that remains and/or flows into the regions.

5. Collaborating Sights • Center for Oral Health Research at the University of Kentucky in Lexington (Central Kentucky) • The Center for Rural Health in Hazard, KY • Mountain Comprehensive Health Corporation facility in Whitesburg, KY (Eastern Kentucky) • St. Clair Hospital in Morehead, KY (Northern Kentucky) • Trover Foundation in Madisonville, KY (Western Kentucky)

6. Areas of Focus • Preterm low birth weight babies • Early childhood caries • Diabetes and oral disease link

7. Preterm Low Birth Weight Babies • The rate of preterm/low birth weight (PTLBW) infants in the U.S. has not significantly decreased during the last 3 decades • Spontaneous preterm births account for 10% of all live births in the US and is a predominant cause of perinatal morbidity and mortality • These rates tend to be highest in underserved rural populations

8. Preterm Low Birth Weight Babies • Cost to the government between $1.4 and $2.6 billion annually in Medicaid and Aid to Families with Dependent Children • It is estimated that an additional $6.4 to $12 billion dollars cost to society as a result of both short term and long term care • In Kentucky >5,000 PTLBW occur annually with an estimated acute care cost of nearly $40,000/birth

9. Oral Health and PTLBW • periodontal (gum) disease has been implicated as a contributing factor to an increased incidence of PTLBW • periodontal infection periodontal pathogens low-level, chronic bacteremia release of chemical mediators cross placenta initiate labor

10. Oral Health and PTLBW • Periodontal disease is preventable and treatable • Cost to maintain periodontal health is minimal when compared to the costs attributed to negative birthing outcomes • The potential reduction of cost to society, impact on family structure, and prevention of disease related to preterm birth validate the need to clarify the association between periodontal disease and preterm birth

11. Centering Pregnancy™ • routine, individually-based prenatal care is abolished • replaced by a system that provides complete prenatal care to groups composed of 8-10 women of similar gestational age • incorporates the three components of prenatal care – risk assessment, education, and support – in a unified format

12. Centering Pregnancy™ • encourages the women to take responsibility for their own health • at each visit, standard prenatal risk assessment is followed by an educational session using a discussion format • free exchange among the group members is encouraged

13. Centering Pregnancy™ • an atmosphere of mutual support is developed • more efficient and cost effective • additional peer-support occurring within these maternal networks

14. Centering Pregnancy™ with Smiles • Adaptation of the Centering Pregnancy model • Designed to create an integrated oral/medical health education and an intervention model

15. Centering Pregnancy™ with Smiles • Integrated educational units • Treatment to control oral infections • Self-assessment of oral diseases

16. Centering Pregnancy™ with Smiles • Oral diseases • Plaque control and disease prevention • Relationship of nutrition & oral health • Oral anatomy and eruption patterns • Maintaining baby’s oral health

17. Early Childhood Caries

18. Early Childhood Caries (ECC) • active dental decay in children up to 72 months of age • devastating impact on the early development of children • decreases in learning potential and • decreases in socialization • increased general health needs • substantial risk for long-term dental problems

19. Kentucky Statistics • 46.8% of kids 2-4 yrs of age had ECC in the 2001 KY Children's Oral Health Survey • estimated annual cost for reactive urgent and emergency care for these children is >$15,000,000.

20. SOKiT™Save our Kids Teeth • target new mothers attending Women, Infant, and Children (WIC) Clinics at health departments • establish clearly the exact magnitude of ECC in the targeted rural communities • evaluate a combined behavioral and fluoride varnish approach for decreasing ECC incidence and severity

21. Project Design • enlist mothers and infants by 1 year old at multiple WIC clinics in each Ky-CARAT region. • randomized into 2 treatment groups: • mothers receive intense knowledge and behavioral education regarding ECC causes & prevention, plus the infant will receive 3 applications of fluoride varnish every 4 months for 1 year • the infants receive the fluoride varnish as in group 1, and mothers receive general oral health information.

22. Type II Diabetes Mellitus and Oral Health (formerly NIDDM now T2DM)

23. What is T2DM? • heterogenous metabolic disorder characterized by hyperglycemia = excess glucose in blood • demonstrate normal or elevated basal insulin concentrations • combined with insulin resistance and diminished tissue sensitivity to insulin • leads to impaired ß-cell function in the immune response

24. More about T2DM? • T2DM is usually diagnosed after the age of 30 years • Frequently observed as part of a multifaceted syndrome that includes • obesity • hypertension • dyslipidemia • atherosclerotic cardiovascular disease

25. Kentucky in 2003 • estimated 8.5% or 267,000 adults in Kentucky diagnosed with diabetes • estimated that 29% or 109,000 adults are undiagnosed • totaling approximately 376,000 (or 1 in 8) adults Kentuckians have diagnosed or undiagnosed diabetes • Kentucky ranks 7th (tied with two other states) in the nation for the highest percentage of the adult population diagnosed with diabetes.

26. Diabetes byArea Development District

27. The Costs of Diabetes • Direct cost (medical care) and indirect cost (lost of productivity and premature mortality) of diabetes in Kentucky totaled approximately $2.9 billion in 2002 • Diabetes is the 6th leading cause of death in Kentucky

28. Diabetes – PeriodontalDisease Link • People with diabetes are at increased risk of getting periodontal disease. • Periodontal disease may make diabetes worse. Periodontal disease Type 2 diabetes glycemic control

29. How diabetes effects gum disease • blood vessel thicken which impairs the efficiency of the flow of nutrients and removal of wastes from body tissues making them more susceptible to infection, gums included • if diabetes is poorly controlled, higher glucose levels in the mouth fluids will encourage the growth of bacteria that can cause gum disease.

30. Oral Complications of Diabetes • Microvascular disease • Xerostomia • Greater susceptibility of oraltissues to trauma • More opportunistic infections (e.g., candidiasis) • Greater risk of caries

31. Oral Complications of Diabetes • Greater risk of developing periodontal abscesses • Delayed healing • Peripheral neuropathy • Oral paraesthesia, including burning mouth or tongue • Altered taste sensations

32. How gum diseaseeffects diabetes • new research suggests that bacteria causing perio disease may enter the blood stream and activate cytokines • cytokines may destroy cells in the pancreas, where insulin is produced • potential interactions enhancing the morbidity of these two diseases has encouraged an increased interest in these relationships.

33. OBJECTIVEof KY CARAT Research To determine the effect of oral health education and periodontal therapy on measures of diabetic control in a rural adult population with Type 2 diabetics.

34. Project Design • The population will include 300 patients of record at the St. Claire Regional Medical Center with T2DM • Three matched groups (age, gender, time diagnosed): • Group 1 - provided an oral health screening, oral health education, and clinical intervention for periodontal infection and inflammation • Group 2 - provided an oral health screening and oral health education • Group 3 –control group.

35. Results and Benefitsof KY CARAT • Infrastructure development • Training • Research capacity • Healthier Kentuckians!!