Oral Health Oral Health Awareness and Awareness and

Disease PreventionDisease Prevention

Session 3 - PartnershipsSession 3 - Partnerships

Judy Skelton, RDH, PhDJudy Skelton, RDH, PhDUniversity of Kentucky College of DentistryUniversity of Kentucky College of Dentistry

KY CARATKY CARATKKentuckentuckyy – – CConsortiumonsortium forfor

AAppliedpplied Oral HealthOral Health RResearch esearch aandnd TTreatmentreatment

PurposesPurposes provide an infrastructure for provide an infrastructure for

educating dental professionalseducating dental professionals

provide state-of-the-art clinical care provide state-of-the-art clinical care of patients in these communitiesof patients in these communities

enable the development of outreach enable the development of outreach research capabilities in rural regions research capabilities in rural regions of the Commonwealth. of the Commonwealth.

Purposes Purposes (cont.)(cont.)

provide an economic impact by: provide an economic impact by: decreasing expenditures for “major/heroic” oral decreasing expenditures for “major/heroic” oral

health care of children and adultshealth care of children and adults

focusing oral health dollars for regional focusing oral health dollars for regional implementation of preventive and early intervention implementation of preventive and early intervention strategiesstrategies

providing an economic stimulus to the regional sites providing an economic stimulus to the regional sites through creation of jobsthrough creation of jobs

increasing oral health care access, thus broadening increasing oral health care access, thus broadening the participation and generating a new funding base the participation and generating a new funding base that remains and/or flows into the regions.that remains and/or flows into the regions.

Collaborating SightsCollaborating Sights Center for Oral Health Research at the Center for Oral Health Research at the

University of Kentucky in Lexington (Central University of Kentucky in Lexington (Central Kentucky)Kentucky)

The Center for Rural Health in Hazard, KYThe Center for Rural Health in Hazard, KY Mountain Comprehensive Health Corporation Mountain Comprehensive Health Corporation

facility in Whitesburg, KY (Eastern Kentucky)facility in Whitesburg, KY (Eastern Kentucky)

St. Clair Hospital in Morehead, KY (Northern St. Clair Hospital in Morehead, KY (Northern Kentucky)Kentucky)

Trover Foundation in Madisonville, KY Trover Foundation in Madisonville, KY (Western Kentucky) (Western Kentucky)

Areas of FocusAreas of Focus Preterm low birth weight babiesPreterm low birth weight babies

Diabetes and oral disease Diabetes and oral disease

linklink

Early childhood Early childhood

cariescaries

The rate of preterm/low birth weight (PTLBW) The rate of preterm/low birth weight (PTLBW) infants in the U.S. has not significantly infants in the U.S. has not significantly decreased during the last 3 decadesdecreased during the last 3 decades

Spontaneous preterm births account for 10% Spontaneous preterm births account for 10% of all live births in the US and is a of all live births in the US and is a predominant cause of perinatal morbidity predominant cause of perinatal morbidity and mortalityand mortality

These rates tend to be highest in These rates tend to be highest in underserved rural populationsunderserved rural populations

Preterm Low Birth Preterm Low Birth Weight BabiesWeight Babies

Cost to the government between $1.4 and Cost to the government between $1.4 and $2.6 billion annually in Medicaid and Aid to $2.6 billion annually in Medicaid and Aid to Families with Dependent ChildrenFamilies with Dependent Children

It is estimated that an additional $6.4 to $12 It is estimated that an additional $6.4 to $12

billion dollars cost to society as a result of billion dollars cost to society as a result of both short term and long term careboth short term and long term care

In Kentucky >5,000 PTLBW occur annually In Kentucky >5,000 PTLBW occur annually with an estimated acute care cost of nearly with an estimated acute care cost of nearly $40,000/birth$40,000/birth

Preterm Low Birth Preterm Low Birth Weight BabiesWeight Babies

Oral Health and Oral Health and PTLBWPTLBW

periodontal (gum) disease has been periodontal (gum) disease has been implicated as a contributing factor to an implicated as a contributing factor to an increased incidence of PTLBW increased incidence of PTLBW

periodontal infection periodontal infection

periodontal pathogens periodontal pathogens

low-level, chronic bacteremia low-level, chronic bacteremia release of chemical release of chemical

mediatorsmediators

cross placentacross placenta

initiate labor initiate labor

Oral Health and Oral Health and PTLBWPTLBW

Periodontal disease is preventable and Periodontal disease is preventable and treatabletreatable

Cost to maintain periodontal health is Cost to maintain periodontal health is minimal when compared to the costs minimal when compared to the costs attributed to negative birthing attributed to negative birthing outcomesoutcomes

The potential reduction of cost to The potential reduction of cost to society, impact on family structure, and society, impact on family structure, and prevention of disease related to prevention of disease related to preterm birth validate the need to preterm birth validate the need to clarify the association between clarify the association between periodontal disease and preterm birthperiodontal disease and preterm birth

routine, individually-based prenatal care is routine, individually-based prenatal care is abolishedabolished

replaced by a system that provides replaced by a system that provides complete prenatal care to groups composed complete prenatal care to groups composed of 8-10 women of similar gestational ageof 8-10 women of similar gestational age

incorporates the three components of incorporates the three components of prenatal care – risk assessment, education, prenatal care – risk assessment, education, and support – in a unified format and support – in a unified format

Centering Centering Pregnancy™ Pregnancy™

encourages the women to take encourages the women to take responsibility for their own healthresponsibility for their own health

at each visit, standard prenatal risk at each visit, standard prenatal risk assessment is followed by an assessment is followed by an educational session using a discussion educational session using a discussion formatformat

free exchange among the group free exchange among the group members is encouraged members is encouraged

Centering Centering Pregnancy™ Pregnancy™

an atmosphere of mutual support an atmosphere of mutual support is developedis developed

more efficient and cost effectivemore efficient and cost effective

additional peer-support occurring additional peer-support occurring within these maternal networks within these maternal networks

Centering Centering Pregnancy™ Pregnancy™

Adaptation of the Centering Adaptation of the Centering Pregnancy model Pregnancy model

Designed to create an integrated Designed to create an integrated oral/medical health education oral/medical health education and an intervention model and an intervention model

Centering Centering Pregnancy™ Pregnancy™ with Smileswith Smiles

Integrated educational unitsIntegrated educational units

Treatment to control oral Treatment to control oral

infectionsinfections

Self-assessment of oral diseasesSelf-assessment of oral diseases

Centering Centering Pregnancy™ Pregnancy™ with Smileswith Smiles

Oral diseasesOral diseases Plaque control and disease preventionPlaque control and disease prevention Relationship of nutrition & oral healthRelationship of nutrition & oral health Oral anatomy and eruption patternsOral anatomy and eruption patterns Maintaining baby’s oral healthMaintaining baby’s oral health

Centering Centering Pregnancy™ Pregnancy™ with Smileswith Smiles

Early Childhood CariesEarly Childhood Caries

Early Childhood Caries Early Childhood Caries (ECC)(ECC)

active dental decay in children up to active dental decay in children up to 72 months of age 72 months of age

devastating impact on the early devastating impact on the early development of childrendevelopment of children decreases in learning potential and decreases in learning potential and decreases in socializationdecreases in socialization increased general health needs increased general health needs

substantial risk for long-term dental substantial risk for long-term dental problems problems

Kentucky Statistics Kentucky Statistics 46.8% of kids 2-4 yrs of age had ECC 46.8% of kids 2-4 yrs of age had ECC

in the 2001 KY Children's Oral Health in the 2001 KY Children's Oral Health SurveySurvey

estimated annual cost for reactive estimated annual cost for reactive urgent and emergency care for these urgent and emergency care for these children is >$15,000,000. children is >$15,000,000.

SOKiT™SOKiT™Save our Kids Teeth Save our Kids Teeth

target new mothers attending Women, target new mothers attending Women, Infant, and Children (WIC) Clinics at Infant, and Children (WIC) Clinics at health departmentshealth departments

establish clearly the exact magnitude of establish clearly the exact magnitude of

ECC in the targeted rural communitiesECC in the targeted rural communities

evaluate a combined behavioral and evaluate a combined behavioral and fluoride varnish approach for decreasing fluoride varnish approach for decreasing ECC incidence and severityECC incidence and severity

Project DesignProject Design enlist mothers and infants by 1 year old enlist mothers and infants by 1 year old

at multiple WIC clinics in each Ky-at multiple WIC clinics in each Ky-CARAT region. CARAT region.

randomized into 2 treatment groups: randomized into 2 treatment groups: mothers receive intense knowledge and mothers receive intense knowledge and

behavioral education regarding ECC behavioral education regarding ECC causes & prevention, plus the infant will causes & prevention, plus the infant will receive 3 applications of fluoride varnish receive 3 applications of fluoride varnish every 4 months for 1 yearevery 4 months for 1 year

the infants receive the fluoride varnish as the infants receive the fluoride varnish as in group 1, and mothers receive general in group 1, and mothers receive general oral health information. oral health information.

Type II Type II Diabetes Diabetes Mellitus Mellitus and Oral and Oral HealthHealth

(formerly NIDDM now T2DM)(formerly NIDDM now T2DM)

What is T2DM?What is T2DM? heterogenous metabolic disorder heterogenous metabolic disorder

characterized by hyperglycemia = characterized by hyperglycemia = excess glucose in bloodexcess glucose in blood

demonstrate normal or elevated basal demonstrate normal or elevated basal

insulin concentrations insulin concentrations

combined with insulin resistance and combined with insulin resistance and diminished tissue sensitivity to insulindiminished tissue sensitivity to insulin

leads to impaired ß-cell function in the leads to impaired ß-cell function in the

immune responseimmune response

More about T2DM?More about T2DM?

T2DM is usually diagnosed after the T2DM is usually diagnosed after the age of 30 yearsage of 30 years

Frequently observed as part of a Frequently observed as part of a

multifaceted syndrome that includes multifaceted syndrome that includes obesityobesity hypertensionhypertension dyslipidemiadyslipidemia atherosclerotic cardiovascular disease atherosclerotic cardiovascular disease

Kentucky in 2003Kentucky in 2003 estimated 8.5% or 267,000 adults in Kentucky estimated 8.5% or 267,000 adults in Kentucky

diagnosed with diabetesdiagnosed with diabetes

estimated that 29% or 109,000 adults are estimated that 29% or 109,000 adults are undiagnosedundiagnosed

totaling approximately totaling approximately 376,000 (or 1 in 8)376,000 (or 1 in 8) adults Kentuckians have diagnosed or adults Kentuckians have diagnosed or undiagnosed diabetesundiagnosed diabetes

Kentucky ranks 7th (tied with two other states) Kentucky ranks 7th (tied with two other states)

in the nation for the highest percentage of the in the nation for the highest percentage of the adult population diagnosed with diabetes. adult population diagnosed with diabetes.

Diabetes byArea Development

District

The Costs of DiabetesThe Costs of Diabetes

Direct cost (medical care) and indirect Direct cost (medical care) and indirect

cost (lost of productivity and premature cost (lost of productivity and premature

mortality) of diabetes in Kentucky mortality) of diabetes in Kentucky

totaled approximately totaled approximately $2.9 billion$2.9 billion in in

2002 2002

Diabetes is the 6th leading cause of Diabetes is the 6th leading cause of

death in Kentuckydeath in Kentucky

Diabetes – PeriodontalDiabetes – PeriodontalDisease LinkDisease Link

People with diabetes are at increased People with diabetes are at increased risk of getting periodontal disease. risk of getting periodontal disease.

Periodontal disease may make diabetes Periodontal disease may make diabetes worse. worse.

Periodontal disease

Type 2 diabetes

How diabetes How diabetes effects gum diseaseeffects gum disease

blood vessel thicken which impairs the blood vessel thicken which impairs the efficiency of the flow of nutrients and efficiency of the flow of nutrients and removal of wastes from body tissues removal of wastes from body tissues making them more susceptible to making them more susceptible to infection, gums includedinfection, gums included

if diabetes is poorly controlled, higher if diabetes is poorly controlled, higher glucose levels in the mouth fluids will glucose levels in the mouth fluids will encourage the growth of bacteria that encourage the growth of bacteria that can cause gum disease.can cause gum disease.

Oral Complications of Oral Complications of DiabetesDiabetes

Microvascular diseaseMicrovascular disease XerostomiaXerostomia Greater susceptibility of Greater susceptibility of

oraltissues to traumaoraltissues to trauma More opportunistic infections More opportunistic infections

(e.g., candidiasis)(e.g., candidiasis) Greater risk of cariesGreater risk of caries

Oral Complications of Oral Complications of DiabetesDiabetes

Greater risk of developing Greater risk of developing periodontal abscessesperiodontal abscesses

Delayed healingDelayed healing Peripheral neuropathy Peripheral neuropathy Oral paraesthesia, including Oral paraesthesia, including

burning mouth or tongueburning mouth or tongue Altered taste sensationsAltered taste sensations

How gum diseaseHow gum diseaseeffects diabeteseffects diabetes

new research suggests that bacteria new research suggests that bacteria causing perio disease may enter the causing perio disease may enter the blood stream and activate cytokinesblood stream and activate cytokines

cytokines may destroy cells in the cytokines may destroy cells in the pancreas, where insulin is produced pancreas, where insulin is produced

potential interactions enhancing the potential interactions enhancing the morbidity of these two diseases has morbidity of these two diseases has encouraged an increased interest in encouraged an increased interest in these relationships. these relationships.

OBJECTIVEOBJECTIVEof KY CARAT Researchof KY CARAT Research

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

Project DesignProject Design The population will include 300 patients of The population will include 300 patients of

record at the St. Claire Regional Medical record at the St. Claire Regional Medical Center with T2DMCenter with T2DM

Three matched groups Three matched groups (age, gender, time (age, gender, time

diagnosed)diagnosed): : Group 1 - provided an oral health screening, Group 1 - provided an oral health screening,

oral health education, and clinical intervention oral health education, and clinical intervention for periodontal infection and inflammationfor periodontal infection and inflammation

Group 2 - provided an oral health screening Group 2 - provided an oral health screening and oral health educationand oral health education

Group 3 –control group. Group 3 –control group.

Results and BenefitsResults and Benefitsof KY CARATof KY CARAT

Infrastructure developmentInfrastructure development Training Training Research capacityResearch capacity

Healthier Kentuckians!!