 |
|
|
Home |
Contact
| Subscribe | Events | Jobs | EZinfo | Classifieds | |
|
 |
|
 |
 |
 |
 |
 |
|
Top 5
Emailed Articles
|
October 2007 | MH Web Exclusive
The Source You have questions, so we found answers.  More than once or twice in your lifetime you’ve asked the question, “Why?” And more than once or twice in your lifetime, you’ve probably heard, “Because I said so,” or, “that’s just the way it is.” Well, for us, that’s just not good enough. Here, we not only answer your questions, but we also direct you to the clinical studies and research that backs it up. That way, you and your team can make informed decisions about how to proceed in your practice. Q: I am under the impression that I need to ask patients about tobacco use, and provide tobacco cessation counseling. I only have 45 minutes, and simply do not have the time to perform this extra function. Can I skip this part of the appointment? A: Asking about tobacco use is not an option; it is an ethical and legal responsibility of all healthcare professionals. Smoking and tobacco use is the leading preventable cause of death in the world. When a health professional has a smoking patient or one using other forms of tobacco, three responses are possible: 1) Do nothing 2) Use the full Five A’s protocol 3) Use of the Five A’s in a new way. The easiest thing you can do takes less than 30 seconds, refer the patient to your state quitline, or to the National Quitline: 1-800-QUIT NOW. Resources: Smoking Cessation leadership Center ADHA’s Smoking Cessation Initiative (SCI) Become an EX Q: I was wondering if it is safe to treat women while they are pregnant? A: Health care professionals should recognize that it is not only safe, but vital to help insure good oral health and provide oral health care during pregnancy. Pregnancy causes complex physiological changes that can adversely affect oral health during pregnancy. We also know there is an association between periodontal infection and adverse pregnancy outcomes, such as premature delivery and low birth weight. Some studies have shown that interventions to treat periodontal disease will improve pregnancy outcomes, but we are awaiting conclusive clinical interventional trials to corroborate these preliminary results. Nevertheless, treatment during pregnancy is safe, and control of oral diseases improves a woman’s quality of life and has the potential to reduce the transmission of oral bacteria from mothers to children. Resources: http://www.health.state.ny.us/publications/0824.pdf Oral Health Care during Pregnancy and Early Childhood Practice Guidelines Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak J, Ferguson JE, et al. Treatment of Periodontal Disease and the Risk of Preterm Birth. N Engl J Med, Volume 355(18):1885-1894, November 2, 2006. A: Seal America: The Prevention Invention provides practical guidance for individuals who wish to start a school-based dental sealant program. The manual also addresses issues related to referring students with unmet oral health needs to a dentist, as well as sustainability issues. Established school-based dental sealant programs may also find the manual of interest as they work to improve specific aspects of their program. Resources: A: Absolutely not! It is necessary to maintain oral health prior to, during and following the treatment of cancer. The pretreatment cancer period includes the period of time from the medical diagnosis and hospital admission to the initiation of the chemotherapy, bone marrow transplant conditioning therapy and/ or radiation therapy. If circumstances allow, the pretreatment period is the optimal time to institute an oral hygiene/and or fluoride regime, restore or remove diseased dentition and eliminate potential oral sources of infection and trauma. Cancer treatment usually lasts approximately 30-45 days after chemotherapy induction, bone marrow transplantation, and/or radiation treatment. This period often involves considerable myelosuppression and immunosuppression, which is a consequence of cancer treatment. Therefore, only palliative oral care is regularly provided during cancer treatment. Oral hygiene continues to be of vital importance during this phase. As well, some individuals receive chemotherapy for several years, depending on the type of cancer and the treatment protocol employed. Every series of chemotherapy may result in the cycle of myelosuppression and immunosuppression. The post-treatment cancer period includes long-term follow-up of the patient and ranges from one year to a lifetime. Patients should be closely monitored for recurrence of cancer as well as the increased possibility of a second primary. The chronic sequelae of bone marrow transplantation may necessitate the management of chronic graft versus host disease. Meticulous oral health care for individuals who have received therapeutic radiation to the head and neck is crucial for the life of the individual. Resources: http://www.doep.org/OHCT2monographrevised.pdf Oral Health in Cancer Therapy: A Guide for Health Care professionals (2nd Ed.). http://www.oralcancerfoundation.org/dental/dental-complications.htm http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/healthprofessional
A: Xerostomia is not a disease but can be a symptom of certain diseases. Causes include medications, cancer therapy, Sjögren’s syndrome and other conditions, and nerve damage. It can produce serious negative effects that affect the patient’s quality of life, including dietary habits, nutritional status, speech, taste, tolerance to dental prosthesis, and increased susceptibility to dental decay. The increase in dental caries can be devastating special care must be made to control this process. Risk assessment and treatment strategies should be outlined. Establish if the patient is Xerostomic from symptoms and determine salivary flow rate. Treatments include: switching to an alternate medication; avoidance of caffeinated drinks and tobacco products; use antimicrobial and/or lubricating mouthrinses, sugar-free gum, and over-the-counter moisturizing products such as artificial saliva; use of a humidifier at night; and last, but not least, use of fluoride in the form of dentifrices, rinses, gels, or varnish. Resources: http://www.oralcancerfoundation.org/dental/xerostomia.htm http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/DryMouthXerostomia/ http://yalecancercenter.org/education/download/YaleCares%20June%202007.pdf http://jada.ada.org/cgi/content/full/137/suppl_3/22S http://www.dental-professional.com/Professional_Dental_Dry.aspx http://www.drymouth.info/practitioner/default.asp http://mydrymouth.com/living_with_drymouth.jsp http://www.colgateprofessional.com/ColgateProfessional/Home/US/EN/Docs/PDFs/PatientEd/English/what_is_dry_mouth_new.pdf
A: It is still very much a needed preventive and therapeutic entity. A panel of experts on fluoride convened November 2006 during the Global Consultation on “Oral Health through Fluoride”. The panel urged government and other influential bodies to develop effective legislation, necessary directives and programs to ensure access to fluoride for dental health in all countries. There is concern about growing disparities in dental health and the lack of progress in dealing with the worldwide burden of tooth decay (dental caries), particularly in disadvantaged populations. The benefits of fluoride for the prevention and control of dental caries have been known to the scientific and public health community for more than 60 years. While fluoride in various delivery systems is widely available in many developed countries, it is estimated that globally only 20 percent of the world’s population benefit from appropriate exposure to fluoride. Key recommendations released by US Centers for Disease Control (CDC) include: Continued and expanded fluoridation of community drinking water; use of small amounts of fluoride frequently such as in drinking water with optimal levels of fluoride and fluoridated toothpaste; use of supplements and high-concentration fluoride products judiciously, such as such as professionally applied gels, foams, and varnishes; monitoring the fluoride intake of children younger than six years old; labeling of bottled water with the fluoride concentration; education of health professionals and the public; and conducting additional research. The American Dental Association (ADA) published guidelines in 2005 for fluoride-containing dentifrice products used for the control of dental caries. Resources: http://www.fdiworldental.org/public_health/3_7fluoride.html http://www2.cdc.gov/mmwr/ CDC report http://www.cdc.gov/OralHealth/index.htm DOH website http://www.ada.org/ada/seal/standards/guide_fluoride_dentifrice.pdf http://www.cdc.gov/fluoridation/benefits.htm http://www.nypartnersinoralhealth.com/tableofcontents/benefits_flouride.html
A: The Oral/Systemic link is very real, but it is a possible link or connection, as we do not have sufficient evidence to establish a cause & effect. However, you are safe in explaining that periodontal infection may increase the risk of cardiovascular and heart disease, diabetes, respiratory disease, preterm and low birthweight babies, and even some types of cancer, such as pancreatic cancer. The proposed link is inflammation of the gingiva and periodontium, or the inflammatory process, which has been shown to have significant associations with the health of other body systems. Resources: Scientific American, Procter & Gamble Colgate White Papers https://secure.colgateprofessional.com/app/ColgateProfessional/US/EN/Products/ProductItems/ColgateTotal/WhitePapers.cvsp
Mario Perno Goldie, RDH, MS
|
|
 |
 |
 |
 |
|
