OHP Final

Statement 1: Aspiration pneumonia often has a silent onset. Statement 2: Aspiration pneumonia requires a high level of staff supervision during meal time. E. Statement 1 is true, statement 2 is false F. Statement 1 is false, statement 2 is true G. Both statements are true H. Both statements are false

G

List three common ORAL health conditions for CHILDREN with Down Syndrome? a. _____________________ b. _____________________ c. _____________________

Late Eruption of teeth, Missing Baby teeth, Malocclusion

List three medical conditions is correlated with patients with Down Syndrome? a. _____________________ b. _____________________ c. _____________________

Hearing Difficulties, Vision Difficulties, Thyroid Problem

Dr. Skotko - Lecture 1 Overview of Dental Care for Patients with Down Syndrome using an Interprofessional Approach (1) Down syndrome behavior checklist (2) Medical conditions commonly found in individuals with Down syndrome (3) Oral health conditions commonly found in individuals with Down syndrome

Healthcare Guidelines (for 1 to 5 years w Down syndrome): - Regular well-care visits (check-ups). - Monitor growth (at every visit). - Immunizations (shots). - Heart. Hearing (check every 6 months). (1) DOWN SYNDROME BEHAVIOR CHECKLIST: 1. Exclude Medical Conditions: - Hearing Difficulties - Vision Difficulties - Thyroid Problems - Celiac Disease - Constipation - Obstructive sleep apnea 2. Maximize Expressive Language Skills 3. Think about behavior conditions. (2) 1. HEARING DIFFICULTIES - 75% of children with DS have hearing loss. - Test birth, 6 mo, 12 mo, then yearly. - 1. Conductive Hearing Loss (consider i.e. ear wax removal) - 2. Sensorineural Hearing Loss (consider i.e. hearing aids). - 3. Mixed Hearing Loss (both of above).}. 2. THYROID PROBLEMS - 15% "" - Test birth, 6 mo, 12 mo, then annually. - Symptoms: Tired, Sluggish, Constipation, Unusually Cold, Hyperactive, Restless, Diarrhea, Sweating, Behavior Problems - 1. Hypothyroidism: LEVOTHYROXINE. - 2. Hyperthyroidism: tx w. Medicines - 3. Compensated Hypothyroidism (Hyperthyrotropinemia): Needs to be followed more closely; consider tx with LEVOTHYROXINE if persistently elevated. 3. CELIAC DISEASE - ~5% "" - Tests beginning at 1 yo if symptomatic - Symptoms: diarrhea, constipation, bloating, behavioral problems, vomiting, abdominal pain. - Diagnosis: Start Blood Screen (IgA & TTG): Intestinal Biopsy. - Treatment: 100% gluten-free diet. 4. CONSTIPATION - Bulk-producing agents: dietary fiber; benefiber supplements. - Softens Stool: Colace (Ducosate). - Lubricant: Mineral Oil. - Motility/Stimulant Agent: Senna, Dulcolax, Ex-Lax. - Waters-down stool: Miralax (polyethylene glycol), milk of magnesia, lactulose. 5. OBSTRUCTIVE SLEEP APNEA (OSA). - up to 75% ""! - Test every child by the age of 4. - Questions to ask: "Does your child... snore at night? gasp, choke, short during sleep? fall asleep on short drives / at school? need to nap in an age-innapropriage way? not seem refreshed during the day?" - Sleep Study (POLYSOMNOGRAM) is only definitive diagnosis. - Treatment: medicine; tonsils/adenoid surgery; surgery. - CPAP: hard to predict who will succeed and who will need more assistance (we've had many surprised parents). Tips for success: Make it fun, go slow (may take months for child to get used to wearing the mask), and try different masks. - Hypoglossal Nerve Stimulator: Inspire upper airway stimulation. Inspire therapy continuously monitors breathing patterns, key airway muscles are stimulated. and airway remains open, allowing fresh air to flow freely to lungs. 6. Specific Behavioral Conditions: - ADHD, OCD, Depression, Anxiety. 7. Autism Spectrum Disorder - significant communication difficulties and with social skills, repetitive behaviors. Treatment no less than 25 hours of ABA per week. 8. Overweight or Obese 9. Alantoaxial Instability (AAI) and Occipitoaxial Instability (OAI) - 15%, consequences are rare but dangerous. Test with C-spine (3 views: lateral, flexion, extension) which do not predict well which children are at risk; and don't provide reassurance that child won't develop spine problems later, routine ones are not recommended in asymptomatic children, however special olympics might require them for participation (contact sports concern). - Symptoms: change in gait, in use of arms or hands, in bowel or bladder function, neck pain, stiff neck, head told, torticollis, new-onset weakness, hyperreflexia. - Activity Restrictions = contact sports, gymnastics, horse-back riding, driving, trampoline usage, careful precautions during anesthesia. 10. Seizures - test with EEG as warranted. Includes Infantile Spasms, Partial Seizures, or Generalized tonic-clonic seizures. Treatment same as general population. 11. Hip Dysplasia/Dislocation - limping with leg pain; test with hip and knee x-rays; treatment with surgery and immobilization. 12. Leukemia - <1% - Test: CBC with differential, bone marrow biopsy. - Acute lymphocytic leukemia (ALL): Between 3-6 years; Less likely to have large spleen, chest mass, and central nervous system like typical population; TREATMENT: Chemotherapy. - Acute myelogenous leukemia (AML): Between 1-5 years; History of TMD; TREATMENT: Chemotherapy. 13. Transient Myeloproliferative Disorder (TMD) • occurs10-20% of babies with Down syndrome • present at birth or within first week of life • typically resolves in the first 3 months of life • 20-30% will progress onto leukemia by age 4 - If in this category: CBC ~3 months until age 4-6 14. Abnormal Blood Types 15. Iron-deficiency Anemia - test hemoglobin beginning year 1. - treatments: improve dietary intake; iron supplementation. (3) ORAL HEALTH CONDITIONS - Many children with down syndrome. - Test dental exam every 6 months - Late Eruption of Teeth. - Missing baby teeth - Cavities - Malocclusions - Periodontal Disease.

In patients with Autism Spectrum Disorder, diagnosis rates are unrelated to all of the following except? A. Race B. Socio Economic Status C. Gender D. Education

C

Which ones of these statements is FALSE regarding dental visits for individuals with ASD: A. Treat individuals and caregivers with the same respect and dignity as others receive and recognize unique family strengths B. Listen to caregivers' and individuals' expressed needs (verbal and non-verbal) C. Speak directly to the caregiver, not the individual D. Have short wait times and a low stress, quiet environment, with special or separate waiting rooms

C

What program is named after a child who contracted HIV through a blood transfusion?

Ryan White

1 in 5 children have untreated tooth decay. What is the single best public health measure implemented to reduce tooth decay? A. Community water fluoridation B. Toothpaste C. Regular hygiene visits D. Flossing

A

According to Dr. Perlman's lecture, what is the LEAST appropriate way to manage a young patient with IDD exhibiting disruptive behavior, being uncooperative and unable to sit still, and/or lashing out when you try to get close? A. Sedate the child B. Put the child in a papoose board C. Distract the child with a TV or an iPad D. Allow the child to sit on the dentist's chair E. Use a vacuum pack or liner to make the standard dental chair more comfortable

A

Over the last two decades how has the prevalence of ASD changed? A. Increased 600% B. Remained the same C. Increased 85% D. Increased 200%

A

Which of the following are characteristics of a developmental disability? A. Onset of condition after age 18 B. Patient requires lifelong services C. Patient has substantial functional limitations in most areas of daily living D. B & C E. A & B F. All of the above

D

Why should we screen for HIV in the dental setting? A. 60-70% of adult patients visit the dentist each year B. 10-24% have not seen a physician in a given year C. Dental facilities can serve as additional sites to identify health issues among diverse groups of patients D. All of the above

D

Dr. Holland and Dr. Naderiani - Lecture Topic: 4 Health Literacy and Health Communication Part 1 and 2 (1) National CLAS Standards (2) Definition of health literacy (3) Socio-ecological model (4) Negative consequences of low health literacy (5) Health literacy best practices for effective written communications

(1) The National CLAS Standards are a set of 15 action steps intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services (google). (2) The degree to which individuals have the capacity to OBTAIN, PROCESS, AND UNDERSTAND basic health information and services needed TO MAKE APPROPRIATE HEALTH DECISIONS. (3) Provider (education), Patient (skills), Environment (healthcare system): - Health literacy is 3-pronged problem = Healthcare system + Consumer/Patient + Provider. - Key intervention areas: Provider (education), Patient (skills), Environment (healthcare system). (4) - "In the US, limited literacy skills are a stronger predictor of an individual's health status than age, income, employment status, education level, and racial or ethnic group." - Studies have shown oral health literacy to be associated with: Oral health knowledge level, dental care visits, caries severity, quality of life, failed appointments / no shows. (5) Five of them: 1. Plain language: communication audience an understand THE FIST TIME THEY READ OR HEAR IT. - example: Flossing is an "essential" part of any "oral health care routine". => Flossing "every day" is an important part of "keeping your mouth clean and healthy". 2. Metaphor & Analogy Use* - Explain a foreign dental concept by linking it to a familiar everyday concept. - Example: When the floss reaches the gum line, curve it into a "C shape" against one tooth. => Break off about "18 inches of floss" and wind most of it around one of your middle fingers. 3. Personalization* - Engage the reader by using personal pronouns and customizing scenarios. - Examples: Caries Prevention => "How you can avoid getting cavities"; or Signs & Symptoms => "you may have a cavity if... (and include bulleted list). 4. Chunk & Check*- Group relevant information together by topic, & give reading breaks for the reader to check comprehension. - example: "The type of procedure, your overall health, history of allergies and your anxiety level are considered when determining which approach is best for your particular case." => "What's best for you? You & your dentist will discuss the following: - the type of procedure - your overall health - your history of allergies - your anxiety level." 5. Design & Visual Aids - allow enough 'white space' to balance text and graphics; AVOID text in all caps. For emphasis, bold or underline. Ideal font size is 12-14+, style depends on medium (online sans serif or in print serif) NOTES: - At Risk / its greater among: Older adults, Lower SES, people with limited education, minority populations, persons with limited english proficiency.

Dr. Perlman - Lecture Topic: 3 Overview of Dental Care for Patients with Intellectual and/or Developmental Disabilities (1) Definition of developmental disability (2) Oral health conditions commonly found in individuals with intellectual or developmental disabilities (3) Use of medical immobilization/protective stabilization

(1) Diagnosis of "Developmental Disability": Requires onset of a condition occurring before 18 years of age, is chronic, will require lifelong services, and is associated with substantial functional limitations in most areas of daily living. (2) Oral Health = number one unmet healthcare need individuals with IDND a. Periodontal disease - higher rate of gingivitis and periodontal disease than the general population b. Dental caries - develop caries at the same rate as the general population but prevalence of untreated dental caries is higher c. Malocclusion, missing permanent teeth, delayed eruption, and enamel hypoplasia are more common d. Damaging oral habits may be present (bruxism, mouth breathing, tongue thrust, self injurious behavior and pica e. Increased risk for oral trauma and injury Characteristics of I.D.D. contributing to increased risk of oral disease: - Cognitive, physical or behavioral limitations making it difficult to perform daily oral care and cooperate during dental visits. - Medications affecting oral health. - Elevated rates of poverty. - Older adults who lacked access to care along their lifespan. - Type of residence. - Role of family members or paid care givers. - Medicaid issues. - Scarcity of trained dentists and hygienists - Issue of consent, guardianship. Influence of Disabilities on Orofacial Function: - ORO-Cranio-Facial Anomalies: Micrognathia, cleft lip and palate, hemifacial microsomia, macroglossia. - Neurological Impairment: Congenital, acquired or caused by trauma: Cerebral palsy, stroke, Parkinson's disease multiple sclerosis, amyotrophic lateral sclerosis. - Neuromuscular Disorders: Myotonic dystrophy, Duchenne muscular dystrophy, myasthenia gravis. - Genetic Syndrome: Prader-Willi syndrome, Down syndrome, Williams syndrome, tuberous sclerosis. Breathing Problem - Robin Sequence (cleft palate, micrognathia, glossoptosis. - Hyptotonia of the oro-pharyngeal muscles. - Hypertrophied tonsils and adenoid tissue. - Choanal atresia-narrowing or blocking of the nasal airway by tissue. It is a congenital condition present at birth - Jaw hypoplasia. - Narrow high vaulted palate. - Macroglossia. Dysphagia/Eating/Feeding Problems: Craniofacial anomalies. Breathing difficulties. Congenital heart defects. Impaired oral motor function-sucking in infancy. Swallowing dysfunction. Dental anomalies. Limited mouth opening. Gastrointestinal problems. Motor Speech Disorder: Dysarthria/anarthria-impaired articulation. Dyslalia-minor articulation problems. Apraxia-failure to articulate speech. Stuttering-speech rhythm disorders. Drooling: Seldom hypersalivation. Poor lip seal. Malocclusion. Impaired tongue/soft tissue motility.Poor neck stability. Oral habits. Not socially acceptable. Dysphagia. => Treatment Options for Drooling: Physiotherapy-oral screen. Oral motor appliances. Orthodontic treatment. Salivary gland surgery-excision or re-routed. Nerve resection. Drugs-Anticholinergics. Orthognathic surgery Bruxism: grinding and chelnching wears down teeth. *Factors Affecting Oral Health: Oral hygiene, Malocclusion, Mastication, Trauma, and Behavior. (3) - The trend is toward recognition of medical/dental procedures and use of the term "Medical Immobilization/Protective Stabilization" instead of "Restraint." However, use of MIPS must be limited to the duration of the procedure. - Individuals with developmental disabilities may need medical immobilization and protective stabilization to successfully receive needed medical or dental care and treatment. - Definition: Medical Immobilization/protective stabilization (MIPS) (a) The partial or complete control of an individual's arms, legs, head or torso. Necessary to protect the individual or others from injury. Only used for the duration of a medical or dental appointment or procedure. This includes manual techniques, mechanical devices and the use of a papoose board. (b) MIPS does NOT include very brief holds such as: Blood draws, Eye drops, Injections, Tooth brushing. - Rationale: Facilitate comfort and cooperation. Protect the health and safety of the individual and others. Prevent injury. Facilitate delivery of quality health care. - Use of MIPS considerations: Definitions differ by state. Informed consent. Use only when absolutely necessary. Least restrictive alternative should be used. Documentation MUST be kept. No physical injury. Accepted practice when used appropriately. Safest alternative to sedation and general anesthesia. - Stay N Place Chair Liner for patients (any age) who don't fit well in dental chair = example of stabilization device. People with Disabilities Have: - Higher risk of co-morbid conditions - Greater vulnerability to age related conditions - Increased rates of health risk behaviors, ie: obesity, smoking, physical inactivity - Greater risk of being exposed to violence - Higher risk of unintentional injury (burns, falls, car crashes, bicycles - Higher risk of premature death, ie: schizophrenia and depression (2.6 and 1.7 times greater) ASSOCIATED DISORDERS/CONDITIONS: - SEIZURE DISORDERS: The prevalence of epilepsy approximately 26%. Among those with epilepsy, 68% experienced seizures despite anti-epileptic medication. - DYSPHAGIA: swallowing problems. - ASPIRATION PNEUMONIA: Leading cause of death in individuals with IDND; Often silent onset; Many "culprit" foods contribute to the risk; Requires high level and burden of staff supervision during mealtime. - OSTEOPOROSIS: main contributory factors for low Bone Mineral Density are age, use of antiepileptics, immobility and diagnosis of Down syndrome - CONSTIPATION in 70% of adults in IDND. Down syndrome and cerebral palsy are strongly associated with constipation. - SENSORY PROCESSING DISORDERS - BEHAVIORAL: "communication expression"; Aggression, self injurious, impulse control; Inability to express pain is often causative - OBESITY - MENTAL HEALTH ISSUES - SPASTICITY: feature of cerebral palsy; Chronic pain, muscles are constantly tight or stiff; tx medication, strapping, surgery. needs ongoing PT. - POLYPHARMACY: Overuse of medication, multiple prescribers not communicating - GAIT PROBLEMS: many different types of this. - ACCIDENTS: IDND ppl not have cognitive ability to predict danger or have poor environmental judgement. - DEMENTIA: Down syndrome has a high prevalence for Alzheimer's Disease

Dr. Rai - Lecture Topic: 7 The Role of the Oral Health Team in HIV 1. Potential role of the oral health team 2. Ryan White Dental Plan 3. HIV lifecycle 4. HIV care continuum/cascade 5. Health care integration 6. Facts on HIV (2 slides in Dr. Rai's ppt)

1. Recognize the oral systemic connection - For those with UNKNOWN HIV status, oral manifestations may suggest HIV infection, although they are not diagnostic. - For persons living with HIV disease not yet on therapy, the presence of certain oral manifestations may signal PROGRESSION of disease. - For persons living with HIV disease on antiretroviral therapy the presence of certain oral manifestations may signal a FAILURE IN THERAPY. - Dental offices represent novel settings to reach millions in the U.S. who visit a dentist during the course of a year, but who do not see a physician. - Dental facilities can serve as additional sites to identify health issues among diverse groups of patients. - Dental Examinations as an Untapped Opportunity to Provide HIV Testing for High- Risk Individuals: An estimated 3.6 million Americans report that they are at significant HIV risk yet have never been tested. ( Data from 2005 National Health Interview Survey).. Three quarters or 75% of these people have seen a dental health care worker within the past 2 years. These dental visits represent missed opportunities for HIV screening! - Problems with HIV therapy that dentists can help improve via*: 3 out of 4 people living with HIV in the US have failed to successfully navigate the treatment. Only 28% of the more than 1 million living with HIV/AIDS are getting the full benefits of the treatment to manage the disease and keep the virus under control. - ROUTINE ORAL TESTING & ORAL HEALTH CARE PROVIDER CAN LINK TO CARE & THOSE W REGULAR ORAL HEALTH CARE MORE LIKELY TO BE IN HIV CARE: *Although the range of those aware of their status is about 86% there are still a significant number of people who are not aware and may not see the need for testing. The oral healthcare team role begins here with offering routine testing or at the very least, informing patients of the CDC recommendations for routine testing and asking if patients have been tested or have considered it. For your patients who are HIV(+), discussing their linkage to care is important and should be part of a medical history review - including last visits, meds and other issues. This is also a unique opportunity for medical/dental collaboration. ...& ORAL HEALTH CARE PROVIDER CAN ENCOURAGE ADHERENCE (suppress HIV): If in care and on meds stress importance of adhering to prescribed treatment. If not in regular care discuss how important it is. - ADHERENCE - The role of the Oral Healthcare Team: The oral healthcare team has a unique opportunity during a health history intake or update to discuss a patient's HIV care, including medications. The oral healthcare provider can encourage patients to adhere to treatment regimens and discuss how these promote sound oral health. With consent to contact the medical and support teams, we can alert them to oral issues and concerns 2. - Established in July of 1991 and this program is now in its 26th year of service. - Currently we have over 200 dental practices participating. - The RWDP is a comprehensive dental access program for persons with HIV in Massachusetts and Southern New Hampshire (three counties). - Funded by the Ryan White HIV/AIDS Treatment Extension Act, Part A (referred to as Ryan White Part A) and the Massachusetts Department of Public Health (referred to as MDPH). - RWDP pays for dental care for eligible clients with HIV who are uninsured or underinsured. - RWDP may also reimburse for services not covered or denied by Medicaid or another insurance carrier if these fall within the program's scope of services. - RWDP is not a part of the Medicaid program, and participating dentists do not have to be Medicaid providers. - All information regarding clients and participating dentists is kept strictly confidential, and lists of providers and clients are never distributed. 3. Attachment to CD4 cells => Fusion => Reverse Transcription => Integration => Transcription => assembly => Budding. 4. The HIV Care Cascade - Is an important tool to measure HOW EFFECTIVE our efforts are to combat HIV infection. - TIMELY LINKAGE to care and retention in care have significant health outcomes and are linked with high rates of viral suppression. - The first stage is being able to TEST and 14-18% are unaware of their infection. - KNOWING one's status is the path to linkage and retention in care. - It shows where improvements are needed: 1.2 million people are living with HIV in the us, of that 86% diagnosed -> improvements needed esp once someone is diagnosed to get them into and keep them in care in order to achieve viral suppression. - **The HIV care continuum begins with a diagnosis of HIV infection. The only way to know for sure that you are infected with the HIV virus is to get an HIV test. People who don't know they are infected are not accessing the care and treatment they need to stay healthy. They can also unknowingly pass the virus on to others. CDC recommends that all adolescents and adults be tested for HIV infection at least once, and that persons at increased risk for HIV infection be tested at least annually.** 5. Health care integration - Patient-centered, comprehensive, coordinated - Poor oral health is worsened among non-ART users - Historically diagnosed PLWHA more likely to report oral problems and require dental procedures - Newly diagnosed may benefit from early oral intervention - Getting and staying in medical care: Once you know you are infected with the HIV virus, it is important to be connected to an HIV healthcare provider who can offer you treatment and prevention counseling to help you stay as healthy as possible and prevent passing HIV on to others. Because there is no cure for HIV at this time, treatment is a lifelong process. To stay healthy, you need to receive regular HIV medical care. - Getting on Antiretroviral Therapy (ART): Antiretrovirals are drugs that are used to prevent a retrovirus, such as HIV, from making more copies of itself. ART is the recommended treatment for HIV infection. It involves using a combination of three or more antiretroviral drugs from at least two different HIV drug classes every day to control the virus. United States clinical guidelines recommend that everyone diagnosed with HIV receive treatment, regardless of their CD4 cell count or viral load. Treatment with ART can help people with HIV live longer, healthier lives, and has been shown to reduce sexual transmission of HIV by 96 percent. - Goals Of Therapy: Suppress HIV VL to <50 copies/ml for as long as possible; Improve quality of life; Preserve medications for future use; Restore immune function 6. Facts..... - More than 1.2 million people in the U.S. are currently living with HIV (CDC - also this is one of the reasons why they recommend routine HIV testing, at least once in life). - Almost one in eight—or about 150,000—are unaware of their infection. - According to the most recent data, nearly 45% of youth aged 13-24 with HIV in the U.S. do not know they are infected. - Thousands of people 50 and older are diagnosed with HIV each year in the United States, a development that has significant consequences for the health care and social support they need and the doctors, counselors and others who provide it. - If all the people with HIV who either don't know they have the virus or are not receiving HIV clinical services were receiving care and treatment, we could expect a 90 percent reduction in new HIV infections in the United States," according to the CDC.

A dentist needs permission from the patient to speak with their primary care physician regarding matters essential to the patient's health. A. True B. False

b. false fix why

Transient Myeloproliferative Disorder (TMD) often diagnosed in patients with Down Syndrome is present at _________or within first week of life.

birth

Tina is an Oral Health Educator who goes around to different middle schools to teach students how to properly take care of their teeth. When teaching, she tells students to floss in a "C-shape" pattern to remove plaque from between the teeth. She also tells students to brush in tiny little circles, rotating the toothbrush around and around as though it is a tire on a truck. Tina is using which of the following Health Literacy Best Practice technique: A. Design Aids B. Metaphor and Analogy C. Chunk and Check D. Personalization

B

You are a Caucasian dentist in private practice. Your new patient is a Hispanic man who doesn't speak English very well and hasn't seen a dentist in a few years. How do you approach your care? A. Send him away B. Try to recognize and understand his unique cultural background when educating, diagnosing, and treating any dental conditions he presents C. Try to understand him the best you can using your high school level Spanish and hope he's okay with what you're saying and doing. D. Refer him to a dentist that speaks Spanish

B

Making pediatric dental care an "essential health benefit" under the insurance mandate in the Affordable Care Act is an example of the core public health function of: a. Assurance b. Assessment c. Policy development d. Shared decision-making Dr. gordon

c. we've developed a policy addressing oral health.

Symptoms including increased fatigue, shortness of breath, exertional dyspnea, and new murmurs can be indicative of ____________________ in children with Down Syndrome.

cardiac conditions

According to the CDC, drinking fluoridated water keeps teeth strong and reduces cavities by about ______% in children and adults.

25%

Dr. Silk - Lecture Topic: 6 Interprofessional Collaborative Practice 1. Who plays a role in promoting oral health? 2. Benefits of fluoride varnish 3. Benefits of promoting oral health in a primary care practices 4. Benefits of providing fluoride varnish in pediatric care practices

1. role of primary care in promoting oral health: - Oral disease is prevalent => It takes a Village to address it!!! - Think Metaprofessionally & Act Interprofessionally!!! - Reach out to Primary Care and others!!!! - Dentists willing to screen for: Hypertension (85.8%) CVD (76.8%) DM (76.6%) Hepatitis (71.5%) HIV (68.8%) => Respondents willing to refer for consultation with physicians (96.4%) - Medical Acceptance: a. Dentists should screen: CAD, HTN DM, HIV (61-77%) b. Willing to discuss results with dentist (76%) c. Accept patient referrals (89%) - Patients Acceptance: a. 55-90% approve screening by dentist for: Heart disease, Diabetes, Hypertension , HIV, Hepatitis . b. 48-77% of respondents opinion of the dentist would improve regarding: Professionalism, Competence, Knowledge, Compassion. - Integration of Oral Health and Primary Care Practice 2014: a. Medical Providers should do: Risk Assessment, Oral Health Evaluation, Preventive Intervention, Communication and Education, and Interprofessional Collaborative Practice. - Oral Health: An Essential Component of Primary Care = white paper published June 2015 co-authored by physician and dentist. - Oral health is like the rest of what we do: imp of HEART problems / disease. - 90% of pediatricians feel they have a role in oral health (74% willing to apply fluoride varnish). 2. Fluoride varnish use reduces caries by 37-63% 3. - Oral health prevention opportunities in medicine: Prenatal Visits (13 visits, 4 hours), Infants (WCC, 11 visits before age 2), Children & teens (18 visits, plus sick visits), adults (annually). - *The Benefits of Promoting Oral Health in Your Practice*: a. Patient Benefits: = Fluoride varnish use reduces caries by 37-63% , & Children in practices using fluoride varnish are more likely to establish dental homes. b. Office Benefits: Adopting current best practices (49 states) & Increased office revenue ($26 per pt) {Low volume (5 pts per week) - $6,396 net revenue; High volume (5 pts per day) - $31,980 net revenue}. 4. - 90% of pediatricians feel they have a role in oral health; 74% willing to apply FV. - 49% reduction if first applications start by age 12 and 15 months. - 51% dental providers agree medical offices should apply FV; 19% undecided. - USPSTF Recommendations for children age 1 = Dental Caries: Fluoride Varnish (infants and Children), Dental Caries: Oral fluoride supplementation (children age 6 months to 5 years). - USPSTF Recommendations for age 2,3,4,5: Same as for age 1, plus Visual Impairment: Screening all children at least once between ages of 3 and 5 years.

Fluoride supplements should only be prescribed for children living in non-fluoridated areas. A. True B. False

A. True

Ensuring an adequate dental workforce to meet the needs of a population is an example of the core public health function of a. Assurance b. Assessment c. Policy development d. Shared decision-making dr. gordon

A. make sure there is resources, a workforce available, that adddress oral health.

An 8-year-old patient presents with a stiff, tightly curved hand and spasticity. This condition causes your patient extreme pain and they need ongoing physical therapy and medication. What does your patient have? A. Diabetes B. Cerebral palsy C. Osteoporosis D. Seizure disorder

B

Ms. Raposa - Lecture Topic: 2 Overview of Dental Care for Patients with Autism Spectrum Disorder (ASD) (1) Sensory sensitivities commonly found in individuals with ASD (2) Strategies for managing sensory sensitivities and/or dental anxiety in the dental office setting - how to provide a comfort zone? What is your critical role? What is sensory modulation processing disorder? (3) Current prevalence of ASD in population - whats the increase over the last two decades? what accounts for the inc. in prevalence?

Staggering Stats: - Diagnosis rates are unrelated to: Race, socioeconomic status, education. - more than 3 children per hour are being diagnosed with ASD. - 600% increase in PREVALENCE over the last two decades. - 1% of American children have a diagnosis of autism. - 57% increase from 2002-2006 autism PREVALENCE. - Annual cost of education for typical child is $10,000/year; for child with autism is $40,000 to $60,000/year. - During Pres. Obama campaign, autism identified as one of the administration's top three public health priorities. - The CDC and Prevention have called autism a national public health crisis whose cause and cure remain unknown. Autism and Developmental Disabilities Monitoring (ADDM) Network: - group of programs funded by CDC to estimate number of children with ASDs and other developmental disabilities living in USA. - CDC estimates that 1 in 68 children have been identified with ASD. What accounts for increase in ASD PREVALENCE? - 2011 (1 in 88) and 2009 (1 in 110) reports use the same methodology that produced the CDC's 2007 prevalence findings of 1 in 150. - CDC reports: A broader definition of ASDs "does NOT" account for the increase. Improved early diagnosis accounts for SOME of the increase. - (2011 CDC) More people than ever are being diagnosed with an ASD. It is unclear how much of this inc. is due to a broader definition of ASDs and better efforts in diagnosis. However, a true increase in the number of people with an ASD cannot be ruled out. We believe that the increase in ASD DIAGNOSIS is likely due to a COMBination of these factors..... The CDC tracking system missed 12 of 177 children who were examined and found to have an ASD. This result shows we are likely not counting some children with ASD. (1) SENSORY: differences in the perceptions of SIGHTS, SOUNDS, TEXTURES, SMELLS, AND PAIN. - Olfactory - Auditory - Gustatory (taste and texture) - Visual - Vestibular (chair height or tilt, being still) - Proximity - Proprioception (jaw opening, gagging, body position, lead apron) - Tactile (touch, temperature, and texture) - Manifests as over responsivity, under responsivity, or sensory seeking (both hypo and hyper) YOU: DISCUSS SENSATION IN INTERVIEW: - Positive Stimulations: 1. NOISE AVERSION: hearing protector, Favorite Music / PLAY WHAT THEY LIKE; or dual sound screen (white noise machine). 2. AROMATHERAPY: for individual who has A STRONG TENDENCY TO SMELL OBJECTS. - Negative Stimulations: 1. SIGHTS (most common complaint is light in the eyes). 2. SOUNDS (use distracters. power brush may sound/feel better than slow speed). 3. TASTE (regular toothpaste vs prophy paste - or use: paste-free trophy, fun non-latex disposable trophy angle). 4. TOUCH (human touch can actually be painful for some of these). - Pain Perception Level: questions to ask regarding possible dental pain: "any changes in behavior or prolonged episodes of behavioral abnormalities?" - Temperature Perception Level YOU: DISCUSS SENSATION IN INTERVIEW: - Positive Stimulations: 1. NOISE AVERSION: hearing protector, Favorite Music / PLAY WHAT THEY LIKE; or dual sound screen (white noise machine). 2. AROMATHERAPY: for individual who has A STRONG TENDENCY TO SMELL OBJECTS. - Negative Stimulations: 1. SIGHTS (most common complaint is light in the eyes). 2. SOUNDS (use distracters. power brush may sound/feel better than slow speed). 3. TASTE (regular toothpaste vs prophy paste - or use: paste-free trophy, fun non-latex disposable trophy angle). 4. TOUCH (human touch can actually be painful for some of these). - Pain Perception Level: questions to ask regarding possible dental pain: "any changes in behavior or prolonged episodes of behavioral abnormalities?" - Temperature Perception Level (2) Dealing with: - "Person First Language" = consideration of dehumanizing aspects calling ppl by their disability, condition, organ first. - For the family in need: offer admiration/support/reinforcement for any positive care they are able to provide to the patient, even when not idea. Ask if there are areas in which they wish to have additional intervention - do not assume. Offer additional support services/referral when available, even if previously declined; people may change their minds. - Took Kit for Dental Professionals = Autism Speaks Video & Literature. - In order to avoid CRISIS MANAGEMENT for these patients, do Prevention! - Indvls with autism are at EXTREMELY HIGH RISK FOR DEVELOPING DENTAL CARIES. - Minimal Clinical Training in Medicine on Intellectual Disabilities (ID) is lacking in many medical/dental graduates => BUT, since 2006 thanks to special olympics effort, all schools considered for accreditation by the Commission on Dental Accreditation must assure didactic and clinical opportunities to better prepare us for the care of persons w. intellectual/other developmental disabilities. = Coda Standard 2-24: "Graduates must be competent in assessing the tx needs of patients w. special needs." - COMFORT ZONES: (A) FOR THE CONCERNED PARENTS, concern about child having unpleasant experience (mercury, fluoride, gluten / casein and dental materials, antibiotic agents, acetaminophen, NO) and about their own embarrassment if child non-complaint or has behavioral outburst => BEST SOLUTION: For the parent, the child and the dentist to meet and develop a plan BEFORE THE FIRST VISIT. (B) FOR THE PATIENT - these details can be learned thru documentation and interviews; they are most often learned thru experience w each individual patient. (C) FOR THE PRACTITIONER, you will need: An open mind and open heart, more emotional skills than intellectual or clinical, to get close to your patient both physically and emotionally, to leave behind your reasoning skills (most times they will not work). AGD Advises:COMPASSION. The dental practitioner should function as the NUMBER ONE *ADVOCATE* for proper oral hygiene maintenance; these special and vulnerable patients must DEPEND ON CARING DENTAL PROFESSIONALS to monitor their level of oral hygiene and to INSIST THAT CAREGIVERS NOT NEGLECT this vitally important personal care." - Start at the beginning: which could mean to seek out these patients: brochures in waiting area on treating a patient with special needs. Provide parents that inquire a form that asks questions about their child, since this shows that you understand and care. - WELCOME PACKET SENT TO CAREGIVER SHOULD INCLUDE: (1) Welcome letter (expectations, explain you will review patient info over phone together - see below), and home care tips to practice for the first fist), (2) "MY PERSONAL DENTAL BOX" {=include patient in process and ease transition from taking care of mouth at home to doing it in dental office. Box can include mask gloves, bib, floss, varnish brush, plastic mouth mirror, rubber tip stimulator, dental film. Should include a "my practice checklist." Add to the box at the visit (toothbrush, pictures, etc)}. (3) Office Brochure and/or Social Story. (4) Patient information Form {= describe nature of child's disability; medical; dental experience; physical functioning; sensation; communication; vision; hearing; behavior/emotions; oral habits}. - During the phone call: review patient info form in detail, ask what is best time of day for apt, ask the parent to bring child's fav music/video/toy/blanket/or other COPING DEVICES; ask parent to bring friend who can sit with the child while forms are reviewed; offer to send photos of office and a dental story home w patient for parent to review. - "PRACTICE/TRUST BUILDING" APPOINTMENT: first scheduled appointment should be interview, orientation, and brief exam only (20 mins). Primary goal to establish trust. Help parent and patient know you care about them: LIMIT WAIT TIMES, ask parent to choose a location (wherever), Orientation w. Tell/Show/Do (DONT ASK IF ITS OK), Brief Exam w.o instruments and let patient decide where want to sit, give reward! - What caregivers need from dental office staff: 1. Understanding disability and anxiety individuals have about dental visits. 2. Have short wait times and low stress, quiet environment, with special or separate waiting rooms. 3. Speak directly to the individual. 4. Allow extra time for the apt. 5. Listen to expressed needs (verbal and non-verbal) 6. Allow caregivers to be present during visit (and ask them questions when needed). 7. See the individual as a person w unique meds, not as disabled person. - What caregivers said they should do for themselves: 1. Prepare the individual for dental visit thru role-play, books, and pictures. 2. Bring distractions for waiting rooms and offer rewards. 3. Ask for a "get acquainted" visit. 4. Schedule apt at time of day that is best for the individual (firs tor last apt of the day). 5. Talk to dentist and staff before the visit. 6. Bring a support person. 7. Ask for the same staff each time. - INTERVIEW asking about oral habits including: overall diet, snacking frequency (ABA rewards), Sensory Chewing, Clenching / Grinding, Non-edibles / licking objects. - SENSORY CHEWING: ORAL SENSORY DEVICES = Chew tubes (alternative for those who need extra oral-motor stimulation, or need extra practice with biting and chewing skills); Chewy P&Q (solid rather than hollow for this who seek oral-sensory input) - SENSORY MODULATION PROCESSING DISORDER s.t. sensory processing mb similar to Infant, which manifests as one of the following: OVER RESPONSIVELY (slight input causes extreme reaction), UNDER RESPONSIVELY (requires stronger input to register sensation), or SENSORY SEEKING (hypo and hyper sensitivities co-mingle within the same sense). - Treatment Accommodations: Know that BEHAVIOR = COMMUNICATION. Look for more aggressive, or reduction in eating habits. - Challenge: Determine what is self-inflicted while trying to rule out any ABUSIVE BEHAVIOR BY CARE-GIVERS (many mentally challenged patients sexually assaulted in life). - Communication Devices = CHAT BOX (allows digitized/recorded messages to be spoken by pressing buttons on keyboard( or IPAD (use apps). - Communication Don'ts: avoid patient and speak to caregiver instead; speak louder or use exaggerated tone; ignore signs of confusion, fear and anxiety; use the term "mental retardation"; use medical language or jargon; ask "do you understand?" (use open-ended questions instead). - Make Language Visible: use pictures and gestures to increase comprehension / "Show what you say." - Visual Schedule: Visual representation of what will happen so making ease of transitions and expectations easier (and REDUCE ANXIETY), review it prior to starting and throughout the experience. - First/Then: Visual representation of what is happening now and later - used to REDUCE ANXIETY (helps them deal with activity that is non-preferred). - NEXT SCHEDULED APT based on entirely what you learned about the patient at this apt (e.g. how much time need, what plan to accomplish, what accommodations necessary, how will you measure success) by FOCUS ON PATIENTS ABILITIES (NOT DISABILITIES) TO DETERMINE WHAT WILL WORK. - First dental visit will have typical sensory experience; second dental visit you modify (no overhead light, slow moving repetitive color lamp added, soothing music playing, etc.) => results in ANXIETY LEVELS decreased in all children, as shown by research. - Treatment accommodations: FAMILIARIZATION METHOD = repetitive tasking an familiarization: one new step at each visit, parents/caregivers must practice routine at home, encourage caregivers to "play dentist" at home. = THREE KEY FACTORS: 1. Eye contact "look at me") 2. Educational Modeling (clear direction - "hands on your tummy, feet out straight"). 3. Counting Framework ("let me do it for a count of 10"). - Billing (Ada code for behavior management): If need to do 3 apps for 15 min each (= 1 apt 45 min), no more than 2 weeks btw appointment and caregiver working on specific skills between visits => choose which of the 3 apps to charge for exam and prophy. - DISTRACTION DEVICES: Fidget Toys (aid to concentrate and focus, meeting need to fidget) and Warm Moist Bear Toy (sooth away aches and nerves by giving heat, also massage tool and streets reliever). - Benefits of Isolite Dryfield Illuminatior (isolates max and mandibular quadrants simultaneously): moisture control, procedures will go faster, retracts/protects tongue and cheek, delivers bright and shadowless light throat mouth, obdurates throat to prevent aspiration. Putting it in perspective - autism is a developmental delay that includes symptoms such as speech difficulties, lack of eye contact, isolation, and no fear of danger. What is autism? - a complex brain disorder that inhibits a person's ability to communicate and develop social relationships and often accompanied by extreme behavioral challenges. Conditions associated w: - Epilepsy, GI (diarrhea and constipation), Sleep disorders, Intellectual disability, Motor impairments, Psychiatric conditions (anxiety, ADHD, depression), Sensory processing disorder. Autism Spectrum Disorders: - Include: Autism - Pervasive Developmental Disorder (PDD); Asperger Disorder; Rett Disorder; Pervasive Developmental Disorder - Not otherwise specified (PDD-NOS); Child disintegrative disorder. - Diagnostic Tools: Autism Diagnostic Interview - Revised (ADI-R), or Autism Diagnostic Observation Scale (ADOS). - Early signs/symtpoms: no big smiles or warmful expressions by 6 months; no back and forth sharing of sounds, smiles or facial expressions by 9 months; no babbling by 12 months; etc... any loss of speech or babbling or social skills at any age. - CAUSE IS UNKNOWN, NO CURE YET. - 3 of 19 alternative treatments reviewed could be recommended: Melatonin, Multivitamin/mineral supplements, or Massage therapy.

Health disparities are population-specific differences in the presence of disease, health outcomes, or access to health care. True False dr. gordon

True. That what health disparities are = differences in oral health outcomes, usually those differences are influenced by factors .

Fluoride

more acid resistant. Critical pH is 4 (demoralization of HA is at 5.5).

Dr. Gordon - (lecture capture) - Lecture Topic: 8 Dental Public Health: Oral Health Disparities 1. Core functions of public health 2. History of the discovery of the effects of fluoride on teeth 3. The main points for the 2000 Surgeon General Report Oral Health in America 4. Determinants of health 5. Strategies to reduce oral health disparities 6. Cultural competence

1. Core Functions of Public Health: - ASSESSMENT: Regular collection and dissemination data describing the oral health needs of a community. - POLICY DEVELOPMENT: Use of scientific knowledge and data to plan and develop policies concerning the public's health. - ASSURANCE: Implementing the appropriate programs to achieve desired goals. 2. - "Colorado Brown Stain": Dr. Frederick McKay opens a dental office in Colorado Springs around 1901 (beginning of the clinical discovery phase). Notices discoloration on the teeth of some of his patients. In 1909 Dr. G.V. Black agreed to collaborate with Dr. McKay in researching this condition. - 1931: Dentist H. Trendily Dean appointed to begin the dental hygiene unit of the newly established national institute of health to investigate. - 1934: severity of dental fluorosis characterized as "Dean's Index" compares fluorosis dad from 26 states to tooth decay data - identifies caries lower in cities w more fluoride in their community water supplies at concentrations > 1.0ppm. - 1941: "21 Cities Study" - documented dental caries experience in different communities dropped sharply as F concentration rose toward 1.0ppm, then leveled off. - 1945: Four pair city study - over 15 years, reduced caries in 50-70% children in communities with fluoridated water. - 1950: US public health services issued a policy statement to ADA, supporting community water fluoridation. - 1951: Reaffirmed "community water fluoridation" - official policy of public health service in testimony before senate. - Fluoridation of Drinking Water = "The single most effective public health measure to prevent dental decay". Today water fluoridation continues to reduce dental decay by 20-35%. Prevention, Cost Effectiveness, Population-based, Upstream. - Benefits of Fluoridation: a. it doesn't require costly services of health care professionals to deliver. b. there are no daily-dosage schedules to remember. c. no bad taste. d. widespread community water fluoridation prevents cavities even in neighboring communities that are not fluoridated - "Halo Effect" Or the diffused effect - eating food beverages process from fluoride water. 3. Landmark Paper = Oral Health in America: A Report of the Surgeon General (2000) - Oral Health is more than healthy teeth - Oral Health is integral to general health - Dental disease is preventable - Oral health disparities exist 4. Determinants of Health: - Genetics - Age - Gender - Ethnicity - Income - Education 5. Strategies to Reduce Oral Health Disparities: (a) School-based dental programs - Fluoride varnish - Fluoride mouthrinse and supplements - Sealant (b) Affordable Care Act Oral Health Provisions: - Expand Medicaid coverage to people below 133 percent of the federal poverty level: By 2013 an estimated 3 million more children will gain dental benefits. - Pediatric dental care listed as an essential health benefit under the insurance mandate - Increase funds to: Federally Qualified Health Centers, School-based health center facilities, NHSC loan repayment program, & National five-year oral health prevention and education public campaign. - Provide incentives to shift from quantity driven to quality driven health care model. 6. Cultural Competence: - Cultural Competency meaning we have a workforce that has a level of understanding of other ppls cultures. Need population of dentist representative of patients serving and a culturally competent population of dentists. - Go into the community. - New dental workforce models = Expanded Dental Workforce Models (expanded function dental hygienists or assistants), Alternate dental workforce models, or Non dental worfkoce models. - Public Health Dental Hygienist (MA way to help increase access to care) can...Provide dental hygiene services, Place dental sealants (without first having a dentist examine the patient), Can operate under a written collaborative agreement or under the general supervision of a licensed dentist. NOTES: - "Public Health is what we as a society do collectively to assure the conditions in which people can be healthy.": Prevention, Population-based, Cost effectiveness, Upstream. - Oral Health in America Today: Dental Caries: Dental Caries is the most common chronic illness among school-aged children. About 1 in 5 children (ages 6-11) have untreated tooth decay. About 25% of nonelderly adults have untreated tooth decay. - Notes on New dental workforce models - Alaska (rural) and Minnesota have employed these as patients in these rural areas have less access to dental care. If we train mid-level providers who may not have all the training of dentists but are able to do limited number of procedures to get patients out of pain or referral process, then this could be effective. This concept has been around for a while (new zealand). - Under-represented Minority (URM): African Americans, Mexican-Americans, Native Americans (American Indians, Alaska Natives, and Native Hawaiians), Pacific Islanders, and mainland Puerto Ricans.

Applying Health Literacy Principles to Written Oral Health Materials - Health Literacy Checklist:

1. Plain language 2. Metaphor & Analogy use. 3. Personalization 4. Chunk and Check 5. Design and Visual Aids.

The decision to add fluoride to community water systems is made at the state or local municipality level and is not mandated by any federal agency. A. True B. False

A. Recall that some states/local areas don't have it still.

The core function of public health that involves implementing appropriate programs to achieve desired goals is __________________________.

Assurance

Which of following is NOT a core function of public health? A. Assessment B. Organization C. Policy development D. Assurance

B

According to the ADA, what is the single most effective public health measure to prevent tooth decay? a. Creating a more diverse dental workforce that is representative of the population that it is treating b. Community Water Fluoridation c. Application of dental sealants by dentists d. Providing oral health services in school-based health centers Dr. Gordon

B. Community water fluoridation is population based strategies to prevent oral diseases. Very unique bc crosses racial divides, socioeconomic status, and really allows ppl to receive benefits of fluoride from their drinking water. Unfortunately, some communities haven't approved to have it.

By recognizing "Colorado Brown Stain" in his patients and investigating the etiology of the disease in Colorado Springs, Colorado, Dr. McKay utilized principles of? a. Behavioral Health b. Epidemiology c. Practice Management d. Data dissemination Dr. Gordon

B. Epidemiology - what disease was, source of disease, engage in community to determine why people have this disease / where the source came from.

A 10yr old patient with Down syndrome visits your dental office for a dental cleaning. You notice she is tired, sluggish, and complaining of being cold. You suggest to her parents that she go see her endocrinologist and test for signs of any hormone issues. Next time your patient returns, her parents report that she has a new update in her medications. The endocrinologist is most likely to prescribe which medication to treat your patient's hypothyroidism? A. Iron supplements B. Miralax C. Levothyroxine D. Docusate

C

Which of the following is NOT a goal of antiretroviral therapy (ART) for HIV? A. Suppress HIV VL to <50 copies/ml for as long as possible B. Restore immune function C. Obtain data for clinical trials on ART D. Improve quality of life

C

Which of the following is not an example of the 5 best practices for written communication A. Use clear and simple language B. Use of bullet points or numbering C. Use alliteration or rhymes to better help patients D. Use stories or concepts for comparison to help patients understand concepts

C

Which of the following is true? A. Severe fluorosis is commonly found in people who live in communities that have fluoridated water between .7 and 1.2 ppm. B. Fluoride was used in WWI as a form of mind-manipulation. C. Water fluoridation is a "top ten" public health achievement. D. Fluoride is a naturally found element with similar side-effects to naturally-found lead.

C

You have opened up a new practice in a new area you've never lived in. During the first few months of practice, you notice that many high school students are coming in with fractured teeth. Most of these students tell you that they're not using mouth guards when playing intramural sports. What is the ideal step that you can take to help prevent this issue? A. Advise parents to have their children wear mouth guards when playing sports B. Advise students to be more careful when playing sports C. Talk to the school system to discuss mandating mouth guards during sports D. Do nothing

C

An example of a dentist showing a level of cultural competence includes a. Promoting the use of traditional and culturally appropriate remedies for dental pain, rather than evidence-based, standard of care treatments. b. Referring an African-American patient to an African-American dentist for dental treatment. c. Recognizing and attempting to understand a patient's unique cultural background when educating, diagnosing, and treating dental diseases. d. Imposing one's own beliefs and practices on patients dr. gordon

C.

Which of the following is FALSE? A. The HIV Care Continuum/Cascade begins with diagnosis of HIV B. The only way to know for sure that you're infected with HIV is to get an HIV test C. People who don't know that they're HIV+ can unknowingly pass HIV to others D. More than 10 million people in the U.S. are currently living with HIV

D. (about 1.2 million with HiV)

"ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. Establishment of this begins no later than 12mo of age and includes referral to dental specialists when appropriate." Dr. Perlman

Dental Home

According to Dr. Silk's (Perlman?) lecture, the ____________________ is the ongoing relationship between the dentist and patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, family-centered way.

Dental home

Which of the following words would be appropriate to use in a plain language flyer for elementary school children? A. Cavities B. Caries C. Radiographs D. X-rays E. A and D

E

Which of these is not associated with Autism? A. Epilepsy B. Sleep Disorders C. Intellectual disability D. Motor impairments E. Engage in wide range of activities

E

Who is at risk of limited health literacy? A. older adults B. minority populations C. people with limited education D. people with lower socioeconomic status E. all of the above

E

Which of the following is NOT a determinant of health? A. Genetics B. Age C. Gender D. Ethnicity E. All of the above are determinants of health

E.

Which of the following is NOT a target for antiviral drugs? A. Fusion B. Integrase C. Reverse transcriptase D. Protease E. All of the above are targets

E.

An 8-year-old patient presents with a stiff, tightly curved hand and spasticity. This condition causes your patient extreme pain and they need ongoing physical therapy and medication. What does your patient have? E. Diabetes F. Cerebral palsy G. Osteoporosis H. Seizure disorder

F

Dr. Allukian - Lecture Topic: 5 Community Water Fluoridation 1. Benefits of community water fluoridation 2. Myths about community water fluoridation 3. History of the discovery of the effects of fluoride on teeth Benefits: What is fluoride? How does fluoride help prevent dental decay? What is water fluoridation? How much fluoride is in your water? Fluoride additives? Natural vs adjusted? Effectiveness? Still effective? Discontinuance? Is decay still a problem? Adult benefits? Dietary supplements? Fluoride for children? Alternatives? Bottled water? Home treatment (filter) systems? Safety: Harmful to humans? More studies needed? Total intake? Daily intake? Prenatal dietary fluoride supplements? Body uptake? Bone health? Dental fluorosis? Prevent fluorosis? Warning label? Toxicity? Cancer? Enzyme effects? Thyroid gland? Pineal gland? Allergies? Genetic risk? Fertility? Down Syndrome? Neurological impact? Lead poisoning? Alzheimer's disease? Heart disease? Kidney disease? Erroneous health claims? Fluoridation practice: Water quality? Regulation? Standards? Source of additives? System safety concerns? Engineering? Corrosion? Environment? Public Policy: Valuable Measure? Courts of law? Opposition? Internet? Public Votes? International fluoridation? banned in Europe? Cost effectiveness: Cost effective? Practical?

Info below from ADA Fluoride Facts (sent in email): Sixty years ago, Grand Rapids, Michigan became the world's first city to adjust the level of fluoride in its water supply. Since that time, fluoridation has dramatically improved the oral health of tens of millions of Americans. Community water fluoridation is the single most effective public health measure to prevent tooth decay. Additionally, the Centers for Disease Control and Prevention proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century. Fluoridation of community water supplies is simply the precise adjustment of the existing naturally occurring fluoride levels in drinking water to an optimal fluoride level recommended by the U.S. Public Health Service (0.7 - 1.2 parts per million) for the prevention of dental decay. Based on data from 2002, approximately 170 million people (or over two-thirds of the population) in the United States are served by public water systems that are fluoridated. Studies conducted throughout the past 60 years have consistently indicated that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. It is the most efficient way to prevent one of the most common childhood diseases - tooth decay (5 times as common as asthma and 7 times as common as hay fever in 5- to17-year-olds). Early studies, such as those conducted in Grand Rapids, showed that water fluoridation reduced the amount of cavities children get in their baby teeth by as much as 60% and reduced tooth decay in permanent adult teeth nearly 35%. Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste. The average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. The American Dental Association continues to endorse fluoridation of community water supplies as safe and effective for preventing tooth decay. This support has been the Association's position since policy was first adopted in 1950. The ADA's policies regarding community water fluoridation are based on the overwhelming weight of peer-reviewed, credible scientific evidence. The ADA, along with state and local dental societies, continues to work with federal, state, local agencies and community coalitions to increase the number of communities benefiting from water fluoridation. BENEFITS: 1. What is fluoride? Naturally occurring compound that can help prevent tooth decay. 2. How does fluoride help prevent dental decay? It protects teeth in two ways - systemically and topically (aka the way they are applied). 3. What is water fluoridation? Is the adjustment of the natural fluoride concentration of fluoride-deficient water to the level recommended for optimal dental health. 4. How much fluoride is in your water? If your water comes from a public/community water supply, the options to learn the fluoride level of the wa- ter include contacting the local water supplier or the local/county/state health department, reviewing your Consumer Confidence Report (CCR) and using the Inter- net based "My Water's Fluoride." If your water source is a private well, it will need to be tested and the results obtained from a certified laboratory. 6. Is there a difference in the effectiveness between naturally occurring fluoridated water (at optimal fluoride levels) and water that has fluoride added to reach the optimal level? No. The dental benefits of optimally fluoridated water occur regardless of the fluoride's source. 7. Is water fluoridation effective in helping to prevent dental decay?Overwhelming evidence exists to prove the effective- ness of water fluoridation. Water fluoridation is a very effective method for preventing dental decay for chil- dren, adolescents and adults. Continued assessment, however, is important as the patterns and extent of dental decay change in populations. 8. With other forms of fluoride now available, is water flu- oridation still an effective method for preventing dental decay?Although other forms of fluoride are available, persons in nonfluoridated communities continue to demon- strate higher dental decay rates than their counterparts in communities with water fluoridation. 9. What happens if water fluoridation is discontinued? Over time, dental decay can be expected to increase if water fluoridation in a community is discontinued, even if topical products such as fluoride toothpaste and fluoride rinses are widely used. 10. Is dental decay still a serious problem? Yes. Tooth decay is an infectious disease that continues to be significant oral heath problem. 11. Do adults benefit from fluoridation? Fluoridation plays a protective role against dental de- cay throughout life, benefiting both children and adults. In fact, inadequate exposure to fluoride places children and adults in the high risk category for dental decay. 12. Are dietary fluoride supplements effective? For children who do not live in fluoridated communities, dietary fluoride supplements are an effective alternative to water fluoridation for the prevention of dental decay. 13. Does the ADA recommend fluoride for children under six years of age? Yes. The ADA recognizes that lack of exposure to fluo- ride places individuals of any age at risk for dental decay. Fluoride exposure may take many forms including wa- ter fluoridation and dietary fluoride supplements. 14. In areas where water fluoridation is not feasible be- cause of engineering constraints, are alternatives to water fluoridation available? Yes. Some countries outside the United States that do not have piped water supplies capable of accommodat- ing community water fluoridation have chosen to use salt fluoridation. 15. Can the consistent use of bottled water result in indi- viduals missing the benefits of optimally fluoridated water? Yes. The majority of bottled waters on the market do not contain optimal levels (0.7-1.2 ppm) of fluoride. 16. Can home water treatment systems (e.g. water filters) affect optimally fluoridated water supplies? Yes. Some types of home water treatment systems can reduce the fluoride levels in water supplies potentially decreasing the decay-preventive effects of optimally fluoridated water. SAFETY: 17. Does fluoride in the water supply, at the levels recom- mended for the prevention of dental decay, adversely affect human health? The overwhelming weight of scientific evidence indi- cates that fluoridation of community water supplies is safe. 18. More studies needed / Are additional studies being conducted to determine the effects of fluorides in humans? Yes. Since its inception, fluoridation has undergone a nearly continuous process of reevaluation. As with other areas of science, additional studies on the effects of fluorides in humans can provide insight as to how to make more effective choices for the use of fluoride. The American Dental Association and the U.S. Public Health Service support this on-going research. 19. Does the total intake of fluoride from air, water and food pose significant health risks? The total intake of fluoride from air, water and food, in an optimally fluoridated community in the United States, does not pose significant health risks. 20. How much fluoride should an individual consume each day to reduce the occurrence of dental decay? The appropriate amount of daily fluoride intake var- ies with age and body weight. As with other nutrients, fluoride is safe and effective when used and consumed properly. 21. Is there a need for prenatal dietary fluoride supplementation? There is no scientific basis to suggest any need to in- crease a woman's daily fluoride intake during preg- nancy or breastfeeding to protect her health. At this time, scientific evidence is insufficient to support the recommendation for prenatal fluoride supplementation for decay prevention for infants. 22. When fluoride is ingested, where does it go? Much of the fluoride is excreted. Of the fluoride retained, almost all is found in calcified (hard) tissues, such as bones and teeth. Fluoride helps to prevent dental decay when incorporated into the teeth. 23 .Will the ingestion of optimally fluoridated water over a lifetime adversely affect bone health? No, the ingestion of optimally fluoridated water does not have an adverse effect on bone health. 24. What is dental fluorosis? Dental fluorosis is a change in the appearance of teeth and is caused when higher than optimal amounts of fluoride are ingested in early childhood while tooth enamel is forming. The risk of dental fluorosis can be greatly reduced by closely monitoring the proper use of fluoride products by young children. 25. What can be done to reduce the occurrence of dental fluorosis in the U.S.? The vast majority of dental fluorosis in the United States can be prevented by limiting the ingestion of topical fluoride products (such as toothpaste) and the appropriate use of dietary fluoride supplements with- out denying young children the decay prevention ben- efits of community water fluoridation. 26. Why is there a warning label on a tube of fluoride tooth- paste? The American Dental Association originally required manufacturers to place a label on fluoride toothpaste in 1991 to ensure proper use and therefore reduce the risk of dental fluorosis. 27. Is fluoride, as provided by community water fluoridation, a toxic substance? No. Fluoride, at the concentrations found in optimally fluoridated water, is not toxic according to generally ac- cepted scientific knowledge. 28. Does drinking optimally fluoridated water cause or ac- celerate the growth of cancer? According to generally accepted scientific knowledge, there is no association between cancer rates in humans and optimal levels of fluoride in drinking water. 29. Does fluoride, as provided by community water fluori- dation, inhibit the activity of enzymes in humans? Fluoride, in the amount provided through optimally flu- oridated water, has no effect on human enzyme activity according to generally accepted scientific knowledge. 30. Does the ingestion of optimally fluoridated water ad- versely affect the thyroid gland or its function? There is no scientific basis that shows fluoridated water has an adverse effect on the thyroid gland or its function. 31. Does water fluoridation affect the pineal gland causing the early onset of puberty? Generally accepted science does not suggest that wa- ter fluoridation causes the early onset of puberty. 32. Can fluoride, at the levels found in optimally fluoridated drinking water, alter immune function or produce aller- gic reaction (hypersensitivity)? Answer. There is no scientific evidence of any adverse effect on specific immunity from fluoridation, nor have there been any confirmed reports of allergic reaction. 33. Is fluoride, as provided by community water fluorida- tion, a genetic hazard? Answer. Following a review of generally accepted scientific knowledge, the National Research Council of the National Academy of Sciences supports the conclu- sion that drinking optimally fluoridated water is not a genetic hazard. 34. Does fluoride at the levels found in water fluoridation affect human reproduction, fertility or birth rates? Answer. There is no credible, scientific evidence that fluorida- tion has an adverse effect on human reproduction, fer- tility or birth rates. 35. Does drinking optimally fluoridated water cause an increase in the rate of children born with Down Syndrome? Answer. There is no known association between the consump- tion of optimally fluoridated drinking water and Down Syndrome. 36. Does ingestion of optimally fluoridated water have any neurological impact? Answer. There is no generally accepted scientific evidence es- tablishing a causal relationship between consumption of optimally fluoridated water and central nervous sys- tem disorders, attention deficit disorders or effects on intelligence. 37. Does drinking fluoridated water increase the level of lead in the blood or cause lead poisoning in children? Answer. Generally accepted scientific evidence has not shown any association between water fluoridation and blood lead levels. 38. Does drinking optimally fluoridated water cause Alzheim- er's disease? Answer. Generally accepted science has not demonstrated an association between drinking optimally fluoridated wa- ter and Alzheimer's disease. 39. Does drinking optimally fluoridated water cause or con- tribute to heart disease? Answer. Drinking optimally fluoridated water is not a risk factor for heart disease. 40. Is the consumption of optimally fluoridated water harm- ful to kidneys? Answer. The consumption of optimally fluoridated water has not been shown to cause or worsen human kidney disease. 41. What are some of the erroneous health claims made against water fluoridation? Answer: From sources such as the Internet, newsletters, and personal anecdotes in e-mails, community water fluo- ridation is frequently charged with causing all of the following adverse health effects: AIDS, allergic reactions, Alzkhiemers disease, Asthma, Behavioral problems, bone disease, cancer, chronic bronchitis, colic, down syndrome, etc... AND tooth decay. FLUORIDATION PRACTICE: 42. Will the addition of fluoride affect the quality of drinking water? Answer. Optimal levels of fluoride do not affect the quality of water. All ground and surface water in the United States contain some naturally occurring fluoride. 43. Who regulates drinking water additives in United States? Answer. The United States Environmental Protection Agency regulates drinking water additives. 44. What standards have been established to ensure the safety of fluoride additives used in community water fluoridation in the United States? Answer. The three fluoride additives used in the U.S. to fluori- date community water systems (sodium fluoride, so- dium fluorosilicate, and fluorosilicic acid) meet safety standards established by the American Water Works Association (AWWA) and NSF International (NSF). 45. What is the source of the additives used to fluoridate water supplies in the United States? Answer. Fluoride additives used in the United States are derived from the mineral apatite. 46. Does the process of water fluoridation present unusual safety concerns for water systems and water operators? Answer. No. With proper planning, maintenance and monitor- ing, water fluoridation is a safe process. 47. Does fluoridation present difficult engineering problems? Answer. No. Properly maintained and monitored water fluo- ridation systems do not present difficult engineering problems. 48. Will fluoridation corrode water pipes or add lead, arse- nic and other toxic contaminants to the water supply? Answer. Allegations that fluoridation causes corrosion of water delivery systems are not supported by current scientific evidence.36 Furthermore, the concentrations of con- taminants in water as a result of fluoridation do not ex- ceed, but, in fact, are well below regulatory standards set to ensure the public's safety. 49. Does fluoridated water harm the environment? Answer. Scientific evidence supports the fluoridation of public water supplies as safe for the environment and benefi- cial for people. PUBLIC POLILCY: 50. Is water fluoridation a valuable public health measure? Answer. Yes. Water fluoridation is a public health measure that benefits people of all ages, is safe and is a community public health program that saves money. 51. Has the legality of water fluoridation been upheld by the courts? Answer. Yes. Fluoridation has been thoroughly tested in the United States' court system, and found to be a proper means of furthering public health and welfare. No court of last resort has ever determined fluoridation to be unlawful. Moreover, fluoridation has been clearly held not to be an unconstitutional invasion of religious free- dom or other individual rights guaranteed by the First, Fifth or Fourteenth Amendments to the U.S. Constitu- tion. And while cases decided primarily on procedural grounds have been won and lost by both pro and anti fluoridation interests, to ADA's knowledge no final rul- ing in any of those cases has found fluoridation to be anything but safe and effective. 52. Why does opposition to community water fluoridation continue? Answer. Fluoridation is considered beneficial by the overwhelm- ing majority of the health and scientific communities as well as the general public. However, a small faction continues to speak out against fluoridation of municipal water supplies. Some individuals may view fluorida- tion of public water as limiting their freedom of choice; other opposition can stem from misinterpretations or inappropriate extrapolations of the science behind the fluoridation issue. 53. Where can reliable information about water fluorida- tion be found on the Internet and World Wide Web? Answer. The American Dental Association, as well as other rep- utable health and science organizations, and govern- ment agencies have sites on the Internet/Web that pro- vide information on fluorides and fluoridation. These sites provide information that is consistent with gener- ally accepted scientific knowledge. 54. Why does community water fluoridation sometimes lose when it is put to a public vote? Answer. Voter apathy or low voter turnout due the vote being held as a special election or in an "off" year, confusing ballot language (a "no" vote translates to support for fluoridation), blurring of scientific issues, lack of leader- ship by elected officials and a lack of political campaign skills among health professionals are some of the rea- sons fluoridation votes are sometimes unsuccessful. 55. Is community water fluoridation accepted by other countries? Answer. Over 405 million people in more than 60 countries worldwide enjoy the benefits of fluoridated water. 56. Is community water fluoridation banned in Europe? Answer. No country in Europe has banned community water fluoridation. COST EFFECTIVENESS: 57. Is water fluoridation a cost-effective means of prevent- ing tooth decay? Answer. Yes. Fluoridation has substantial lifelong decay preven- tive effects and is a highly cost-effective means of pre- venting tooth decay in the United States, regardless of socioeconomic status 58. Why fluoridate an entire water system when the vast majority of the water is not used for drinking? Answer. It is more practical to fluoridate an entire water supply than to attempt to treat individual water sources.

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The collection and dissemination of data about fluorosis by Dr. H. Trendley Dean, who also utilized principles of epidemiology and surveillance systems describes which core public health function? a. Assurance b. Assessment c. Policy Development d. Shared Decision-Making Dr. GOrdon

b. He assessed the situation, collected data through the studies, and then used that data to make some change and figure out that its 1 part per million of fluoride thats optimum in drinking water.

As a dental care professional, it's your responsibility to think __________________ and act __________________ as one reaches out to other care providers and people in the community that could help promote oral health.

think metaprofessionally & act interprofessionally

List three risk factors for osteoporosis? a. ____________________ b. ____________________ c. ____________________

use of antiepileptics (64%) Immobility (23%) history of falls (20%)