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HANDOUT LGP Secrets to Patient Compliance Ultimate Guide to Achieving Ultimate Guide to Achieving Periodontal Health Periodontal Health Secrets to Patient Compliance Secrets to Patient Compliance Trisha E. O’Hehir, MS, RDH Phone: 520-444-2279 Compliance — requires behavior change [email protected] Liz Graham, BS, RDH Phone: 707-769-8887 Education = behavior change [email protected] Liz Graham Presents *** Trisha O’Hehir Look for the Reactions Button The Future on the bottom of your Zoom screen I help people achieve with the Thumbs Up choice optimal oral health Cleaning! Thumbs up if you want to help patients Teeth ! achieve oral health rather than just clean teeth U of Minn NEW VISION 1967 Achieving Oral Health! How healthy do you want this patient to be? How healthy does the patient want to be? 15,000 in 1967 200,000 today DH school and board exams: the vision is calculus removal Health Manpower, United States, 1965-1967, National Center for Health Statistics, Series 14:1, 1968. Bureau of Labor Statistics, Occupational Employment and Wages, 2018. …with grades based on competencies grasp, fulcrum, insertion, activation… No requirement to help patients achieve health Not based on health outcomes! Focused on competencies How much of what we were taught in school was true? DH School didn’t teach me how to measure success Time for a Poll How successful is your treatment? My guess was 85% How successful is your treatment? Has anyone asked this of you? Periodontal Health Index (PHI) What is your success rate with periodontal therapy? 30 patients 1,916 pockets — 139 pockets 139 divided by 1,916 = 7% of pockets remained 93% of pockets were eliminated With the PHI, you can calculate your success rate Periodontal Health Index (PHI) Ideal is 0/0 Simple number - like blood pressure 24/38 - means more than just a few 4s and Number of pockets bleeding in the posterior number of bleeding points Goal: 0/0 Worst possible score - 168/168 Perio scores are often 25/100 to 85/140 Patient played tennis with a dentist friend Current score = 3/5 Baseline score = 86/122 Pocket reduction: 97% Bleeding reduction: 96% Evidence Based Dentistry Slot, DE, Van der Weijden, F. Insufficient evidence to determine the effects of routine scale and polish treatments. 2014 Bader, J. Insufficient evidence to understand effect of routine scaling and polishing. 2005 Cochrane Review Routine Scale and Polish for Periodontal Health in Adults - 2018 Scale and polish every 6-12 months vs no DH visits for three years -makes little or no difference in gingivitis, probing depths, bleeding upon probing and oral health-related quality of life The Future Poll Time What keeps you from achieving health for your I help people achieve patients? optimal oral health Too much calculus to remove Too much periodontal disease Not enough time Lack of adequate instruments/equipment Cleaning! Poor patient compliance Teeth ! Something else Breakout Rooms If there is one thing that would make your work Three secrets to make your easier and more successful what would it be? workday easier and I know some of you would like to fire the dentist and work independently, and I’m all for perio patients healthier. independence, but just for now, what would make working in your current position better and more successful in achieving health for all your Are you interested? patients? Do you and your breakout colleagues agree on the one change or does it vary significantly among you? Secrets Three secrets to make your workday easier and 1. Improve oral/systemic health perio patients healthier. 2. Prevent interdental bleeding Are you interested? 3. Prevent supragingival calculus How can we help patients achieve optimum oral health? 1.Biofilm good or bad 2.Impacting the biofilm 3.Health behavior change Biofilm - it’s a complex ecosystem worthy of our respect 1.Biofilm good or bad 1.Biofilm good or bad 2.Impacting the biofilm 3.Health behavior change Biofilm - it’s a complex ecosystem worthy of our respect Too bad 1.Biofilm good or bad plaque Caries Periodontal Diseases biofilm Bad Breath isn’t green! What do Does it your teeth feels like feel like the teeth when you are wake up? wearing Does it Does it feels like feels like the army the bottom marching of a bird through? Or does it feel just plain fuzzy! fimbria Biofilm Formation fibrills Text Quorum sensing 1/3 bacteria 2/3 slime - to absorb water and trap particles Biofilm grows in a fluid environment: saliva and crevicular fluid Bacterial toxic waste subgingivally includes endotoxins that penetrate pocket walls and trigger the immune response destroying tissue and bone Biofilm - it’s a complex ecosystem Biofilm - it’s a complex ecosystem worthy of our respect worthy of our respect DH School didn’t me teach this Pathogenesis Review of Histology Infection & inflammation • outer epithelium • rete pegs • junctional epithelium • connective tissue • capillaries • bone Diagram from text: Periodontal Disease, Page, Schluger and Youdalis. Bacterial endotoxin and antigen bacterial endotoxins Translate bacterial antigens Permeation Agents VSCs cell Volitle Sulfur biology Compounds into hydrogen sulfide and cartoons methal mercaptan • Signals alert the immune system Vasodilation • Mast cells around the blood vessels Endotoxins also trigger a cascade of immune release histamine, responses to protect the causing body from bacteria and vasodilation viruses • PMNs are sent to the area • PMNs release chemical machetes or Cytokines PMN MMP PMN Endothelial cells separate PMN to allow PMNs to exit the prostaglandin blood vessel PMN (pre-term birth) PMN interleukin collagenase PMNs cytokines Breakdown of GAGS Glue glycosamino- glycans MyPerioID® Breakdown of IL-6 active the transport system Krebs Cycle Mitochondria ATPs With oxygen - 24-28 ATP molecules from one molecule of glucose converted to pyruvate, plus the 4 molecules from glycolysis. Not just one mitochondria per cell, but as many as 2,000 in each liver cell • Mitochondria •Uses sugar and oxygen to generate energy for the cell •Energy stored as chemical bonds oxidative stress •With too much “sugar” there is an increase in oxidative stress which leads to inflammation Mitochondria Goal is equilibrium With adequate oxygen and good nutrition, the antioxidant defenses will control free radicals and keep ROS within the cells where they were produced. When free radicals and ROS exit the cell = inflammation Mitochondria Goal is equilibrium Too much refined carbohydrate = mitochondrial dysfunction •Oxidative stress •DNA alternations in the mitochondria •Reduced numbers of mitochondria Inflammation Bleeding is not normal It’s a sign of infection Too much sugar in the blood stream damages blood vessels. Endothelial cells take in too much glucose - causing damage Bleeding is not normal Bleeding is not normal Sugars in the Too much sugar in It’s a sign of infection It’s a sign of infection blood stream bond the blood stream with protein or fat damages blood producing vessels. advanced glycation end-products Endothelial cells (AGEs) take in too much glucose - causing Fructose - 10 X damage glycation than DH School didn’t teach me this glucose Infection and Bleeding is not normal Sugars in the It’s a sign of infection blood stream bond Inflammation with protein or fat • pocket epithelium producing • scar formation in advanced glycation connective tissue end-products • bone loss (AGE) • small band of connective tissue Fructose - 10 X attachment glycation than • capillary formation Oxidative Stress glucose WARNING Biofilm outside the body photo courtesy of Dr. Randall Wolcott After Treatment with Xylitol Medicine Learns from Non-Healing Chronic Wound and Lactoferrin Dental Hygiene photos courtesy of Dr. Randall Wolcott Biofilm causes ear infections Biofilm causes ear infections Biofilm Look at your Toes causes ear infections Squirt your Nose Bacteria and viruses Inflammation and Airway Study Dr. Talal Nsouli, Georgetown Univ, 2015 Trisha - text Nathan SNOT-20 (Sino-Nasal Outcome Test) Score reduced 25% Peak Airflow Increased 36% SNOT-20 Bacterial Adhesion Study (Sino-Nasal Outcome Test, 0 to 5 score) Dr. Tero Kontiokaria, et al - 1998 1. Need to blow nose 11. Difficulty falling asleep 2. Sneezing 12. Wake up at night Bacterium 3. Runny nose 13. Lack of sleep Streptococcus 4. Cough 14. Wake up tired Pneumoniae 5. Post-nasal discharge 15. Fatigue 6. Thick nasal discharge 16. Reduced productivity Reduced from 7. Ear fullness 17. Reduced concentration 41 bacteria 8. Dizziness 18. Frustrated/restless per cell to 13 per cell 9. Ear pain 19. Sad/irritable 10. Facial pain/pressure 20. Embarrassed 68% reduction Addiction to Side effects of oxymetazoline hydrochloride Pharmaceutical Nasal Spray • blurred vision • fast, irregular or pounding Nasacort heartbeat Affrin Simply Saline • headache,dizziness, drowsiness or lightheadedness Zicam NeilMed • high blood pressure Flonase • increase in runny or stuffy nose • Rhinocort nervousness • trembling Polymerase Chain Reaction (PCR) Polymerase Chain Reaction (PCR) Invented by Kary Mullis Invented by Kary Mullis Nobel Prize in Chemistry - 1993 Nobel Prize in Chemistry - 1993 • PCR - photocopy the virus Cycle Threshold (CT) • LSD was involved • Currently 40 CT • So was a talking fluorescent • More accurate at 30CT raccoon (63% no long positive) Nose is the source of 90% of SARS-CoV-2 Xylitol and SARS-CoV-2 University of North Carolina - Chapel Hill - 2020 Conclusion: nasal lavages, topical antivirals or immune modulation might be beneficial. Utah State University Destroys University of Geneva COVID in University of Tennessee 15 minutes Xylitol and COVID19 Symptoms
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