4/4/2019
Down and Dirty The Effects of Oral Biofilm on Systemic Health
By: Susie Keepper MSN, APRN-CNS, RDH
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z I have nothing to disclose. z z Disclosure
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z z What To Do? z
°What is wrong with this patient?
°Where do I begin?
°What EBP do I search for?
°Who do I call?
°What do I prescribe?
°Are they going to eat me? °HELP!!
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z z OBJECTIVES Discuss Discuss Oral Biofilm
Explain Explain How Oral Bacteria Relates to Systemic Health
Recognize Recognize Periodontal Disease
Identify Identify Medications Creating Xerostomia
Know Know Pharmacological Interventions
Discuss Discuss Smoking Cessation
Describe Describe Premedication Guidelines
Summarize Summarize Patient Oral Health Care Needs
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z What is the hardest substance in the body?
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z z What is Biofilm?
° Bacteria
° Plaque
° Mineralization
° Tarter/Calculus
° Periodontal Disease
° Oral Conditions
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z z z Systemic Involvement
°Visible calculus on x-rays
°Irritates gum issue
°Inflammatory response
°Tissue bleeds
°Systemic gateway
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z Radiograph of Periodontal Disease
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z z Periodontal Disease
° Halitosis
° Inflammation
° Bright Red Gums
° Receding gums
° Mobile Teeth
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z Vascular Disease
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z z Streptococcus Mutans (SM)
Most effective RX against SM
° Amoxicillin
° Penicillin G
° Chloramphenicol
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Mechanisms linking oral infection and periodontal disease to cardiovascular disease
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STROKE
Streptococcus sanguis Porphyromonas gingivalis
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z Infective Endocarditis
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z Diabetes
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z Ventilator Associated Pneumonia (VAP)
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9 4/4/2019 In VAP Bundle VAP In
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z z Prescription Peridex
° Oral chlorhexidine gluconate
° Substantivity for 12-hrs
° Stains teeth brown
° Stains composite restorations
° Bactericidal
° Cost $15
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z Helicobacter Pylori
° Treatment: Triple Therapy
° PPI before meals BID
° Clarithromycin 500 mg BID
° Amoxicillin 1g BID or (Metronidazole for PCN allergies)
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z z Did you know z flossing can add years to your life?
°Fresh breath
°No bleeding gums
°Reduced systemic involvement
°Decreased tooth decay
°Better self-image
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z z How long does it take a cavity to form?
A. 6 months
B. 1-2 years
C. 3-5 years
D. 7-8 years
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z What Causes Hyposalivation?
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z z Medications That Create Xerostomia
° Antidepressants
° Decongestants
° Antihistamines
° Muscle relaxants
° Appetite suppressants
° Diuretics
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z z How Dry I am!
° Anti-anxiety
° Anti-psychotics
° Anti-seizure
° Anti-cholesterol
° Narcotics
° Lung Inhalers**
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Sticky! z ° Anti-nausea
° Anti-diarrheal Antihypertensives
° ACE inhibitors
° Calcium channel blockers
° Beta Blockers
° Anti-arrhythmias Anti-Anything!
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z z Why is this important?
° No saliva to wash off bacteria
° Bacteria accumulates
° Calculus formation
° Gingivitis/Inflammation
° Bleeding gum tissue
° Creates bacteremia
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z z How to Treat Xerostomia
OTC with:
°Biotene
°Oasis
°Xerostom
°XyliMents
°Drink Water!
°DO NOT RECOMMEND LISTERINE!
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z z zPrescription NeutraSal
°Mimics natural saliva
°Single use packets
°1 box = 30 packets
°Cost: $24.99
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z Prescriptions- Saliva Stimulators
° Pilocarpine (Salagen) ° Cevimeline (Evaxac)
° 5 mg or 7.5 mg TID ° 30 mg TID
° Sjogren’s Syndrome ° Sjogren’s Syndrome
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z Prescription Peroex
z z • Oral chlorhexidine gluconate • Same properties as Peridex • Water based • Does not create xerostomia • Cost: $13
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z Peridex VS Peroex
Alcohol-Based: Xerostomia Water-Based
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z z Prescription PerioMed
° Stannous Fluoride
° Incorporates into the oral biofilm
° Bactericidal
° Bacteriostatic
° Cost: $18
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z z A growing fetus takes calcium from the mother’s teeth and causes tooth decay?
° True
° False
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z z Oral Conditions and Pharmacology
The more you know, better patient outcomes will be seen.
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z z Acute Herpetic Stomatitis
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z Burning Tongue Syndrome
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z z Angular Cheilitis
° Fungal Infection
° Cracked skin
° Bleeding
° Crustiness
° Itchy
° Painful
° Swollen
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Bisphosphonate-Associated Osteonecrosis (BON)
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Aphthous Ulcers or Canker Sores
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z Which body part shows the first signs of stress?
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z z Black Hairy Antibiotics
Smoking Tongue
Poor oral hygiene
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z First person who admits they are a smoker will win a prize!
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z z Smoking Cessation
° Chantix
° Bupropion
° Gum
° Patches
° Lozenges
° Dental Hygienist!
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z z
z Prevention of Infective Endocarditis Guidelines
Dental Related Guidelines Premed (antibiotic) must be given with prosthetic cardiac valve repairs or previous IE for the 1st six-months after the procedure. Premed for ALL dental procedures including routine cleanings!
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z z What type of brush should you use?
A. Hard
B. Medium
C. Soft
D. Super Soft
E. Wire
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z z Nurses Role in Oral Health
Barriers
° Pt discomfort
° Not important
° Lack of time
° Difficult
° Repulsive
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z What Grows in the Mouth? Gram Negative Bacteria
‹ Staphylococcus aureus
‹ Streptococcus pneumoniae
‹ Acinetobacter baumanii
‹ Haemophilus influenzae
‹ Pseudomonas aeruginosa
‹ Actinobacillus actinomycetemcomitans
‹ Porphyromonas gingivalis
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26 4/4/2019 BED SIDE ORAL EXAM SIDE BED ORAL
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z Health Care Providers: You Can Do It!
° Educate Staff
° Pediatric Toothbrush
° Low Foaming Toothpaste
° Glycerin Swabs
° Mouthwash
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z How Many Times a Day Should Patients’ Teeth be Brushed?
A. Once
B. Twice
C. After every meal
D. Before discharge
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z z
Special thanks to Dr. Matthew Walls for furnishing the prizes in todays presentation!
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z Questions and Comments
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