Put More Bite Into Health Promotion

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Put More Bite Into Health Promotion

• Overview

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Put More Bite into Health Promotion

• What does it mean?

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Health Promotion Yesterday.

• Brushing and Flossing

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Today...

• General Health Promotion
• in the
• Army Dental Clinics
• for
• Total Health of the Soldier

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Health Promotion is a

• KEY FORCE MULTIPLIER
• and deals with the human side of readiness by
  striving to keep service members physically,
  mentally, and spiritually fit.

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Army Dental Care System

• Why Us ?

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ADCS Vision

• The Armys dental care system of choice, focused
  on readiness, health promotion and exceeding our
  customers expectations.

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TSGs Top 20

• On- and Off-the-job
• Disease Injury Prevention
• are top priorities of
• LTG Blanck
• The Army Surgeon General

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TSGs 4 Ps

• Productivity
• Prevention - education, early disease detection
• Practice Guidelines
• People

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We Know . . .

• Todays Army
• is a
• YOUNG Army . . .
• 25 years old or younger

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We Know . . .

• 90 of all soldiers
• are seen in our
• dental clinics
• annually

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The ADCS

• is capable of having a sizeable impact
• on reducing health care costs through eliminating
  preventable disease and injury

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Objective of the Health Promotion Initiatives

• Put more dental into health promotion and put
  more health promotion into the dental care
  system.
• MG Patrick Sculley

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Partnering . . .

• U.S. Army
• Center for Health Promotion
• and
• Preventive Medicine
• (USACHPPM)

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• DENCOM and USACHPPM
• are separate commands - neither has the authority
  to direct the other what to do.

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• The only way DENCOM and USACHPPPM can jointly
  accomplish anything is through a partnership.

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• To accomplish this objective, DENCOM and USACHPPM
  devised the
• Put More Bite Into Health Promotion Campaign

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Guidelines Followed in Developing Bite

• Be mindful of provider curative workload
• Be mindful of need for provider buy-in
• Craft a well-focused, narrow, doable, politically
  acceptable agenda
• Make initiatives evidence based
• Literature Review Research

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Initial Package

• 5 Health Promotion Initiatives
• 4 - patient oriented initiatives
• 1 - provider oriented initiative

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Initial Package

• Tobacco Intervention
• Sealants
• Mouthguards
• Skin, Lip and Oral Cancer
• Put Prevention Into Practice

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• Rationale for Bite
• Patient-oriented
• Health Promotion Initiatives

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Put Prevention Into Practice

• Revitalize health promotion in the ADCS
• Educate everyone
• TEAM approach

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TEAM

• T each
• E very
• A vailable
• M oment

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Challenges to changing health related behaviors

• Everybody loves to learn but nobody likes to be
  taught.
• -Winston Churchill

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• HP Messages delivered
• through
• Multiple Channels

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Old Clinical Axiom

• What is said is
• NOT
• What is heard

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Multiple Channels

• Oral
• Written
• Visual

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Fact Sheets

• Adult Mouthguards / Sealants
• Sun Smart Quiz
• Sunscreens
• Sealants / NBTD
• Lip Cancer / Oral Cancer
• Dental IQ

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TEAM Approach

• Clinic Waiting Room
• Video Loops
• Posters
• Pamphlets
• Static Display

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TEAM Approach

• Clinical Staff
• Patient Interviews
• Reinforce Positive Lifestyles
• Reinforce Oral Messages with written materials
• Referrals

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Why Mouthguards
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Objectives of the Bite Mouthguard Initiative

• Inform practitioners about the incidence of
  oro-facial trauma and the role mouthguards play
  in their prevention
• Have practitioners educate patients and coaches
  about mouthguards
• Convince practitioners to fabricate more
  mouthguards
• Inform practitioners about the types of
  mouthguards and barriers to their use

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Mouthguard Initiative

• Promote Awareness and use of Mouthguards
• Educate / Fabricate / Motivate

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Mouthguards

• Military population is highly athletic
• American Academy for Sports Dentistry recommends
  MGs for 40 sports - including skydiving

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Types of Impact Injuries in Sports

• participant
• apparatus (e.g. bat)
• projectile (e.g., ball or puck)
• (Pinkham Kohn, Dent Clinics N Amer 35609-26,
  1991)

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Sports with Mandatory Mouthguard Rules for
Practice and Competition

• Amateur
• boxing
• football
• ice hockey
• mens lacrosse
• womens field hockey
• Professional
• boxing

(Ranalli and Lancaster, J Public Health Dent 53
96-100, 1993)
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ADA Endorsement of Mouthguards

• 1960 - first resolution endorsing use of
  mouthguards passed
• 1985 - resolution supporting the use of
  mouthguards for all sports where risk of injury
  is significant passed.
• (Johnsen Winters, Dent Clinics N Amer
  35657-66, 1991)

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Protective Benefits of Mouthguards

• reduce tooth fractures dislocations
• protect against intraoral soft tissue lacerations
  bruises
• protect against jaw fractures by absorbing energy
  from traumatic blows to the chin
• prevent upward backward displacement of
  mandibular condyle
• (Johnsen Winters, Dent Clinics N Amer
  35657-66, 1991)
• may protect against brain concussions by
  cushioning shock from a blow to the jaw
  preventing transmission of the shock through the
  TMJ to the skull
• (Blum Kranz, J Dent Children 4922-24, 1982)

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Cost/Benefit of Mouthguards

• Total rehabilitative costs for a single
  knocked-out tooth are more than 20 times that of
  a custom-made mouthguard.
• 200,000 (est.) football injuries per year are
  prevented by mouthguards. (ADA Council on Dental
  Materials, JADA 10984-7, 1984)
• Incidence of facial dental injuries per 100
  players declined from 2.2 to 0.3 following
  adoption of face-mask mouthguard regulations.
  (Heintz, JADA 77632-36, 1968)
• Dental treatment for teeth avulsed by youngsters
  trying to slam-dunk basketballs ranged from
  35-2,200, with a mean cost of 929. (Kumamoto
  et al JADA 1281273-74, 1997)

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Rugby

• Poll of 1987 U.S. World Cup Team
• 95 believe mouthguards protect
• 50 wear mouthguards
• (Chapman, Am J Sports Med 17690-91, 1989)

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Injury Prevention
On- and Off-the-job Injury Prevention is
one of the top priorities of LTG Blanck, the
Army Surgeon General.
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Injury Prevention

• Ankle injuries and HEAD TRAUMA tie as the
  leading cause of MAJOR injuries in IDF
  paratroopers.
• Overall injury rate 0.89 or 9/1000 plane jumps.
• Earlier studies show injury rates of 0.3-1.4
  or 3.1-14/1000 plane jumps. (Bar-Dyan,
  Bar-Dyan, Shemer, Milit Med 1631-2, 1998)

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Types of Mouthguards

• Stock
• Boil-and-bite
• Custom-made

(Padilla Balikov, CDAJ 2127-37, 1993)
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Improper Fit Means Suboptimal Protection

• Arch length studies show the largest sized
  mouth-formed mouthguard available fails to
  properly cover all posterior teeth in 85 of high
  school college athletes.
• (Kuebeker, Morrow, Cohen, Physicians Sports
  Medicine 1469-74, 1986)

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Why Athletes Dont Use Mouthguards

• lack of awareness
• may not know mouthguards are recommended for
  the sports they engage in
• use not encouraged by coach
• not mandatory for the sports they engage in
• object to mouthguard use

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Educating Patients About Mouthguards
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Points to Emphasize Orally

• If you play sports, you may need a mouthguard
• Mouthguards will help protect your teeth against
  fractures and loss from sports injuries
• Custom-made mouthguards offer the best protection

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Mouthguards Should Be Checked Regularly for

• Distortions
• Bite-throughs
• Tears
• If present, replace.

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Mouthguard Initiative

• Educate / Fabricate / Motivate.
• US Army Dental Laboratory
• at Ft Gordon
• Send Models to ADL
• ADL will FABRICATE MGs
• DENTACs will complete final fit and trim

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Put More Bite IntoHealth Promotion

• Sealant Initiative

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Sealant - a thin plastic coating applied to pit
and fissure surfaces of teeth.
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Objectives of the Bite Sealant Initiative

• Correct practitioner misperceptions about
  sealants
• Make the case for sealants in the military
  population
• Have practitioners educate patients about
  sealants
• Convince practitioners to place more sealants

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Common Practitioner Misperceptions About Sealants

• Sealants lock in dental decay.
• Sealants are for kids.
• Sealants dont stay in place.

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Common Practitioner Misperceptions About Sealants

• Sealants lock in dental decay

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• seal out decay-causing microorganisms
• make decay-causing mircoorganisms non-viable
  by sealing out food and air.
• (Siegal, Farquhar, and Bouchard, Public Health
  Rpt 11298-107, 1997)

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Dentists fear of inadvertently sealing in
caries is unfounded and should no longer be a
concern.(Swift, JADA 116 700-04, 1988)
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A small cavity can be arrested by a
sealant.(Handelman, Leverett, and Iker, J.
Pedod 9119-26, 1985 Mertz-Fairhurst, Schuster,
and Fairhurst, JADA 112 194-97, 1986)
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Old Sealant Need Guidelines

• Sealants are indicated only within 4 years of a
  tooths eruption.

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New Sealant Need Guidelines

• Age should not be a factor in determining sealant
  need - degree of risk for caries is uniform.
• (Workshop on Guidelines for Sealant Use, J Public
  Health Dent 55 263-73, 1995)

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Why Sealant Guidelines Changed

• longitudinal study in Coast Guard cadets
  established that sealants are appropriate for
  adults.
• 33 of CG cadets had sound pit fissure tooth
  surfaces at entry to the academy that became
  decayed by graduation.
• timely application of sealants could have
  preserved these surfaces.
• (Stahl and Katz, J Public Health Dent 53 212-18,
  1993)

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New Sealant Need Guidelines

• Age should not be a factor in determining sealant
  need - degree of risk for caries is uniform.

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Sealants are notcost-effective if applied to all
patients without regard to diet, caries activity,
etc.(Burke, J Irish Dent Assn 36 13-15, 1990)
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Apply Sealants On Teeth With

• no evidence of decay but judged to be at risk
• questionable caries
• definite caries confined to the enamel of pits
  fissures
• (Workshop on Guidelines for Sealant Use, J Public
  Health Dent 55 263-73, 1995)

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Common Practitioner Misperceptions About Sealants

• Sealants dont stay in place

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Sealant Retention After a Single Application
92-96 1 year 67-82 5
years 41-57 10 years
28 15 years (Ripa, Caries Res 27 77-82,
1993 Mertz-Fairhurst, J Dent Educ 48 18-25,
1984 Simonson, JADA 122 34-42, 1991)
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By placing a sealant, checking it annually, and
replacing it, as necessary, one can improve the
retention of sealants to nearly 100.
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Factors Contributing to Decline in Dental Caries

• Fluoride (smooth surfaces)
• Better oral hygiene
• Diet changes

(Soderholm, J Public Health Dent 55 302-11, 1995)
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Sealants have contributed relatively little to
the overall decline in caries.(Soderholm, J
Public Health Dent 55 302-11, 1995)
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Sealant Prevalence in U.S. Military Recruits by
Age
AGE
1994TSCOHS
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Sealant Prevalence in Active Duty U.S. Military
Personnel by Age
AGE
1994TSCOHS
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Points to Emphasize Orally

• Sealants are appropriate for all ages
• Sealants prevent tooth decay
• Sealants are plastic coatings applied to teeth
  to seal out decay
• A dental drill and shot are not required to
  place a sealant
• Once placed, sealants should be checked at
  least annually

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Skin, Lip Oral Cancer

• 800,000 new cases of skin cancer annually
• 30,00 new cases of oral cancer annually
• Early detection is key to high survival rate

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SLO Cancer Risk Factors

• Sun Exposure
• Tobacco
• Alcohol

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Sun Exposure

• Minimize sun exposure
• Use SPF 15 sunscreen, even on overcast
  days
• Avoid the sun between 10am-3pm

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Skin, Lip Oral Cancer Awareness / Screening
Initiative

• Promote Awareness
• Cancer Risk Factors
• Protective Measures
• Screenings Referrals

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• Tobacco Intervention

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Tobacco Kills

• Over
• 400,000 people each year

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Tobacco Kills

• More people than heroin, cocaine,alcohol, AIDS,
  fires, homicides, suicides and automobile
  accidents COMBINED

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• Thats the equivalent of TWO fully-packed jumbo
  jets colliding everyday and leaving
• NO SURVIVORS.

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We Know

• If a person isnt a tobacco user by age 18, he
  will most likely never use tobacco, unless . . .

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• That person is in the
• MILITARY.

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Tobacco Intervention

• Active duty compared to recruits
• Limited to enlisted only with lt 5 years service
• Standardized for age, sex, and race
• (TSOHS)

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Time Pressures

• Recommended Guidelines to be performed by primary
  care providers
• 3 minutes or less

• 4
• 1 - Hour
• Classes

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TEAM Approach

• T each
• E very
• A vailable
• M oment

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Tobacco Interdiction / Cessation

• Encourage non-smokers
• not to start.

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4 As

• Ask
• Advise
• Assist
• Arrange

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Great American Smokeout

• 16 November 2000

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Great American Smokeout

• Sponsored by the (ACS)American Cancer Society
• 3rd Thursday in November
• 16 Nov 00

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ACS Supplies

• Posters
• Pamphlets
• Stickers
• Quit Kits
• Press Kits

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Light-hearted, Fun, Upbeat

• Against TOBACCO Products,
• NOT
• Tobacco Users

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• Adopt a Tobacco-User

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ACS Homepage

• American Cancer Society
• http//www.cancer.org
• Download information
• Xerox
• Distribute
• Have Fun!

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Tobacco Websites

• Tobacco Intervention Networkhttp//www.quittobacc
  o.com
• Oregon Mint Snuff Company www.mintsnuff.com

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Other Resources

• American Lung Association
• American Heart Association
• National Cancer Institute
• Your local MEDDAC/MEDCEN

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Partnering with your local MEDDAC/MEDCEN

• Army Community Health Nursing
• Internal Medicine
• Dermatology
• Dieticians
• Wellness Center

• ACS
• Fitness Center
• Sports Branch

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Resource Manual

• Overview
• Media Tool Kit
• Resources
• PPT Slides for All Initiatives

• References
• Logos
• Websites

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Implementation

• Initially Limited to 6 DCRI Sites
• Expansion System-wide

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Health Promotion

• Goes
• to the
• field...

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Health Promotion

• Field
• Training

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AMEDD CS

• OBC
• OAC
• BNCOC
• ANCOC
• 91Ex-2

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Put More DENTAL into Health Promotion . . .

• CHPPM-EUR Health Promotion Conference
• USACHPPM Health Promotion Conference
• DENTAC - MEDDAC Partnerships

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ADA Procedure Codes

• 00120 Oral Cancer Screening (OCS) during
  annual exam (Periodic Oral Eval)
• 00140 OCS (without annual exam)
• 01320 Tobacco Counseling
• 01351 Sealant (per tooth)
• 09941 Mouthguard Fabrication

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• You can resist an invading Army you cannot
  resist an idea whose time has come.
• - Victor Hugo

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• Questions ?

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Points of Contact

• Pamila T. Richter, USA DENCOMCom 210-221-8241
  DSN 471-8241
• pamila.richter_at_amedd.army.mil
• MAJ Mark Piotrowski, USACHPPMCom 410-436-7390
  DSN 584-7390
• mark.piotrowski_at_amedd.army.mil