Tooth brushing each day keeps pneumonia at bay!
BY LUANNE RIFE
The Roanoke Times Shannon Munro was being prepped for surgery a few months ago when a Carilion Clinic nurse asked when she’d last brushed her teeth. I asked, Where did you get that question? And they said, from the V. The answer prompted her to smile. As a nurse researcher at the Salem VA Medical Center, Munro knows better than most why patients are encouraged to brush their teeth: The simple act saves lives. Munro is on the leading edge of national research demonstrating that if the biofilm that forms on teeth is removed twice a day, harmful bacteria will not migrate into patients lungs and cause pneumonia. Her first test of the low-tech practice was in the VA’s Community Living Center, which offers long-term care to veterans on two floors of
the Salem hospital. Most of the patients are elderly with complex medical problems. Munro reviewed 10 years of records and
found that the center averaged four cases of pneumonia every month. Once nurses were trained to brush patients teeth twice per day, the number dropped to zero. We’ve prevented a lot of cases, 48 cases at a savings of $1.92 million in 13 months, she said.
It’s really amazing. The results are so amazing and so easy to achieve that toothbrushing regimens are spreading across the
country and internationally, she said. Munro and her fellow researchers are being feted with awards and are speaking at regional, national and international conferences. The Centers for Disease Control and the American Hospital Association are interested
in the work, she said. Munro hopes that nursing homes and assisted living facilities, which also have patients at risk of acquiring pneumonia, adopt tooth-brushing regimens. For the last decade, hospitals have focused on ventilator-acquired pneumonia because Medicare penalizes caregivers for not preventing the infection, which mostly occurs in patients in intensive care units.
But researchers are finding just as many patients, many of them younger and including new moms, acquire pneumonia while staying on regular medical and surgical floors for all types of reasons. Munro said there appears to be a common denominator: oral care. Certainly being elderly, malnourished and being on a lot of medications puts them at high risk, but the one factor
common in all patients was they were not receiving adequate oral care, Munro said. That’s the one thing that we as nurses can do to improve the lives of our patients. Every patient, every shift, every day Munro and the Salem VA became involved in the teeth-brushing research when Munro attended a conference where a friend she made while working on her doctorate at the University of Hawaii was presenting her work. Diana Baker, a nurse researcher with the Sutter Medical Center and professor
at California State University Sacramento, talked about her work in preventing infections by brushing patients teeth. When she was done, I said, Why am I not involved in this study? I need to be involved, Munro said. We started working on this initiative
together, and it has grown. Hospitals in every state and across the globe are adopting the practice and are documenting tooth-brushing in patients records. Tooth brushing isn’t the only way to prevent hospital-acquired pneumonia, but good
oral hygiene is making a difference, said Donna Bond, a pulmonary clinical nurse specialist for Carilion. Carilion already was
practicing oral hygiene on intensive care unit patients. For patients on ventilators, the pneumonia rate dropped from more than 10 per 1,000 patients in 2008 to fewer than three per 1,000 today. Bond said she heard about Munro’s work, and Carilion implemented pre-surgery tooth brushing for surgery patients at Roanoke Memorial and Community hospitals.?Pneumonia rates
dropped from nearly 3 out of 1,000 patients in 2013 to fewer than 1 per 1,000 in 2015. Starting the toothbrushing regimen was
not too difficult at the Salem VA. Community Living Center nurse managers LeslieWoodie and Georgine Karnide said getting the nurses buy-in was easy. We had to change some of the way we practice. Every single caregiver provides oral care to every patient, every shift, every day, Woodie said. They were already offering oral care, but they weren’t always documenting it and sometimes it was skipped. There’s always a rush in doing morning care. Sometimes the patient has to be in physical therapy or elsewhere, Woodie said. And sometimes, nurses were swabbing mouths or wiping them with a washcloth, especially for patients
with swallowing difficulties. That practice does not remove the biofilm. We know that nationwide, oral care is missed 70 percent of the time during a patient’s hospital stay, Munro said. The germs on teeth multiply five times every 24 hours. So if you quit brushing your teeth, pretty quickly a biofilm grows on the teeth.
Taken from article in Danville Register and Bee January 9, 2018.
Are Electronic Cigarettes a Safe Alternative To Cigarettes?
By Carrie Rogers, RDH, BS
Recently I have received a number of questions from patients regarding the use of electronic cigarettes. Some are interested in using them as an alternative to traditional cigarettes, while others are inquiring about health risks. This is a relatively new technology having been introduced to the United States in 2006. They originated in China and are just now being subject to regulation.
On May 5, 2016 the FDA announced that it will now be extending its authority to include electronic cigarettes and other tobacco products. This comes as a result of e-cig manufactures suing the FDA in 2009 in an attempt to dodge regulation of their product, stating that the FDA did not have the legal authority to oversee them. President Barrack Obama was responsible for delegation of duties to the FDA in an attempt to protect and educate electronic cigarette users. This oversight includes delivery systems and content.
Although some studies have been completed, many more will be undertaken as this is a new product. Completed studies show that cartridges stating water only contained amounts of nicotine as well. Clinical finding showed that smoking e-cigs restricts blood flow to oral tissues, is toxic to living cells and causes throat and mouth irritation. The results were regardless of nicotine content. In other words, nicotine delivered by traditional way or by e-cig is detrimental to your body. Direct contact of cartridge content can be toxic or lethal as teaspoon of nicotine containing e-cig solution can be fatal to toddlers. There have been several documented instances of e-cigs exploding and catching fire while in use. The effects of 2nd hand exposure have not been tested yet.
In conclusion electronic cigarettes are not a safe alternative to traditional cigarettes. They should not be used as a method of smoking cessation.
Is It Really Necessary To Brush and Floss Often?
By Carrie Rogers RDH, BS
For as far back as I can remember I have been told to brush and floss often. Is this an idea that was developed by floss and toothbrush manufactures to ensure their livelihood. Much like the apple industry that coined the phrase, an apple a day keeps the doctor away. Well, most people actually do brush a least once daily, but what about flossing? Is it really necessary to floss all that often? And what is actually considered often?
The suggested practice of at least daily brushing and flossing is based on peer reviewed scientific research. Here is what we know about the biofilm (plaque) that take up residence on and in between your teeth.
Plaque is a sticky, invisible film that forms on and in between your teeth after you eat. Plaque is full of bacteria, which release acid that destroy a tooth’s enamel. The damage to your enamel eventually causes tooth decay and can also lead to periodontal disease. This is a fact that we have heard many times, but as they say timing is everything
The longer plaque stays on your teeth the more harm it does and it also changes properties. Ever noticed the hard brittle stuff on the back of your front bottom teeth? That was once soft plaque that converts to a hardened substance that cannot be brushed or flossed off. Here is where the timing comes into play. The soft plaque turns to tarter (calculus) within 24 hours. Oh snap. This is not too much of a problem where your toothbrush is reaching since I KNOW you brush daily. But what about inter proximal areas? This is the reason that you need to clean in between your teeth (somehow) daily. If you don’t like to floss using the traditional method, there are all kinds of things you can use to remove plaque. Two that come to mind are inter dental picks and the AirFlosser. The important thing is to find a method you will be willing to utilize within a 24 hour timeframe before calculus forms. If you have questions regarding a good way for you to remove biofilm on and in between your teeth, we will be happy to discuss ways during your office visit.
What’s the Dry Idea
Cindy Bailey, RDH
An estimated 64% of the population has dry mouth. This should be on the office health questionnaire. A total of one thousand medications can contribute to xerotomia. Seventy percent of the US population takes at least one medication and dry mouth is NOT a part of normal aging. There are many new products available for xerostomia that contain xylitol. Some of the new products available are :
Salipen Xerostom-olive oil based
Oral 7 Prevident for dry mouth
Bioxtro Saliva max-being used in cancer patients
Twenty five percent of oral cancer victims never used tobacco.
Sonicare UV sanitizer is good for immunocompromised patients.
Other helpful stategies include lip balm, humidifier and xylitol gum.
Mouth KOTC products have lemon and lime flavoring.
Oral Balance gel can be used in office before treatment.
Many times people that use pepto bismol get black hairy tongue.
Apothous ulcer can be caused by a toothpaste with sodium lauryl sulfate.
Ulcers can be treated with Debacterol. DO NOT use on people with sulfur allergies.
There is an 81% reduction in ulcers once a patient stops using SLS
Herpetic lesions can be treated with AverteaX topical ointment or Viroxyn.
Stress Less: You Management vs Time Management
Questions to ask yourself?
What is the one thing if you complete tomorrow will make you feel the most accomplished and free?
Of the things I need to do, which will have the greatest impact a year from now?
The only way to gain time is to do less or do things less perfectly.
Ask is this situation in or out of my control
Take charge or let it go.
Fix what you can. Face what you can’t.
Speak your truth
You can only hold on thought in your head at a time.
When your thoughts, actions and words are in alignment, we feel happier and in control
Sometimes you have to say no to others to say yes to yourself.
Patient Education and Dentures
Do and Don’ts for your partials and dentures
Remove and rinse your dentures after eating
Handle your dentures with care – Don’t bend, Don’t leave them laying around.
Clean your mouth also and any natural teeth that you have.
Brush your denture or partial at least daily with a non abrasive denture cleaner.
Don’t sleep in your partial or denture – studies show that it increases the risk of pneumonia, it cuts down on infections.
Rinse before putting them back in your mouth
Schedule regular dental check-ups – this is to make sure they still are fitting properly and to check the inside of your mouth and gum health.
See your dentist if you have a loose fit.
Avoid abrasive cleaning materials, whitening toothpastes, bleach-containing products and hot water
Tips for loose dentures or partials
an adjustment often helps
adhesives will help to retain your appliance
Implants might be a good option for a more stable denture or partial
Just a few reminders and dentures and partials. If you have questions, please feel free to contact our office.
Oral Cancer: What do you need to know? (Oral Cancer Foundation, Inc.) www.oralcancer.org
There are risk factors for oral cancer. Listed are ones that you can control and ones that you can not control.
Tobacco Use, Excessive alcohol consumption, combination of tobacco and alcohol, excessive unprotected exposure to sun, low intake of fruits and vegetables, use of betel nut and bedis. Age, HPV16 viral infection, race, ethnicity, economics, a recurrence, gender.
Signs and Symptoms – In the early stages or oral cancer’s development, it is often painless, and the physical signs may not be obvious. This makes it a very dangerous disease. Regular screenings by a qualified medical or dental professional, combined with a person’s knowledge of the warning signs and symptoms, will allow its discovery in the earliest possible stages, when cure and survival are most likely. Even pre-cancerous tissue changes can often be detected by a trained professional. Early indicators are: Red and/or white discolorations of the soft tissues of the mouth, any sore which does not heal within 14 days, hoarseness which lasts for a prolonged period of time. Advanced indicators: a sensation that something is stuck in your throat, numbness in the oral region, difficulty in moving the jaw or tongue, difficulty in swallowing, ear pain which occurs on one side only, a sore under a denture, which even after adjustments of the denture, still does not heal, a lump or thickening which develops in the mouth or on the neck.
The good news: It can often be found early in its development. When you are at the dentist or doctor’s office, in just 3-5 minutes you can receive a comprehensive oral cancer exam. Some doctors may use a special light or a special dye to aid in the discovery of tissues which are suspicious. If suspect area is found, the doctor may collect cells from that area with a small brush to exam under a microscope. If there is something abnormal then the doctor will refer you to a specialist for another opinion and perhaps even a small, painless biopsy. An oral cancer screening should be done every year and can be incorporated into your routine check-ups and exams.
Each year in the US alone, approximately 37,000 individuals are newly diagnosed with oral cancer. The death rate for oral cancer is very high; about 43% of those diagnosed will not survive more than 5 years.
Avoid Risk Factors
Get an annual screening
Dental care for aging senior is a growing problem in Virginia.
It’s no secret today a healthy body starts with a healthy mouth. That is abundantly clear when you look at the teeth and gums of many nursing home residents in Virginia.
The lack of daily oral care in nursing facilities is an epidemic that’s almost universally overlooked.
The number of people who have lost most or all of their teeth (edentulism) has decreased steadily during the years. But without regular dental care as we age, the teeth and gums are increasingly vulnerable to disease. And the overall health consequences of poor oral care can be life threatening.
Prevention is the key. Our seniors deserve a chance to live their lives free of pain, dental disease and other serious problems that can arise when oral health is neglected.
Loose teeth, poorly fitting dentures, cavities and infected gums, make life so difficult and painful some residents stop socializing and even eating, leading to malnourishment and assorted debilitating health problems.
Dr. Ted Sherwin, President of Virginia Dental Association
9 Surprising Symptoms of Stress
When was the last time you went through a period of stress? Can you remember the way your body reacted? Chances are you didn’t feel quite like yourself. Health experts say that stress can come with some pretty surprising symptoms-from forgetfulness to nausea to skin rashes. Is your body sending you an S.O.S. that you shouldn’t ignore? Read on to find out if stress is taking a toll on you-and what you can do to reverse the effects. Read More >>
Should I use mouth rinses?
The answer is yes! While it is no substitute for brushing and flossing, mouth rinses are an important part of obtaining and maintaining good oral health. Your teeth represent only 5% of your mouth, so the other 75% needs help with hygiene!
Which rinse should I use? Well, first and foremost, make sure it carries the ADA seal of approval. A company earns the ADA seal for its product by submitting scientific evidence that the product is safe and effective.
Cosmetic mouth rinses temporarily reduce bad breath, but they do not deal with the causes of bad breath. It is best to use a therapeutic rinse that will help reduce plaque, gingivitis, cavities and bad breath. Therapeutic mouth rinses that contain fluoride help prevent or reduce tooth decay, but should not be used by children six and younger as they may swallow the rinse.
In conclusion, mouth rinses should be used in conjunction with brushing and flossing. Be sure to use an ADA approved rinse and follow the manufacture directions. Clinical studies indicate that regular use of a fluoride mouth rinse can provide additional protection against cavities over that provided by a fluoride tooth paste.
HPV (Human Papilloma Virus) once almost exclusively associated with cervical cancer is now linked to head and neck cancer. The study conducted showed that subjects with HPV positive tumors had a significantly higher severity of periodontitis. Therefore, it is very important to stay up-to-date with visits to your dentist to keep a check on your gums as well as your medical doctor to be checked for HPV and/or to be sure it stays under control and doesn’t turn into cervical or oral cancer.
Article from Dentistry Today
Did you know that flossing your teeth daily can make you 6.4 years younger? Check out www.realage.com to learn more.
Diet for a Pretty Smile
Dried licorice root may fight tooth decay, new research has found. But if you’re not a fan, these foods can also help keep teeth, gums, and breath healthy, says Mark Wolff, DDS, PH.D of NYU College of Dentistry.
- YOGURT? The lactic acid may ward off periodontal disease, but skip the sugary varieties.
- SUGAR-FREE GUM AND HARD CANDIES ? These promote saliva flow and also help fight cavities. Xylitol-sweetened ones work best.
- RAW OR FIRM VEGETABLES ? Chewing celery and other crunchy veggies helps scrub your teeth. Ones with vitamin C broccoli; red, green and yellow peppers may also protect against gum disease,
Good Housekeeping May 2012
Burden of Diabetes – Complications include:
- heart disease
- high blood pressure
- visual impairment
- renal disease
- complications in pregnancy
Costs $132 billion of that $92 billion direct medical costs and $40 billion in indrect costs ie: disability, work loss, premature mortality.
What is the link between diabetes and perondontitis? Epidemiological studies provide support for a relationship between insulin. Perio disease is a chronic inflammatory disease. People with high levels of inflammation are more likely to have insulin resistance than those with lower levels.
Insulin resistance is a continuing problem in people with diabetes. People with chronic inflammation are more likely to acquire diabetes at some time in the future. Inflammation involves increased permeability of the capillaries leading to potential portals to the systemic circulation for inflammatory mediators and products of the bacterial infection.
Treating periodontal infection can have important potential in managing diabetes.
Compiled by Carrie Rogers, RDH
from Inside Dentistry April 2007 Issue
For more information go to www.insidedentistry.net
What is Tooth Erosion?
A recent survey of AGD members revealed that dentists think tooth erosion is more common today compared to five years ago, and many respondents stated that consuming soft drinks, as well as other foods with a low pH value (such as fruit juices, pickles, fresh fruit and yogurt), contributes to tooth erosion. Tooth erosion is the breakdown of tooth structure caused by the effects of acid on the teeth. Dental enamel is the thin, outer layer of hard tissue that helps maintain the tooth’s structure and shape while protecting it from decay.
Taken from AGD in Action September 12, 2007 issue Antibiotic prophylaxis – Making sense of new AHA guidelines
The American Heart Association announced in April that it no longer recommends antibiotic prophylaxis for the prevention of infection endocarditis in certain dental patients. If you have heart conditions please contact your cardiologist for information on whether you need to take antibiotics before your dental treatment. For more information go to www.ada.org
DO YOU REMEMBER WHEN?
Do you remember when there were no childproof caps on drugs, and that was OK?
Do you remember when you could hold a child in your lap in the car, and that was OK?
Do you remember when you could rely on Social Security for retirement, and that was OK?
Do you remember when twice a year dental cleanings were the standard, and that was OK?
The facts are that the old six-month cleaning is obsolete for many patients. As our knowledge increases about the effects of systemic diseases and oral health, we have to consider: “Is what we’ve done for so long enough?” We know that bacterial inflammation in the mouth can be a factor in the development of diabetes, heart disease, stroke and other serious problems. Because of this, a few dental benefit companies have recently begun to offer additional “hygiene” service provisions, either as part of a dental plan or as part of a medical management program. Some plans are offering extra cleanings for diabetic patients who are enrolled in a disease management program. Delta of Virginia recently added a benefit designed to address research indicating that incidences of premature, low-birth weight infants may be related to oral conditions. They are now covering extra cleanings for pregnant women under certain conditions. In dentistry, we have advocated 3-4 month recall appointments for diabetics, pregnant women, those with heart problems, auto-immune disorders, patients under going chemotherapy and patients in orthodontics, just to name a few.
Insurance companies may be starting to get on the bandwagon, but what if yours does not cover the extra care you need? The link between systemic health and oral health is becoming clearer and insurance benefits should NOT be the only consideration when making a decision about treatment. People who have lost their teeth often say they would give any amount of money to get them back. A person’s smile, attractiveness, ability to chew and enjoy food and general sense of well-being are dependent on dental health. Now we know that general health is impacted as well.
Edited from RDH magazine