Oral health- something to worry about in Neuro rehabilitation settings? Mohit Kothari BDS, PhD Hammel Neurocenter. Talk of the Day!!
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1 Department of Clinical Medicine HEALTH Talk of the Day!! Oral health- something to worry about in Neuro rehabilitation settings? Do we really have a problem? How to identify? Screening/ Indexing How big/ severe is the problem? - Screening How to solve the problem? - Treatment plan Are there any firm treatment plans? - Mixed Mohit Kothari BDS, PhD Hammel Neurocenter Can acute care setting be translated into rehabilitation arena or it requires some modification? Key components of oral health Teeth Tongue Gingiva (bleeding and redness) Mucosal lining Left unnoticed in the oral cavity The dorsal posterior aspect of the tongue is major source of microorganisms as cleaning is not undertaken as a routine Interproximal area of teeth Lips (dry/cracked) Saliva- consistency, production (hyper/hypo) Swallowing habits Standard oral care protocol Adult/ and seldom pediatric manual tooth brush Standard foam tooth paste Foam sticks Saline as a rinse Lubricant Recommended in our set-up Tooth brush Pediatric (soft-bristled baby tooth brush) Electric tooth brush (Research shows the best outcome) Toothpaste Fluoridated non-foaming tooth paste (readily rinsed) Dental Floss Oral moisturizers 1
2 Recommended in our set-up Suction devices (tip) Bite Blocks Tongue Scrapers (backward to forward) Introduction (What has been proven so far?) Incidence of neurological patients- ageing population Combination of motor, sensory, perceptual and cognitive deficit- Impacts ADL Three dimensions of oral self care: Function, education and training, and compliance Introduction (What has been known so far?) Dental plaque and oral pathogen loads: possible starter/ worsens systemic health problems or viceversa Commonest condition associated with systemic disease: Periodontitis But on the other end Various clinical guidelines and assessments Each country has oral health guidelines Oral Assessment Guide (OAG) Bed side Oral Examination (BOE) Research protocols Clinical measurements (1-12) Microbiological examination Immunological aspect Socio-behavioral aspect Why Oral Health care not a priority? Common barrier to effective oral care Perception oral care doesn t provide significant benefits Inadequate nursing staff Few trainings and unfocused care policies Even expressed strong dislike for oral care At least 15 articles in Critical Nursing Care, Gerodontology etc. Need for a planned, easy to follow, tailor-made protocol for the staff in rehabilitation settings Protocol should be: Easy to follow Cost effective Simple bedside oral examination protocol Without an extra burden to present clinical staff Aim: Comprehensive oral health assessment in neuro rehabilitation setting 2
3 Materials and Methods Possible assessment tool (Measurements) 12 ABI patients from semi-intensive care unit (one ward) Self administered structured questionnaire Full mouth clinical examination protocol Entire examination took: 60 minutes Social History Gender/ Age/Marital Status/Education/Alcohol/Smoke/ Medical History Behavioral aspects Dental visit/ Only when had some trouble Tooth brushing frequency EFA and its oral health sub score Onset of Disease (Time since injury) Dental Armamentarium Mouth Mirror Arch Explorer UNC-15 probe Clinical measurements Plaque and calculus indexing Pocket depth indexing Bleeding on probing Clinical attachment loss Decayed, missing, filled tooth indexing Bedside Oral Examination (BOE) Modified from the oral assessment guide (OAG) Scores: 8 to : Excellent oral health 11-14: Moderate impaired oral health 15-24: Significantly impaired oral health 3
4 Microbiological examination Saliva Trachesotomy secretions Swab from posterioir 1/3 of tongue Results No significant effect of smoking or alcohol consumption on oral health Brushing frequency related to severity and extent (P<0.03) Dentist appointment related to periodontal severity (P=0.02) All patients were diagnosed with chronic generalized periodontitis (P<0.001) Results Correlation between BOE and severity of periodontitis (P<0.01) Patient age group was significantly related to poor oral health Higher BOE score (P=0.01) Extent and severity of periodontitis was higher (P<0.02) Discussion Assessment of oral health: Beyond traditional clinical markers Need to perform comprehensive oral health assessment including all possible measures All evaluated ABI had chronic generalized periodontitis: enhanced oral health care Association between periodontitis and systemic disease (Cerebro vascular, endocarditis, stroke) Discussion Conclusion BOE provides a narrative and visual reference, useful tool to reinforce and sustain the assessment practice Older population shows relation between oral health and systemic disease as well as QOL Most of the recent literature demands to perform a structured and validation study involving all available tools for comprehensive oral health assessment in a larger patient based population Access to professional oral health care is not limited to Rx per se but also to the motivation and instructions to the patients 4
5 Future Plans Acknowledgement Standardized Assessment criteria of clinical oral health status, behavioral and microbiological outcomes are required to confirm oral health disparities MOHIT (Mouth and Oral Hygiene Indexing and Treatment plan) Mouth and Oral Hygiene Indexing Treatment plan 0 week/ 2 week Professor Jørgen Felbæk Nielsen, MD, PhD, Dr Med. Hammel Neurorehabilitation and University Research Clinic, Hammel, Denmark Mette Skjærbæk Svane, Occupational Therapist Early Intensive Care Unit, Hammel Neurorehabilitation and University Research Clinic, Hammel, Denmark Rubens Spin-Neto, BDS, PhD Section of Oral Radiology, School of Dentistry,, Denmark Thank you 5
Many thanks to my sponsor:
Oral Care for the Medically Complex Patient: From Intensive Care to Long-term Care Michigan Dental Association Lansing MI April 25, 2015 Cindy Kleiman RDH, BS Oral Care Consultant and Speaker Many thanks
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