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Published on June 18, 2007

Author: Pravez

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Slide1:  Put More “Bite” Into Health Promotion:  Put More 'Bite' Into Health Promotion Overview Put More ‘Bite’ into Health Promotion:  Put More ‘Bite’ into Health Promotion What does it mean? Health Promotion Yesterday….:  Health Promotion Yesterday…. Brushing and Flossing Today...:  Today... General Health Promotion in the Army Dental Clinics for Total Health of the Soldier Health Promotion is a:  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. Army Dental Care System:  Army Dental Care System Why Us ? ADCS Vision:  ADCS Vision The Army’s dental care system of choice, focused on readiness, health promotion and exceeding our customers’ expectations. TSG’s Top 20:  TSG’s Top 20 On- and Off-the-job Disease andamp; Injury Prevention are top priorities of LTG Blanck The Army Surgeon General TSG’s 4 Ps:  TSG’s 4 Ps Productivity Prevention - education, early disease detection Practice Guidelines People We Know . . .:  We Know . . . Today’s Army is a YOUNG Army . . . 25 years old or younger We Know . . .:  We Know . . . 90% + of all soldiers are seen in our dental clinics annually The ADCS:  The ADCS is capable of having a sizeable impact on reducing health care costs through eliminating preventable disease and injury Objective of the Health Promotion Initiatives:  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 Partnering . . .:  Partnering . . . U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) Slide16:  DENCOM and USACHPPM are separate commands - neither has the authority to direct the other what to do. Slide17:  The only way DENCOM and USACHPPPM can jointly accomplish anything is through a partnership. Slide18:  To accomplish this objective, DENCOM and USACHPPM devised the 'Put More ‘Bite’ Into Health Promotion Campaign' Guidelines Followed in Developing “Bite”:  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 andamp; Research Initial Package:  Initial Package 5 Health Promotion Initiatives 4 - patient oriented initiatives 1 - provider oriented initiative Initial Package:  Initial Package Tobacco Intervention Sealants Mouthguards Skin, Lip and Oral Cancer Put Prevention Into Practice Slide22:  Rationale for ‘Bite’ Patient-oriented Health Promotion Initiatives Put Prevention Into Practice:  Put Prevention Into Practice Revitalize health promotion in the ADCS Educate everyone 'TEAM' approach “TEAM”:  'TEAM' T each E very A vailable M oment Challenges to changing health related behaviors:  Challenges to changing health related behaviors Everybody loves to learn but nobody likes to be taught. -Winston Churchill Slide26:  HP Messages delivered through Multiple Channels Old Clinical Axiom:  Old Clinical Axiom What is said is NOT What is heard Multiple Channels:  Multiple Channels Oral Written Visual Fact Sheets:  Fact Sheets Adult Mouthguards / Sealants Sun Smart Quiz Sunscreens Sealants / NBTD Lip Cancer / Oral Cancer Dental IQ “TEAM” Approach:  'TEAM' Approach Clinic Waiting Room Video Loops Posters Pamphlets Static Display “TEAM” Approach:  'TEAM' Approach Clinical Staff Patient Interviews Reinforce Positive Lifestyles Reinforce Oral Messages with written materials Referrals Why Mouthguards:  Why Mouthguards Objectives of the “Bite” Mouthguard Initiative:  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 MOUTHA-2-02 Mouthguard Initiative:  Mouthguard Initiative Promote Awareness and use of Mouthguards Educate / Fabricate / Motivate Mouthguards:  Mouthguards Military population is highly athletic American Academy for Sports Dentistry recommends MGs for 40 sports - including skydiving Types of Impact Injuries in Sports:  Types of Impact Injuries in Sports participant apparatus (e.g. bat) projectile (e.g., ball or puck) (Pinkham andamp; Kohn, Dent Clinics N Amer 35:609-26, 1991) MOUTHA-2-03 Slide37:  Sports with Mandatory Mouthguard Rules for Practice and Competition:  Sports with Mandatory Mouthguard Rules for Practice and Competition Amateur boxing football ice hockey men’s lacrosse women’s field hockey Professional boxing (Ranalli and Lancaster, J Public Health Dent 53: 96-100, 1993) MOUTHA-2-07 ADA Endorsement of Mouthguards:  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 andamp; Winters, Dent Clinics N Amer 35:657-66, 1991) MOUTHA-2-09 Protective Benefits of Mouthguards:  Protective Benefits of Mouthguards reduce tooth fractures andamp; dislocations protect against intraoral soft tissue lacerations andamp; bruises protect against jaw fractures by absorbing energy from traumatic blows to the chin prevent upward andamp; backward displacement of mandibular condyle (Johnsen andamp; Winters, Dent Clinics N Amer 35:657-66, 1991) may protect against brain concussions by cushioning shock from a blow to the jaw andamp; preventing transmission of the shock through the TMJ to the skull (Blum andamp; Kranz, J Dent Children 49:22-24, 1982) MOUTHA-2-11 Cost/Benefit of Mouthguards:  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 109:84-7, 1984) Incidence of facial andamp; dental injuries per 100 players declined from 2.2 to 0.3% following adoption of face-mask andamp; mouthguard regulations. (Heintz, JADA 77:632-36, 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 128:1273-74, 1997) MOUTHA-2-12 Rugby:  Rugby Poll of 1987 U.S. World Cup Team 95% believe mouthguards protect 50% wear mouthguards (Chapman, Am J Sports Med 17:690-91, 1989) MOUTHA-2-23 Injury Prevention:  Injury Prevention On- and Off-the-job Injury Prevention is one of the top priorities of LTG Blanck, the Army Surgeon General. MOUTHA-2-32 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, andamp; Shemer, Milit Med 163:1-2, 1998) MOUTHA-2-34 Injury Prevention Types of Mouthguards:  Types of Mouthguards Stock Boil-and-bite Custom-made MOUTHA-2-37 (Padilla andamp; Balikov, CDAJ 21:27-37, 1993) Improper Fit Means Suboptimal Protection:  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 andamp; college athletes. (Kuebeker, Morrow, andamp; Cohen, Physicians andamp; Sports Medicine 14:69-74, 1986) MOUTHA-2-43 Why Athletes Don’t Use Mouthguards :  Why Athletes Don’t 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 MOUTHA-2-46 Educating Patients About Mouthguards:  Educating Patients About Mouthguards MOUTHA-2-50 Points to Emphasize Orally:  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 MOUTHA-2-51 Mouthguards Should Be Checked Regularly for::  Mouthguards Should Be Checked Regularly for: Distortions Bite-throughs Tears If present, replace. MOUTHA-2-54 Slide51:  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 Mouthguard Initiative Put More “Bite” IntoHealth Promotion:  Put More 'Bite' Into Health Promotion Sealant Initiative Sealan-2-01 Sealant - a thin plastic coating applied to pit and fissure surfaces of teeth.:  Sealant - a thin plastic coating applied to pit and fissure surfaces of teeth. Objectives of the “Bite” Sealant Initiative:  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 Sealan-2-03 Common Practitioner Misperceptions About Sealants:  Common Practitioner Misperceptions About Sealants Sealants lock in dental decay. Sealants are for kids. Sealants don’t stay in place. Sealan-2-04 Common Practitioner Misperceptions About Sealants:  Common Practitioner Misperceptions About Sealants Sealants lock in dental decay Sealan-2-18 Slide57:  seal out decay-causing microorganisms make decay-causing mircoorganisms non-viable by sealing out food and air. (Siegal, Farquhar, and Bouchard, Public Health Rpt 112:98-107, 1997) Sealan-2-20 Dentists’ fear of inadvertently “sealing in” caries is unfounded and should no longer be a concern.(Swift, JADA 116: 700-04, 1988) :  Dentists’ fear of inadvertently 'sealing in' caries is unfounded and should no longer be a concern. (Swift, JADA 116: 700-04, 1988) Sealan-2-39 A small cavity can be arrested by a sealant.(Handelman, Leverett, and Iker, J. Pedod 9:119-26, 1985; Mertz-Fairhurst, Schuster, and Fairhurst, JADA 112: 194-97, 1986):  A small cavity can be arrested by a sealant. (Handelman, Leverett, and Iker, J. Pedod 9:119-26, 1985; Mertz-Fairhurst, Schuster, and Fairhurst, JADA 112: 194-97, 1986) Sealan-2-22 Old Sealant Need Guidelines:  Old Sealant Need Guidelines Sealants are indicated only within 4 years of a tooth’s eruption. New Sealant Need Guidelines:  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) Sealan-2-07 Why Sealant Guidelines Changed:  Why Sealant Guidelines Changed longitudinal study in Coast Guard cadets established that sealants are appropriate for adults. 33% of CG cadets had sound pit andamp; 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) Sealan-2-08 New Sealant Need Guidelines:  New Sealant Need Guidelines Age should not be a factor in determining sealant need - degree of risk for caries is uniform. 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):  Sealants are not cost-effective if applied to all patients without regard to diet, caries activity, etc. (Burke, J Irish Dent Assn 36: 13-15, 1990) Sealan-2-10 Apply Sealants On Teeth With::  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 andamp; fissures (Workshop on Guidelines for Sealant Use, J Public Health Dent 55: 263-73, 1995) Sealan-2-15 Common Practitioner Misperceptions About Sealants:  Common Practitioner Misperceptions About Sealants Sealants don’t stay in place Sealan-2-40 Sealant Retention After a Single Application:  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) Sealan-2-27 By placing a sealant, checking it annually, and replacing it, as necessary, one can improve the retention of sealants to nearly 100%.:  By placing a sealant, checking it annually, and replacing it, as necessary, one can improve the retention of sealants to nearly 100%. Sealan-2-29 Factors Contributing to Decline in Dental Caries:  Factors Contributing to Decline in Dental Caries Fluoride (smooth surfaces) Better oral hygiene Diet changes Sealan-2-46 (Soderholm, J Public Health Dent 55: 302-11, 1995) Sealants have contributed relatively little to the overall decline in caries.(Soderholm, J Public Health Dent 55: 302-11, 1995):  Sealants have contributed relatively little to the overall decline in caries. (Soderholm, J Public Health Dent 55: 302-11, 1995) Sealan-2-57 Sealant Prevalence in U.S. Military Recruits by Age:  Sealant Prevalence in U.S. Military Recruits by Age 1994TSCOHS AGE Sealan-2-61 Sealant Prevalence in Active Duty U.S. Military Personnel by Age:  Sealant Prevalence in Active Duty U.S. Military Personnel by Age 1994TSCOHS AGE Sealan-2-62 Points to Emphasize Orally:  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 Sealan-2-68 Skin, Lip & Oral Cancer:  Skin, Lip andamp; 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 SLO Cancer Risk Factors:  SLO Cancer Risk Factors Sun Exposure Tobacco Alcohol Slide76:  Sun Exposure:  Sun Exposure Minimize sun exposure Use SPF 15 sunscreen, even on overcast days Avoid the sun between 10am-3pm Skin, Lip & Oral Cancer Awareness / Screening Initiative:  Skin, Lip andamp; Oral Cancer Awareness / Screening Initiative Promote Awareness Cancer Risk Factors Protective Measures Screenings andamp; Referrals Slide79:  Tobacco Intervention Tobacco Kills:  Tobacco Kills Over 400,000 people each year Tobacco Kills:  Tobacco Kills More people than heroin, cocaine,alcohol, AIDS, fires, homicides, suicides and automobile accidents COMBINED Slide82:  That’s the equivalent of TWO fully-packed jumbo jets colliding everyday and leaving NO SURVIVORS. We Know:  We Know If a person isn’t a tobacco user by age 18, he will most likely never use tobacco, unless . . . Slide84:  That person is in the MILITARY. Tobacco Intervention:  Tobacco Intervention Active duty compared to recruits Limited to enlisted only with andlt; 5 years service Standardized for age, sex, and race (TSOHS) Slide86:  Slide87:  Slide88:  Time Pressures:  Time Pressures Recommended Guidelines to be performed by primary care providers… 3 minutes or less 4 1 - Hour Classes “TEAM” Approach:  'TEAM' Approach T each E very A vailable M oment Tobacco Interdiction / Cessation:  Tobacco Interdiction / Cessation Encourage non-smokers not to start. Slide92:  Slide93:  Slide94:  4 A’s:  4 A’s Ask Advise Assist Arrange Slide96:  Great American Smokeout:  Great American Smokeout 16 November 2000 Great American Smokeout:  Great American Smokeout Sponsored by the (ACS) American Cancer Society 3rd Thursday in November 16 Nov 00 ACS Supplies:  ACS Supplies Posters Pamphlets Stickers Quit Kits Press Kits Light-hearted, Fun, Upbeat:  Light-hearted, Fun, Upbeat Against TOBACCO Products, NOT Tobacco Users Slide101:  Adopt a Tobacco-User ACS Homepage:  ACS Homepage American Cancer Society http://www.cancer.org Download information Xerox Distribute Have Fun! Tobacco Websites:  Tobacco Websites Tobacco Intervention Network http://www.quittobacco.com Oregon Mint Snuff Company www.mintsnuff.com Other Resources:  Other Resources American Lung Association American Heart Association National Cancer Institute Your local MEDDAC/MEDCEN Partnering with your local MEDDAC/MEDCEN:  Partnering with your local MEDDAC/MEDCEN Army Community Health Nursing Internal Medicine Dermatology Dieticians Wellness Center ACS Fitness Center Sports Branch Resource Manual:  Resource Manual Overview Media Tool Kit Resources PPT Slides for All Initiatives References Logos Websites Implementation:  Implementation Initially Limited to 6 DCRI Sites Expansion: System-wide Health Promotion :  Health Promotion Goes to the field... Health Promotion :  Health Promotion Field Training AMEDD C&S :  OBC OAC BNCOC ANCOC 91Ex-2 AMEDD Candamp;S Put More DENTAL into Health Promotion . . .:  Put More DENTAL into Health Promotion . . . CHPPM-EUR Health Promotion Conference USACHPPM Health Promotion Conference DENTAC - MEDDAC Partnerships ADA Procedure Codes :  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 Slide113:  You can resist an invading Army; you cannot resist an idea whose time has come. - Victor Hugo Slide114:  Questions ? Points of Contact :  Points of Contact Pamila T. Richter, USA DENCOM Com 210-221-8241 DSN 471-8241 pamila.richter@amedd.army.mil MAJ Mark Piotrowski, USACHPPM Com 410-436-7390 DSN 584-7390 mark.piotrowski@amedd.army.mil

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