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Oral Health Screening TrainingOral Health Screening Training for Registered Nursesfor Registered Nurses
Georgia Oral Health Prevention Program
““YouYou’’re re not healthy without good oral healthnot healthy without good oral health””Surgeon General 1982-1989:
C. Everett Koop, MD
“Tooth decay is currently the single most common chronic childhood disease –
5 times more common than asthma……
The burden of disease restricts activities in school, work, and home, and often diminishes
the quality of life.”
“Oral health must bea critical component
of the provision of health care and the design of community programs.” Surgeon General’s Report on Oral Health:
May 2000, S.G. David Satcher, M.D., Ph.D.
The mouth is a mirror of general health, wellThe mouth is a mirror of general health, well--being.being.
•Diagnostic role•Barrier, as well as portal, for infections •Additional diagnostic potential of saliva, buccal mucosa, and other oral components
ObjectivesObjectives
I. Oral Health Screening– Recognize normal from abnormal– Classify the screening– Refer appropriately– Know who can perform OH screening in GA
II. Dental Emergencies– Recognize common dental emergencies– Respond appropriately
Note: **An oral health screening is not a diagnosis and does not take the place of regular dental care.
REGISTERED NURSES ROLE IN ORAL HEALTH SCREENING
GREENGREEN
YELLOWYELLOW
REDRED Stop
Caution
Go
ORAL HEALTH SCREENING: Classify the Patient
REDRED -- EMERGENCY– Immediate dental
care
YELLOWYELLOW -- Caution– Early dental care
needed– Non-urgent
preventive
GREENGREEN –– Go -Routine care
•• Pain, infectionPain, infection, swelling, , swelling, ulceration > 2 wks durationulceration > 2 wks duration
•• Cavities Cavities w/ow/o Pt. complaintPt. complaint-- spontaneous bleeding, spontaneous bleeding, suspicious white or red soft suspicious white or red soft tissue lesions, poor fitting tissue lesions, poor fitting appliancesappliances
•• Normal, No Apparent NeedNormal, No Apparent NeedNo obvious problemsNo obvious problems–– Continue regular careContinue regular care
Good Oral Health is for Everyone
Recognize Normal From Abnormal
Clinical Dental Examination Diagnostic – Treatment Planning Form
To be completed by a licensed dentist
Georgia Department of Human Resources CERTIFICATE of EAR, EYE AND DENTAL EXAMINATIONSTO BE FILED WITH SCHOOL AT TIME OF CHILD’S ENROLLMENT
This is to certify that the child identified here has received or been excused for special or provisional reasons from receiving EXAMINATIONS, TESTS or INSPECTIONS.
CHILD’S NAME First Middle Last DATEMo. Day
OF BIRTH
Yr.
SEX LOCAL RESIDENCE (Street & Number, P.O. Box, Route, Etc.) SCHOOL
Male Female CITY STATE & ZIP CODE COUNTY RACE
White Black Other
PARENT’S NAME ADDRESS (Street or R.F.D. No., City or Town, State)
EYE-VISION
Screening Test Passed Needs Further Professional Examination Special Certificate Provisional Certificate
Examination Done By
County Health Volunteer Organization Private Practitioner
Date
Examiner’s Signature Title
EAR-HEARING
Screening Test Passed
Needs Further Professional Examination Special Certificate Provisional Certificate
Examination Done By
County Health Volunteer Organization Private Practitioner
Date
Examiner’s Signature Title
DENTAL Normal Appearance (Green)
Needs Further Professional Examination (Yellow) Emergency Observed Problem (Red)
Special Certificate Provisional Certificate
Examination Done By Public Health: Dentist, Hygienist, PH/School R.N. Private Practitioner: Dentist, Physician
Date
Examiner’s Signature Title
Form 3300 (Rev. 6-98)
FOR INFORMATION: CONTACT YOUR COUNTY HEALTH DEPARTMENT, OR YOUR PRI-VATE PRACTITIONER
FOR INSTRUCTIONS: SEE REVERSE SIDE OF THIS PAGE.
http://health.state.ga.us/programs/oral/publications.asphttp://health.state.ga.us/programs/oral/publications.asp
Screening data reporting form for assessments by registered nurses. Please fax or mail to your health district dental contact found at http://health.state. ga.us/pdfs/family health/oral/oralhe althcontacts.pdf
PRIMARY ERUPTION SCHEDULE
20 Primary (Baby) Teeth
PERMANENT ERUPTION SCHEDULE
Who can perform an oral health screening in GA?
•• Georgia licensed Dentists, Dental Georgia licensed Dentists, Dental Hygienists, Physicians, or Registered Hygienists, Physicians, or Registered NursesNurses
• Not Dental Assistants or LPNs• Not lay persons who are trained
“Lift the Lip and Take A Look”Parent’s Position
Lift the Lip
Knee to Knee Position
Check for normal healthy teethWHAT TO LOOK FOR
Definition of tooth decay:Definition of tooth decay:• ½ mm loss of enamel
• Staining of walls might not be present in young children (at cervical 1/3 might not be present)
• Broken/chipped teeth with visible decay
• Retained roots of decayed teeth
• Temporary fillings presentLook for Normal or Abnormal when screening.Look for Normal or Abnormal when screening.
White Spots LesionsWhite Spots Lesions 6 Max Anterior teeth at cervical 1/3 of tooth only (gum line) - w/ or w/o break in enamel or staining “at risk for ECC”
Early Childhood Caries (ECC)Early Childhood Caries (ECC) (< age 6: ) Any decayed, filled or missing tooth due to caries Severe ECC: *At least 1 of 6 maxillary anterior teeth decayed, filled or missing due to caries
Rampant DecayRampant Decay Treated or untreated decay on > 7 teeth (>age 5)
* Definition of ECC used for statewide surveys
Check for early signs of ECC: White Spot LesionsWhite Spot Lesions Identifies children at risk for ECC or Rampant Decay
WHAT TO LOOK FOR
Check for later signs of ECC: brownbrown areasWHAT TO LOOK FOR
Check for advanced severesevere ECCWHAT TO LOOK FOR
SMOOTH SURFACE DECAY
RED RED YELLOW YELLOW GREENGREEN
PIT & FISSURE DECAY
RED RED YELLOW YELLOW GREENGREEN
TOO MUCH FLUORIDE
Can cause fluorosis
Goal is to recognize Normal and Abnormal Goal is to recognize Normal and Abnormal when screeningwhen screening
SEALANT: BEFORE and AFTER
RED RED YELLOW YELLOW GREENGREEN
Flat, dark grey/black, asymptomatic, unknown duration.Amalgam tattoo.
http://www.oralcancerfoundation.org/
Clinical Diagnosis = Multifocal, Nodular LeukoplakiaMicroscopic Exam = Well Differentiated Squamous Cell
Carcinoma.
Clinical Diagnosis = Erythroplakia (red) Microscopic Examination = Squamous Cell Carcinoma
EXTENSIVE DENTAL DECAY
– RAMPANT (>7 TEETH)
RED YELLOW GREEN
DENTAL ABSCESS A localized collection of pus, formed by tissue
disintegration and surrounded by an inflamed area.
RED RED YELLOW YELLOW GREENGREEN
Abscess (circumscribed area of pus)and Fistula (an abnormal passage directing or draining pus to
surface)
Recent Electrical Burn
Laceration of Tongue
Injury to Primary Incisor
Fractured Primary Tooth
1- 3 million teeth/yr in US, mostly young children > 90% can be saved
Re-implant 15-30 min > 90% chance retained for life. Practical experience indicates this may be unrealistic.
Place in cold milk, Place in cold milk, isoiso saline, water, or saline, water, or saliva saliva -- Refer to dentist ASAP.Refer to dentist ASAP.
What to What to do...do... Fights,
Sports Injuries, Accidents
Screen & ReferScreen & Refer•• RedRed, YellowYellow and GreenGreen
– Red: Emergency Care - immediately – Yellow: Early Care -as soon as possible,
within 1-3 months– Green: Routine Care – every 6 months
• Medicaid/PeachCare, Community DDS, Public Health Providers
(678) 578-2920 (client line) 1-800-982-4723 if outside of metro Atlanta
(678) 578-2931 (provider toll-free) 1-888-473-2444 if outside of metro Atlanta
Monday–Friday 8:30 AM- 4:30 PM
GEORGIA PARTNERSHIP FOR CARINGhttp://www.gacares.org/how_to_qualify.htm
The Healthy Mothers, Healthy Babies Coalition of GAPower Line. Metro Atlanta 770-451-5501
Statewide 800-822-2539 http://www.hmhbga.org/index.html
Select “Resources” - has links to Medicaid/PeachCare health plans & providers: Amerigroup | PeachState | Wellcare
DENTAL PROVIDER REFERRAL RESOURCES
To locate a Medicaid or PeachCare Dental Provider go to the Georgia Health Partnership web site at
https://www.ghp.georgia.gov/ and
select “Provider Information”
Under “Find Health Care Resources”Select “Search for Medical Services”
Enter your city, state & zip code,Click on “Select Specialty” in the blue box
Choose “D-G” from the alphabetical list at the bottom of the page to search for “Dental”
Check the “Dentistry, General Practice” box, Click on “Select Specialty” in the blue box,
you will be returned to the address entry screen
Click on “Select Organization” in the blue box
Choose the insurance organization that provides your coverage;
Then click on “Select Organization” in the blue box
Peach State-Atlanta is used for illustration only
Select the number of miles of radius you are willing to travel, Click on “Search” in the blue box
A list of dental providers who accept your insurance is displayed.
List of Public Health Dental Providers for each health district.
http://health.state.ga.us/programs/oral/index.asp
http://http://health.state.ga.us/programs/oral/index.asphealth.state.ga.us/programs/oral/index.asp