Harry-Sam Selikowitz, Dr. Odont.

Presentasjon om: "Harry-Sam Selikowitz, Dr. Odont."— Utskrift av presentasjonen:

1 Harry-Sam Selikowitz, Dr. Odont.
Tannhelsepersonellets rolle i det store sykdomsbilde. Strategiske tanker fremover. Muligheter og utfordringer for tannhelsetjenesten Harry-Sam Selikowitz, Dr. Odont. Nestleder, FDIs Vitenskapskomite Folkehelsenettsverks konferanse 2014

2 Ikke-smittsomme sykdommer - Non- communicable diseases - NCDs
Ikke-smittsomme sykdommer er definert som: hjerte- og karsykdommer kreft kroniske lungesykdommer diabetes Hoved - risikofaktorene for disse sykdommene: bruk av tobakk usunt kosthold for lite fysisk aktivitet skadelig bruk av alkohol

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4 World Health Organization
8 April 2017 8 April 2017 NCDs are the third largest global risk Oil spikes Retrenching from globalization Asset price collapse Food price volatility Financial crisis Noncommunicable diseases Infectious diseases "A problem neither the developed world nor the developing world can afford" " (WEF Global Risk 2010 Report) 4

5 Dødelighet av ikke-smittsomme sykdommer i Norge
Ett av tre dødsfall i Norge skjer før 75-års alder Langt over halvparten av for tidlige dødsfall skyldes de fire gruppene av ikke-smittsomme sykdommer Totalt (for alle aldersgrupper under ett) er hjerte- og karsykdommer viktigste dødsårsak Før 75 års alder er kreft viktigste dødsårsak Kvinner: 1) Lunge, 2) Bryst, 3) Tykk- og endetarm Menn: 1) Lunge, 2) Tykk- og endetarm, 3) Prostata Ett av tre dødsfall i Norge skjer før 75-års alder, og langt over halvparten skyldes ikke-smittsomme sykdommer. Av disse for tidlige dødsfallene skyldes fire av ti kreft (først og fremst lungekreft, tykktarmskreft, brystkreft og prostatakreft), to av ti hjerte- og karsykdommer (først og fremst hjerteinfarkt og hjerneslag), mens mindre enn én av ti dør av lungesykdommer eller diabetes (alene). Ulykker, andre sykdommer og selvmord er andre årsaker til tidlig død. Byrden av sykdom er imidlertid langt større enn hva antall døde kan gi inntrykk av. Rapport overleveres til Helseministeren neste fredag.

6 Risikofaktor som fører til død i Norge
Usunt kosthold Høyt blodtrykk Røyking Overvekt/fedme Fysisk inaktivitet Høyt kolesterol Alkohol Høyt blodsukker Rusmiddelbruk Radon Lav bentetthet 10005 9444 6623 4238 3623 2727 2465 873 501 316 277 Antall dødsfall

7 Oral health and NCDs

8 Unhealthy Diet - Rebound hypoglycaemia
Nutrition transition – globalization uncontrolled Diabetes and obesity worldwide: epidemics in full flight "Obesity: now deadlier than smoking." The Health Risks of Sugar - Rebound hypoglycaemia

9 Obesity

10 Diabetes Obesity Coca-Cola the No 1 item sold in NZ super markets
Tooth decay What would consumers say to this? I am proposing a mandatory warning on these bottles which would read. “WARNING this bottle contains 40 tsp of sugar. Just one of these bottle contains is a weeks supply of a teenagers recommended total sugar consumption Everyday on my way to work I see teenagers holding half empty bottles on their way to school at their local dairy

11 2014 WHO draft sugars guideline
Free sugars intakes should be <10% of energy intake <5% = additional benefits Free sugars: all sugars added to food by the manufacturer, cook or consumer, & sugars naturally present in honey, syrups, fruit juices & fruit concentrates.

12 Big Sugar views on new WHO recommendations
WSRO: The Draft Guideline fails to reflect the weakness of the scientific evidence and makes recommendations that are not supported by the totality of the available scientific evidence. Sugar Assoc (USA): Unfortunately, we remain concerned that the draft guidelines’ suggested limits rely heavily on insufficient scientific evidence

13 Oral diseases in the UN Political Declaration
“… renal, oral and eye diseases pose a major health burden for many countries and that these diseases share common risk factors and can benefit from common responses to non- communicable diseases” Oral health in UN declaration

14 What does this UN political declaration imply for global oral health?
Implication is that promotion of oral health should be integrated into the main strategies to prevent the major NCDs such as diabetes, cancer, cardiovascular and respiratory diseases. It constitutes an obligation for governments, to introduce policies to reduce NCDs, including oral health.

15 Oral health and NCDs: FDI advocacy guide
Call for action Content of the UN High-level meeting on NCD A practical tool Enhance synergies Inform and advise Influence policy Develop strategies to reduce intake of sugar FDI advocacy to build on declaration

16 FDI: tannsykdommer og andre ikke-smittsomme sykdommer
Policy Statements: Non-communicable diseases Oral health and the Social determinants of health Salivary Diagnostics Oral Infection as a Risk factor for systemic diseases The Istanbul Declaration FDI advocacy to build on declaration

17 The Common Risk factor Approach
Controlling a small number of risk factors The key concept underlying the integrated common risk approach is that promoting general health by controlling a small number of risk factors, may have a major impact on a large number of diseases at a lower cost than disease specific approaches.

18 Common risk factors to chronic diseases
Tobacco Cancers * Lung * Urinary tract * Kidney * Mouth/throat Respiratory diseases Alcohol CVD Diet Obesity Diabetes Stress Periodontal disease Dental caries Hygiene Dental erosion (Grabauskas WHO Regional Office for Europe 1987; Sheiham & Watt, 2000)

19 Using the Common Risk Factor Approach (CRFA) to control risks common to a number of chronic diseases, including oral diseases: These are: A food and health policy to reduce sugars consumption. A community approach to improve body hygiene and oral hygiene. Smoking cessation policy. Policy on alcohol Policy on reducing accidents. In addition to those strategies, the specific oral strategies are: 6. Policies on fluoride toothpaste use. 7. Ensuring the availability of appropriate, acceptable, evidence- based dental prevention and dental care.

20 Folkehelseloven Bidra til en samfunnsutvikling som fremmer folkehelse og utjevner sosiale helseforskjeller Sikre at folkehelse prioriteres Langsiktig kunnskapsbasert og systematisk arbeid Bedre samordning Samhandlingsreformen Jeg skal se på hvordan vi ligger an når det gjelder det første målet.

21 De sosiale ulikhetenes mønster
Tiltak bør rettes mot hele befolkningen (ikke bare høyrisiko-grupper) Tiltak bør rettes i hele årsakskjeden (ikke bare individuell atferd) Sosial ulikhet i helse og oral helse. Gradient. | 21 | 21 21

22 Common Risk Factor Approach: Conditions Model
Obesity Cancers Heart disease Respiratory disease Dental caries Periodontal diseases Trauma Risk Factors Diseases Risk Factors Tobacco Diet Workplace Alcohol School Stress Exercise Control Policy Housing Injuries Hygiene Political environment Physical environment Social environment 22

23 Refocusing Upstream Not Downstream
Three levels of public health interventions to improve health of the population: The downstream level; consumes most resources, but covers a very small segment of the general population Mid-stream prevention; involves primary and secondary prevention to encourage people not to carry out health compromising behaviours Upstream; healthy public policy interventions governmental, institutional, and organizational actions In line with pattern of general health inequalities Different oral conditions - 23

24 Oral complications of diabetes mellitus
The relationship of diabetes mellitus and periodontal disease seems to be bidirectional Diabetes is an important risk factor for periodontitis, leading to increased prevalence, severity, and progression of the disease i.e. increased attachment loss even early in life Periodontal infections can lead to increased levels of hemoglobin A1c (HbA1c), increased mortality from cardiovascular outcomes, and more renal and vascular complications in patients with diabetes. Assessment and Management of Patients with Diabetes Mellitus in the Dental Office. Evanthia Lalla, DDS, MSa,*, Ira B. Lamster, DDS, MMScb Dental Clinics of North America. 56,24, 2012

25 Responsibilities of oral health professionals
Know the major type 2 diabetes risk factors and seek to identify dental patients at risk who may remain unidentified/undiagnosed Evaluate signs and symptoms indicative of poor metabolic control in patients with known diabetes Inform identified patients about their condition and advise on lifestyle modifications Refer patients, if necessary, to a physician for proper evaluation and treatment Oral health professionals must discuss with their patients the link between oral and general health, how diabetes and periodontitis interrelate

26 Patients with known diabetes mellitus
Whole-mouth periodontal evaluation consisting of probing depth and attachment loss measurements Assessment of the level of plaque and gingival inflammation Radiographic evaluation of bone levels, as needed Identification of signs and symptoms of opportunistic infections (eg, oral candidiasis) Clinical protocols and guidelines should be in place in every dental practice setting for determining Due to possible hypoglycemic episodes, dental professionals must consider timing and duration of appointments Treatment of periodontal disease can reduce blood sugar levels in type 2 diabetes –decrease of HbA1c Assessment and Management of Patients with Diabetes Mellitus in the Dental Office. Evanthia Lalla, DDS, MSa,*, Ira B. Lamster, DDS, MMScb Dental Clinics of North America. 56,24, 2012

27 Oral health and cardiovascular disease (CVD)
Infection and inflammation play a key role in the initiation and progression of atherosclerosis Individuals with severe chronic periodontitis have a significantly increased risk of developing CVD including Atherosclerosis, Myocardial infarction, Stroke Severe periodontitis has been associated with high BP in elderly Studies have shown a dose-dependent relationship between number of teeth and Cardiovascular Disease (CVD) mortality, indicating a link between oral health and CVD

28 Approaches by dentists addressing CVD in the dental practice
Modifiable lifestyle associated risk factors for periodontitis and CVD should be addressed in the dental office and in the context of comprehensive periodontal therapy, i.e. smoking cessation programs and advice on lifestyle modifications (diet and exercise) Determine and prevent : Patients at risk for infective endocarditis may require antibiotics prior to dental procedures Educate: Discuss with patients risk factors such as hypertension and high blood pressure Screening tools

29 Oral health and cancer Oral cancer is globally the eight most common malignancy Mostly in the tongue, floor of the mouth, lips and cheeks. Risk factors for oral cancer include use tobacco and alcohol Poor prognosis – early detection saves lives Treatment with radiation and chemotherapy effect oral microflora caused by radiation-induced xerostomia. Increased caries risk, periodontal disease, other infections  Dental treatment include oral evaluation and treatment, encourage a non-cariogenic diet and consult oncology team

30 Screening and monitoring for non-oral NCDs
Hypertension blood pressure measures Diabetes mellitus plasma glucose, A1c Cardiovascular disease LDLC, HDLC Salivary testing

31 How willing would you be to gather the following samples or data as part of your practice?
Very Somewhat Not sure Very unwilling willing unwilling N (%) Saliva 1,245 (64.3) 454 (23.4) 104 (5.4) 60 (3.1) 74 (3.8) Finger stick blood 552 (28.5) 530 (27.4) 320 (16.5) 316 (16.3) 218 (11.3) BP 1,359 (70.1) 401 (20.7) 65 (3.4) 50 (2.6) Ht/wt 640 (33.1) 471 (24.3) 297 (15.3) 300 (15.5) 228 (11.8) Greenberg BL, et al JADA 2010; 141(1): 52-62

32 Integration and collaboration
Identification Referrals Diagnosis Treatment Monitoring After Michael Glick Oral health care professionals Physicians’ scope of practice

33 Konklusjoner Ikke-smittsomme sykdommer er en av vår tids største utfordringer, både i Norge og verden. Orale sykdommer og andre ikke-smittsomme sykdommer har samme risikofaktorer – Common Risk Factor Approach. Tannhelsepersonale har en mulighet og en utfordring til å diagnostisere, forebygge og kontrollere ikke-smittsomme sykdommer. På grunn av stor personell-tetthet, høy frekvens av tannlegebesøk, god grunn og etterutdanning og har tannhelsepersonell i Norge en god forutsetning og mulighet for å begrense NCDs. Dette vil komme og vi er en ubenyttet ressurs i dette arbeidet. Viktig at tannhelsetjenesten samarbeider tett med generell helsetjeneste, også ved Samhandlingsreformen.

34 Fra dental isolasjon til integrasjon for helse harrysam@odont.uio.no