By Marianne Lincoln

This is the second in a series of stories from the Pierce County Oral Health Summit. This one is more graphic, so it is designated for mature audiences.

The Oral Health Summit continued with a panel format with three presenters who spoke on diabetes, sexually transmitted infections and the health department’s Comprehensive Community Oral Health Plan (CCOHP). Of particular interest was how individual dentists should approach the patients when these conditions are apparent. Dentists are as human as the patients and the questions asked showed that they have a difficult time reaching out to the patients about these other medical problems that are apparent when the teeth are treated.

Dr. Neal Raval, DDS, MSD,spoke on diabetes and its effect on oral health.  He said, “Oral Health is an important component of total health, systemic health does not exist without oral health.”  Periodontal health is not just about the teeth, it includes oral facial pain, cancer lesions of the head & neck, birth defects, and the cranial-facial complex.

Patients with diabetes and periodontal disease have increased collagen breakdown; their wounds and sores do not heal well. The flora (mixture of substances with saliva in the mouth) of diabetic patients becomes altered and affects the periodontal disease.

When physicians and dentists look at cardiovascular disease, it has been shown to have has an association with periodontal disease and progresses more quickly in diabetics.  Dr. Raval noted, “If you treat periodontal disease, a diabetic person’s insulin status will improve.” With poor diabetic control, periodontal status is worsened.

The room got quiet and ‘oohs and ahhs’ were heard when Mary Galagan, RDH, MS spoke about sexually transmitted infections (STI’s) in her presentation titled, Oral Manifestations of STI’s. Luckily for most people, we do not usually see the kinds of mouths she presented in her photos. Dental practitioners, however, have special risks working with these patients. In her job as a dental hygienist, she sees a lot of cases and she also gives presentations to teenagers in middle and high schools. Because of there is no risk of pregnancy from oral sex, statistics show many more teenagers engage in it. The risk of getting the same sexual diseases exists, however. Gonorrhea, herpes, chlamydia, syphilis and AIDS can all be transmitted orally. Ms. Galagan showed photos of how some of these conditions present orally.

She made a particular emphasis that gonorrhea, which gives a white appearance in mouth, may be confused with strep because it has similar symptoms (pain, fever and swollen tonsils), but does not test out for strep. She showed a photo of a females tongue white was literally colored white from the infection.

Unfortunately, she said the reaction to her presentation that she got from a group of teenage boys (close to her own family) was that they will start carrying flashlights (to do oral screening of girlfriends), but are not about to stop having sex. Therefore, she underscored the need for dentists to recognize these symptoms as they treat teenage and young adult patients.

She noted that herpes of the mouth is often asymptomatic. Then she displayed photos of patients’ mouths that showed swollen pus filled patches around the outer lips that were visually symptomatic of herpes.

Less in teenagers, but more likely for patients between 20 and 30, are cases of syphilis. It is transmitted by contact with sexual fluids and also can be spread to a child in the birth canal. There is a tooth condition in children called mulberry molar that is a symptom of syphilis. Syphilis can be cured most easily in the primary stage. There are additional symptoms in the secondary stage and tertiary stages. This link is to a health department warning on the increase in syphilis rates in Pierce County from 2011. This is another about syphilis trends.

And of course, AIDS is always a concern for dentists. She did not elaborate on this particular problem.

She ended her presentation with the recommendation that kids need to be tested more for these conditions. Readers can see some of the graphic photos of oral STI’s at this link.

Linda D. Gillis, RDH, BSDH presented the health department’s Comprehensive Community Oral Health Plan (CCHOP). As part of the TPCHD  Strategic Plan (downloadable PDF file), the CCHOP is an assortment of ways the health department would like to approach oral health in the community.

Here are the CCHOP Oral Health proposals for Pierce County :

• Complete a community engagement process to allow for the review and adaptation of the CCOHP in response to community input by Sept 2013

• Increase community coalition investments in improving oral health for Pierce County residents

• Provide ongoing oral health resources and education through the Health Department Network Nursing programs

• Integrate the work of the oral health program into the efforts to address overweight, obesity and tobacco use in Pierce County

• Increase referral of young mothers to dental (offices) homes

• Fluoridation of public water supplies

•Launch a “Call to Action” to improve access to adult dental services for all residents of Pierce County and increased access to emergency care

•Work with community leaders to develop and pass policies that provide community-wide oral health improvements

•Increase the number of dentists becoming ABCD providers (Access to Baby & Child Dentistry)

•Increase children’s access to school-based preventive oral health services

This is a link to the TPCHD Oral Health Program site.