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Integrating Evidence-Based Practices› Practice Guidelines and Best Practices› Focusing on the Body as a System

Evaluating the Literature› Strength of Evidence

Medical Conditions/Disease Associated with Dental Conditions/Disease› Systemic Disease

HPV; HIV; Diabetes; Crohn’s Disease; Anticoagulation Tx› Pregnancy› ECC

Collaborations/Knox County Programs Contact Information References

Goal:Prevent and control oral and craniofacial diseases, conditions, and injuries, and improve access to preventive services and dental care.

“By what age does your state EPSDT guidance recommend a referral for a dental examination? 3 years oldV.asp?StateID=TN&Year=2009http://apps.nccd.cdc.gov/synopses/StateData

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CDC: A National Call to Action to Promote Oral Health

1. Change perceptions of oral health.2. Overcome barriers by replicating effective programs

and proven efforts.

3. Build the science base and accelerate science transfer.

4. Increase oral health workforce diversity, capacity, and flexibility.

5. Increase collaborations.

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35 yobm Health History negative No medications

Cause↔Effect

Associated relationship

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Case Reports Case Control Study Cohort Study Randomized

Controlled Trial Practice Guidelines Systemic Review Meta-Analysis

Weakest

↓Strongest

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Diabetes Cardiovascular Disease HIV Crohn’s Disease

Antibiotic Guidelines Premedication

› AHA Guidelines› Joint Replacement

Anticoagulation› INR› Current Practice Guidelines

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HIV› EBV› Kaposi’s Sarcoma

HPV Diabetes Leukemia

HPV › ~ 120 virus types

5 low risk HPV types 13 high-risk HPV types

› Benign sequela Skin warts

› Cancerous sequela Cervical Cancer Anogenital Cancer H&N Cancer (HPV 16&18)

Risk Factors› Alcohol› Tobacco

HPV (16 &18) associated with H&NSCC› Diagnosis at a younger age› Higher survival rate than non-HPV

related OSCC

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Two Vaccines› Bivalent vaccine (Cervarix) HPV 16 and 18

› Quadrivalent vaccine (Guardisil) HPV 6, 11, 16, 18

Will it positively affect the future of the recent rise of OSCC?

Decrease Bacterial Load of the Mother

Education› Nutrition

Balance Limited Exposure to

Carbohydrates/Sugar› Home Care

Good Oral Health Care Habits

Transmission of Disease› Routine Preventive Tx

Pregnancy Gingivitis Pyogenic Granuloma

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28 yohf Prenatal Anemia Medications: Prenantal vitamins and iron

Decrease Bacterial Load of the Mother/Cargiver

Education› Nutrition› Home Care› Routine Preventive Tx

Early Home Care First Dental Visit by First

Birthday› Nutrition› Home Care› Routine Preventive Tx

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4 yo with ECC

Dry mouth› Many medications HAART Psycotrophics

Gingival Hyperplasia› Antihypertensives nifedipine amlodipine

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Huge Effect of Diet on Caries› Soda› Sports Drinks› Carbohydrates

Night time bottle at bedtime› What does is contain?

Sippy Cups

FREQUENCY OF CONTACT

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EPSDT Visits Women’s Health WIC Ryan White

Diabetic Clinics Oncology

› Chemotherapy & Radiation Treatment

Thanks!!

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Carol Ann Shipley, DDS MPH140 Dameron AvenueKnoxville, TN 37917Work Phone: 865 215 5110Fax: 865 215 5117Email:

carol.shipley@knoxcounty.org

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Department of Health & Human Services; Maternal and Child Health Bureau Oral Health Leading Health Indicators – Healthy People 2020 –

healthypeople.gov/2020/lhi/oralHealth.aspx CDC – “A National Call to Action to Promote Oral Health”; www.cdc.gov NY Times – “Sharp Cuts in Dental Coverage for Adults on Medicaid” 28 August 2012 Caries Prevention, Risk Assessment, Diagnosis, and Treatment –

www.ohiodentalclinics.com/curricula/caries Rothman, M., et al. “Nonfluoride caries-preventive agents”, JADA 142 (9): 1065-1071, September 2011 Bader, J., et al. “Physicians’ Roles in Preventing Dental Caries in Preschool Children”, US Preventive

Services task Force; www.uspreventiveservicestaskfource.org ADA Guidelines for prescribing Dental Radiographs FDA Pregnancy Categories UW Drug Information Center. “Medication Exposures During Pregnancy and Lactation” Kinkade, K., “Which Common Meds Put Pregnant Women, Infants at Risk?” – www.drBicuspid.com , 09

August 2012 Radiation and Pregnancy: A Fact Sheet for Public Health – www.bt.cdc.gov/radiation/pernatal.asp Mughal, R., “Dentists Not Following Antibiotic Prescribing Guidelines”, www.dr.bicuspid.com, 06

January 2012 “Guidelines on Use of Antibiotic Therapy for Pediatric Dental Patients”, American Academy of

Pediatric Dentistry, V33: No 6, 11/12 Hulbutt, M., “CAMBRA: Best Practices in Dental Caries Management”, Dental CE Digest, August 2011 Watterson, D., “Emerging Concepts in Periodontitis and Overall Health – Separating Fact from Fiction”,

Professional Dental Management Oral Health During Pregnancy & Early Childhood: Evidenced-Based Guidelines for Health Professionals

– www.cda.org ADA Center for Evidenced-Based Dentistry http://ebd.ada.org

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Section on Evidence Based Health Care, The New York Academy of Medicine -www.nyam.org/fellows-members/ebhc/

http://www.surgeongeneral.gov/library/calls/oralhealth/index.html Chaturvedi,A., et al. “Incidence Trends for Human Papillomavirus Related and Unrelated

Oral Squamous Cell Carcinomas in the United States”American Society of Clinical Oncology; 01Feb2008 vol.26, no. 4, 612-619.

Clavel C, et al. “Hypbrid Capture II-based human papillomavirus detection, a sensitive test to detect in routine high-grade cervical lesions: a preliminary study on 1518 women. Br J Cancer. 1999;80;1306-11.

Reddout, N. “High risk HPV types 18 and 16 are potent modulators of oral squamous cell carcinoma phenotypes in vitro”. Infectious Agents and Cancer 2007,2:21.

DynaMed search: cavities; anticipatory guidance (pediatric preventive care); Updated 2012August 1:37pm (Pediatrics2012 Jun); oral health-oral health recommendations.

"What is EBM?". Centre for Evidence Based Medicine. 2009-11-20. http://www.cebm.net/index.aspx?o=1914. Retrieved 2011-06-17

Alan L Lin; Dorthea A Johnson; Carol Ann (Shipley) Sims; Kevin T Stephan; Chih-Ko Yeh. Salivary gland function in HIV-infected patients treated with highly active antiretroviral therapy (HAART). Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 2006;102(3):318-24.