Community Oral Health

Introduction to Oral Health Inequalities

The following case analysis is about the dental condition of David who is a 45 years Indigenous patient from Ballarat Victoria. He has complained of bad breath and a hole in tooth visisble but no pain. Following on after the initial investigation of David’s dental condition, the treatment plan and further management will be discussed with focus on behavioural change models. Although David has a family history of obesity and diabetes, he is not showing any signs or symptoms of either obesity or diabetes. He is not on any medications and no allergies present. His risk behaviours compromise both his eating habits, smoking habits and sedentary lifestyle. His smoking habit is 5 cigarettes a day for the past 15 years. His smoking goes up at work since his co-workers also smoke. His diet is not healthy, for the lunch he either goes hungry or has large iced coffee or heavy lunch with clients which include wine, steak and Indian cuisine. His dinner is never home cooked meal and it consists of alcohol and seafood, steak, ice-creams and fruits. His work doesn’t allow much for exercise and is very hectic as he works as a lawyer. The social determinants affecting his impulse eating habit are situational factors cultural factors, working place and his economic situation (Manickam & Lakshmanamoorthy, 2018). Behavioural analysis for him will focus on his eating habits, drinking habits and work place surrounding (Garcia-Continente et al., 2015; Hood et al., 2015). From the video provided he is not receptive of any professional help neither from any close relative, although the manner in delivering heath advice can be changed.

Clinical Presentation

The clinical presentation will be based on the dental chart and periodontal chart provided.

In the dental chart it is visible that he has dental attrition which is wear and tear on 12 tooth including the canines and incisors. Adhesive is visibly present on five tooths of the upper incisors and molars. Abrasion is seen only on one upper molar. Erosion is present on 8 tooths, on the molars. Cavity is present on two tooth, second molar on left of upper and lower jaw. Metallic dental implants are present on 7 tooths, the molars.

From the periodontal chart in the maxillary region 8 tooth are at the risk of developing gum disease due to probing depth of 2-3, 6 tooth are at the early stages of gum diseases due to probing depth of 4-5 signalling the beginning of periodontitis requiring further treatment with rest of the tooth can be managed with at-home dental care. The mandibular region shows 15 tooth are at the risk of developing gum disease due to probing depth of 2-3, 9 tooth are at the early stages of gum diseases due to probing depth of 4-5 signalling the beginning of periodontitis requiring further treatment and rest can be managed with at-home dental care. His periodontal status is sever leading to mobility, bone loss and tooth loss (Michaud et al., 2017; Clementini, et al., 2014). His dental status from the dental and periodontal chart along with his smoking habit and nutritional status put him at risk of developing multiple caries, periodontal diseases and oral cancer (Bertoldi et al., 2013).

Nutrition and Health Implications

His diet of high consumption of sugar rich foods, inadequate nutrients, and low to no fibre intake increases the risk of him developing obesity, diabetes, and dental caries. High consumption of carbohydrates in his dietary lifestyle and eating habits out him at a high risk of developing dental decay. The cariogenic microorganism present in the carbohydrates, their fermented end products are the main cause of tooth destruction. His risk of developing periodontal disease is high because of multiple factors such as not consuming enough nutrients, not maintain proper oral hygiene, smoking habits and his family genetics of obesity and diabetes (Hujoel & Lingström, 2017; Chapple et al., 2017).

He has one cup of tea every day, although it is not mentioned if it is green tea, as green tea contains catechins which help in prevention of dental caries. His eating lifestyle doesn’t include milk which help in the body’s calcium and phosphate contents. Disturbance in the nutritional status of the body will lead to negative effect on the mineralization of tooth process and increase the risk of developing caries His high consumption of sugar will lead to enamel decay and consumption of sugar in any amount will add to the risk of developing dental caries. His consumption of sugar at various times along with snacks along increase the risk (Hujoel & Lingström, 2017; Chapple et al., 2017). His diet which is high in sugar and carbohydrates are major risk facts which will lead to him developing diabetes and cardiovascular disease later in life. High carbohydrate diet also outs him at risk of suffering from myocardial infarction and increased risk of mortality. Lack of vitamin C in his diet will increase the risk of him suffering from gingival bleeding, lack of Vitamin D will increase the risk of tooth loss and caries, loss of vitamin B12 will lead to the tooth’s periodontal status deteriorating irrespective of his oral hygiene. Lack of fruits and vegetables in his dietary lifestyle affects his nutritional status adversely and increase the risk of bleeding gums (Hujoel & Lingström, 2017; Chapple et al., 2017).

His oral hygiene routine, presence of caries, periodontal disease risk will lead to tooth loss which will lead him towards food selection and deterioration of his dental condition. Loss of consumption due to tooth loss will have significant impact on his nutritional status. (Toniazzo et al., 2018). The depth of lesions from his dental examination, sugar preference and genetic factor plays a role in him being susceptible to periodontitis. His behavioural factors which include high sugar diet, alcohol consumption, and smoking increase his chances of developing periodontal disease. Loss of micronutrients such as magnesium, calcium, antioxidants, and docohexanoic acid increase the risk of caries and periodontal diseases. His diet which is high in carbohydrates will lead to increased inflammation and gingival bleeding. His high pressure working environment and improper diet shows to increased risk of caries (Chapple et al., 2017).

Social Determinates of Health

The World Health Organization, (2020) defines social determination of health as the conditions surrounding the individual during their birth, growing up period, where they live, their work place environment and their age. These conditions are affected by other factors such as the availability of natural resources, monetary income and these social determinants cause major health differences among the individuals. Health literacy affected by socioeconomic variables affect the individual oral health outcomes, in particular income, education and the personal choice by the individual affect their oral health. An individual with low health literacy will have low quality of life and higher chances of developing oral diseases such as caries or periodontal diseases (Batista et al., 2018). The social determinant of health play an important role in oral health which is an important part of the individual’s quality of life. David eating choices, insufficient consumption on macro and micronutrients, along with smoking and drinking habits are the major risk factor affecting his oral health. His work and social lifestyle of a lawyer which has him travelling a lot, eating carbohydrate rich and high sugar content food with little to no fibre or vegetables affect his choices in behaviour thus affecting his oral health (Batista et al., 2018).

Oral health is also affected when there is limitation in accessing to the oral health facilities and culture and behavioural factors also play a major hand. The information about oral health has strong association with the individual’s levels of education, which ethnicity they belong to, do they prefer using the dental services or not. How much knowledge they have about oral health hygiene and oral health care they can manage at home. Those who have high education and high income tend to report better oral health. Poor oral health is related to poor living conditions which also contributes to their morality rate (Naghibi et al., 2013).

The subjective oral health condition of an individual is affected by the person environmental and individual factors. When an individual has more close relationship with “generalized resistance resources” such as the individual’s access to income, literacy and knowledge, understanding and experience, how they manage health behaviour and avoid stress lead to the individual’s sense of coherence towards developing a good oral health hygiene. Having a better socio-economic status will the individual to better access to the oral health care facilities, have a good oral heath, improve quality of life and overall better health. Along with the high status, availability of these resources also affect the oral health and tend to create differences among the general community population. People in high socioeconomic status can afford to maintain their oral health in good condition, better able to deal with stress, and this decreases people who are in low socioeconomic levels. In high socioeconomic status had better support from family and society, better coping ways as well to manage the oral health condition in particular their subjective oral health outcomes (Gupta et al., 2015).

Behaviour Analysis and Plan for David

Behaviour analysis is based on the information provided and the video.

David working as a lawyer has less time to take care of his health and is travelling most of the time. He doesn’t pay much attention to his oral health thus affecting his overall health and quality of life. His work has him skipping lunch at times or consuming high amount of carbohydrate and sugar intakes. Both of which are directly related to declares in oral health condition as mentioned above. He doesn’t regularly visit his dentist and although he is in good shape, having a positive family history of obesity and diabetes puts him in the high risk category of developing those chronic health conditions as well poor oral health. He understands his other risk factors include his smoking habit, which tends to increase when he is surrounded by his work colleagues. When told by his dentist that there are medications available to reduce his food intake, he didn’t respond positively was annoyed by this. He also mentioned that his family members and other doctors have also tried prescribing him something before which didn’t work and he doesn’t like getting suggestions about this. His behaviour towards his food lifestyle is also harmful as he doesn’t eat homemade cooked food and dining outside which are rich in carbohydrates, high fat and high protein content. He has ice-cream on a regular basis thus having a constant sugar exposure, fast food for lunch and his alcohol regular consumption also negatively affects his oral health.

Treatment plan: Model of behaviour change

Trying to change his behaviour through improving his health literacy is the basic model of plan. Promoting health education through health literacy of oral health is a key strategy that can be implemented. Other than helping him with providing reading pamphlets, arranging for health services, but also to raise his capacity in health literacy to use the oral health information provided to him. Improving his health literacy will make him take better decisions regarding other social determinant of health including the economic part and is the most important strategy in oral health patient counselling to prevent oral tooth deterioration (Batista et al., 2018; Naghibi et al., 2013). Lower health literacy will lead to negative oral health outcome for David who already multiple caries according to his dental check-up. Improving his health literacy will make him realize the importance of keeping regular dental appointment for regular check-up and prevent further spread of the tooth decay or caries condition. Focusing on increasing his functional literacy which will allow him a better understanding of the health risks he is at and how to avail the health services. That will be followed by improving is interactive literacy which will allow him gather information and relate them to his personal oral and overall health status. This will be improving his critical literacy through which he will be able to analyse the information provided to him in a critical manner and gain more control over his surrounding life situations (Batista et al., 2018; Naghibi et al., 2013).

3 (nutrition based) Suggestions

Suggesting low-fat diet will help David in his health outcome particular in prevention any cardiovascular disease. The focus should be on his diet should not contain more than 7-10% of saturated fat, less than 1% of unsaturated fat with the rest of calorie to be provided by “monosaturated fats and omega-3 polyunsaturated fat”. David can accomplish by having a diet of meat products which have low fat content, focus more on vegetables and choosing food products which have low trans-fat content (Eilat-Adar et al., 2013).

A low-carbohydrate diet with the consumption limit set to 30-130 gm each day, as this will help in reducing the triglyceride content in the body, help in reducing weight preventing obesity, preventing developing chronic cardio vascular condition. Along with that he should be encouraged to consume more vegetables and fruits. Fruit serving regular vegetable intakes decrease the risk of CHD as well cardio vascular mortality/. In addition to those benefits they also help in lowering blood pressure and along with low carbohydrate, high fibre improve the individual oral health and overall health (Eilat-Adar et al., 2013).

Suggesting to David that he should consider having more whole grain and dietary fiber in his nutritional plane as they reduce the risk factors of cardio vascular diseases or chronic heart disease in individuals and help in reducing the triglyceride levels as well (Eilat-Adar et al., 2013).

Conclusion/Prognosis on Oral Health Inequalities

David has a history of not taking proper care of this teeth and is influenced by multiple factors. His risk factor of unhealthy eating habits and smoking contribute a great deal to the negative health of his tooth. Along with that he chooses to ignore health care services suggestions as well as from his family. The environmental factors associated with his poor oral health are responsible as much as he is as well. An improvement in his health literacy will go a long way for him to control his tooth condition and prevent any further damages. Due to his family history, he is at high risk of developing obesity and diabetes. Since his lifestyle doesn’t show that he does physical activities, controlling his food choices is the best way of preventing any cardiovascular diseases or morbid health conditions. Explaining to him that the health interventions are for his benefit is the biggest challenge as he refuses to accept help. The family help should be taken as well since their support might convince him to change his lifestyle and behavioural choices. Davis has to understand the consequences of not adhering to the suggested diet regime will lead to negative health outcomes and although it may be challenging at first when switching to high fibre, low salt, low sugar diet, the overall benefits will be worth it.

References for Oral Health Inequalities

Batista, M. J., Lawrence, H. P., & de Sousa, M. D. L. R. (2018). Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health18(1), 60. https://doi.org/10.1186/s12889-017-4443-0

Bertoldi, C., Lalla, M., Pradelli, J. M., Cortellini, P., Lucchi, A., & Zaffe, D. (2013). Risk factors and socioeconomic condition effects on periodontal and dental health: A pilot study among adults over fifty years of age. European Journal of Dentistry7(3), 336. doi: 10.4103/1305-7456.115418

Chapple, I. L., Bouchard, P., Cagetti, M. G., Campus, G., Carra, M. C., Cocco, F., ... & Manton, D. J. (2017). Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. Journal of Clinical Periodontology44, S39-S51. https://doi.org/10.1111/jcpe.12685

Clementini, M., Rossetti, P. H. O., Penarrocha, D., Micarelli, C., Bonachela, W. C., & Canullo, L. (2014). Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery43(3), 323-334. https://doi.org/10.1016/j.ijom.2013.11.012

Eilat-Adar, S., Sinai, T., Yosefy, C., & Henkin, Y. (2013). Nutritional recommendations for cardiovascular disease prevention. Nutrients5(9), 3646-3683. https://doi.org/10.3390/nu5093646

Garcia-Continente, X., Allué, N., Pérez-Giménez, A., Ariza, C., Sánchez-Martínez, F., López, M. J., & Nebot, M. (2015). Eating habits, sedentary behaviours and overweight and obesity among adolescents in Barcelona (Spain). Anales de Pediatría (English Edition)83(1), 3-10. https://doi.org/10.1016/j.anpede.2015.05.017

Gupta, E., Robinson, P. G., Marya, C. M., & Baker, S. R. (2015). Oral health inequalities: relationships between environmental and individual factors. Journal of Dental Research94(10), 1362-1368. https://doi.org/10.1177/0022034515592880

Hood, K. K., Hilliard, M., Piatt, G., & Ievers-Landis, C. E. (2015). Effective strategies for encouraging behavior change in people with diabetes. Diabetes Management (London, England)5(6), 499–510. DOI: 10.2217/dmt.15.43

Hujoel, P. P., & Lingström, P. (2017). Nutrition, dental caries and periodontal disease: a narrative review. Journal of Clinical Periodontology44, S79-S84. https://doi.org/10.1111/jcpe.12672

Manickam, T., & Lakshmanamoorthy, T. (2018). Social Determinants of Personality Development. Social Psychiatry: Principles & Clinical Perspectives, 102. https://www.apibpj.com/book/9789352704224/chapter/ch9

Michaud, D. S., Fu, Z., Shi, J., & Chung, M. (2017). Periodontal disease, tooth loss, and cancer risk. Epidemiologic Reviews39(1), 49-58. https://doi.org/10.1093/epirev/mxx006

Naghibi Sistani, M. M., Yazdani, R., Virtanen, J., Pakdaman, A., & Murtomaa, H. (2013). Determinants of oral health: does oral health literacy matter?. ISRN Dentistry2013. https://doi.org/10.1155/2013/249591

Toniazzo, M. P., Amorim, P. D. S. A., Muniz, F. W. M. G., & Weidlich, P. (2018). Relationship of nutritional status and oral health in elderly: Systematic review with meta-analysis. Clinical Nutrition37(3), 824-830. https://doi.org/10.1016/j.clnu.2017.03.014

World Health Organization. (2020). Social determinants of health. Retrieved from: https://www.who.int/social_determinants/sdh_definition/en/

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