Relationship of Oral and Systemic Health Clinical Case #3

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Question 1 of 3

1. Question
You would like to start a fluoride varnish program in your office since your state Medicaid program now reimburses for this service. Your team members are concerned about introducing an additional procedure into already busy well child visits. You have recently learned about the importance of oral health to overall health and would like to present data to your team members about the importance of promoting good oral health.

Which of the following statements is true?
- Dental caries is five times more common than asthma in children.
- Oral cancer is the fourth most prevalent cancer in adults. Oral cancer is actually the 10th most prevalent cancer in adults. It affects over 70,000 adults annually and approximately 14,000 people die from oral cancer annually, in part because it is often diagnosed late.
- Children are more likely to lack medical insurance compared with dental insurance. Children are actually 2.5 times more likely to lack dental insurance compared to medical insurance. Most children have a medical home long before they have a dental home.
- All of the above Only one statement is correct.
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Question 2 of 3

2. Question
The conversation with your team then turns to what oral health services your practice should offer. One of your team members points out that many oral problems are already managed in the office. Your office manager is confused and thought oral health was exclusively the domain of dentists.

Which of the following are routine oral health related scenarios that primary care providers should feel comfortable addressing?
- Managing anticoagulation before, during and after dental procedures in collaboration with a dentist Medical providers play a vital role in managing anticoagulation medications around the time of oral procedures. Anticoagulation can be continued during most oral procedures to avoid an increased risk of thrombosis. Local clotting agents can be used if there is excessive bleeding during the procedure. However more than one response is correct.
- Initially evaluating oral trauma Medical providers often are asked to initially evaluate and triage oral trauma, either in person or by telephone. It is important for them to be able to offer accurate advice, especially in areas where emergency dental care is difficult to access afterhours. However more than one response is correct.
- Managing the oral effects of common medications Many medications have side effects that affect the mouth. Primary care clinicians can warn patients to watch for these effects and reduce their risks by minimizing doses, choosing medications with fewer oral effects, and promoting good oral hygiene. However more than one response is correct.
- Consulting with dentists about the need for antibiotic prophylaxis before a dental procedure The American Heart Association antibiotic prophylaxis guidelines were updated in 2006. Many patients who previously required antibiotic prophylaxis no longer do. Assisting dental colleagues with decision making for this important intervention is an essential role for medical clinicians. However more than one response is correct.
- All of the above
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Question 3 of 3

3. Question
Your varnish program proves to be successful. After 3 months your team decides to expand their scope of involvement in the promotion of oral health.

With a minimal amount of continuing education, clinicians in your office could play all of the following roles EXCEPT:
- Advocate for community water fluoridation and fluoride varnish programs Primary care clinicians can play a vital role in advocating for community water fluoridation and varnish programs. Water fluoridation saves $38 in health care costs for every $1 spent and fluoride varnish reduces caries by 38%. The public respects what primary care clinicians have to say about these topics.
- Develop closer relationships with local dentists to improve the effectiveness of referrals Developing close relationships with dentists helps a primary care clinician know what type of patients their local dentists accept (infants, Medicaid patients, pregnant patients, patients with special health care needs) and therefore makes referrals more effective and efficient.
- Extract teeth in the office
- Apply fluoride varnish Fluoride varnish application is an easy skill to learn and can reduce caries by 38%. Primary care clinicians who apply it are reimbursed by Medicaid in all 50 states.
- Have posters promoting oral hygiene and teeth injury prevention in every exam room Health promotion via posters in the office helps send a consistent message to patients and their families
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The Relationship of Oral and Systemic Health

Relationship of Oral and Systemic Health Clinical Case #3

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