Transcript Dr. Harry-Sam Selikowitz DDS, MSc, PhD.

Harry-Sam Selikowitz, Dr. Odont.
Nestleder, FDIs Vitenskapskomite
Folkehelsenettsverks konferanse 2014
Ikke-smittsomme sykdommer er definert som:
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hjerte- og karsykdommer
kreft
kroniske lungesykdommer
diabetes
Hoved - risikofaktorene for disse sykdommene:
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bruk av tobakk
usunt kosthold
for lite fysisk aktivitet
skadelig bruk av alkohol
NCDs are the third largest global risk
Oil spikes
Retrenching from globalization
Asset price collapse
Food price volatility
Financial crisis
Infectious diseases
Noncommunicable
diseases
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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
10005
9444
Usunt kosthold
Høyt blodtrykk
Røyking
6623
4238
Overvekt/fedme
Fysisk inaktivitet
3623
Høyt kolesterol
2727
2465
Høyt blodsukker
Alkohol
Lav bentetthet
Rusmiddelbruk
Radon
873
501
316
277
Antall dødsfall
Nutrition transition – globalization uncontrolled
Diabetes and obesity worldwide: epidemics in full
flight
"Obesity: now deadlier than smoking."
The Health Risks of Sugar
- Rebound hypoglycaemia
Coca-Cola the No 1 item sold in NZ super markets
Obesity
Diabetes
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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.
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
“… 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 noncommunicable
diseases”
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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.
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Call for action
Content of the UN
High-level meeting on
NCD
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A practical tool
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Enhance synergies
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Inform and advise
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Influence policy
◦ Develop strategies to reduce
intake of sugar
Policy Statements:
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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
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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.
Tobacco
* Lung
* Kidney
Alcohol
Cancers
* Urinary tract
* Mouth/throat
Respiratory diseases
CVD
Diet
Obesity
Diabetes
Stress
Periodontal disease
Dental caries
Hygiene
Dental erosion
(Grabauskas WHO Regional Office for Europe 1987; Sheiham & Watt, 2000)
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These are:
1. A food and health policy to reduce sugars consumption.
2. A community approach to improve body hygiene and oral
hygiene.
3. Smoking cessation policy.
4. Policy on alcohol
5. 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, evidencebased dental prevention and dental care.
Bidra til en samfunnsutvikling som
fremmer folkehelse og utjevner
sosiale helseforskjeller
Sikre at folkehelse prioriteres
Langsiktig kunnskapsbasert
og systematisk arbeid
Bedre samordning
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Samhandlingsreformen
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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.
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Common Risk Factor Approach: Conditions Model
Risk Factors
Diet
Diseases
Risk Factors
Obesity
Tobacco
Cancers
Workplace
School
Stress
Heart disease
Alcohol
Respiratory disease
Control
Policy
Dental caries
Exercise
Periodontal diseases
Hygiene
Political
environment
Trauma
Physical
environment
Housing
Injuries
Social
environment
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
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
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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
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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
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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
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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
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Oral cancer is globally the eight most common malignancy
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Mostly in the tongue, floor of the mouth, lips and cheeks.
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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
Hypertension
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Diabetes mellitus
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plasma glucose, A1c
Cardiovascular disease
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blood pressure measures
LDLC, HDLC
Salivary testing
Saliva
Finger stick
blood
BP
Ht/wt
Very
Somewhat
willing
willing
N (%)
N (%)
N (%)
N (%)
N (%)
1,245 (64.3)
454 (23.4)
104 (5.4)
60 (3.1)
74 (3.8)
552 (28.5)
530 (27.4)
320 (16.5)
316 (16.3)
218 (11.3)
1,359 (70.1)
401 (20.7)
65 (3.4)
50 (2.6)
65 (3.4)
640 (33.1)
471 (24.3)
297 (15.3)
300 (15.5)
228 (11.8)
Not sure
Somewhat
unwilling
Very
unwilling
Greenberg BL, et al JADA 2010; 141(1): 52-62
Identification
Referrals
Oral health care
professionals
Diagnosis
Treatment
Physicians’
scope of
practice
Monitoring
After Michael Glick
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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.