Common Risk Factors Associated with General and Oral Health

Overview

  • Common Risk Factors: These are influences that have been identified as contributors to poor general and oral health.

Learning Outcomes

  • **Identify Causes of Premature Death in England:
    1. Understand the major contributors to mortality.
    2. Recognize common risk factors linked to both general and oral health.
    3. Apply knowledge effectively to provide preventive advice.

Knowledge Requirements

  • Knowledge K03: Variance in disease presentation across diverse cultural and social groups, including those with protected characteristics, and how this variance affects diagnosis, prevention, and treatment.
  • Knowledge K04: Understanding general and systemic diseases and psychological conditions that are relevant to oral health, including their impacts on clinical treatment, patient compliance, self-care, and outcomes.
  • Knowledge K07: Familiarity with psychological and social concepts, theories of health, illness, behavioral change, and disease.
  • Knowledge K18: How diet and nutritional status influence oral and general health, as well as how to provide appropriate advice and support.
  • Knowledge K20: Responsibilities of the dental team as an access point linking to wider healthcare services.
  • Knowledge K22: The impact of medical and psychological conditions across various patient populations, and how cultural identity and values influence patient compliance and self-care.
  • Knowledge K51: Basic principles of a population health approach, including demographics, trends, determinants of health, and inequalities in health; metrics by which these are measured and analyzed.
  • Knowledge K52: Understanding the dental and wider healthcare systems dentists work within, encompassing local and national health policy, system delivery, and equity issues.
  • Knowledge K53: Role of health promotion in addressing changes in environment, community, and individual behaviors for health improvement.
  • Knowledge K58: Importance of collaboration within the healthcare and social care sectors to benefit individual patients and communities.

Skills Development

  • Skills S01: Ability to identify clinical presentations of oral and dental diseases relevant to Clinical Dental Technicians, along with underlying principles for diagnosis, prevention, and treatment.
  • Skills S20: Capacity to identify medical and psychological conditions' impacts across a variety of patients, understanding how these influence patient compliance, self-care, and outcomes in light of cultural identity and values.

Behaviours Required

  • Behaviours B1: Compassionate and professional behavior; addressing the fundamental needs of patients and caregivers.

Life Expectancy in the United Kingdom

  • Statistics from WHO (2023): Life expectancy trends:
    • 2000: Males: 78 years, Females: 80 years
    • 2010: Males: 80 years, Females: 82 years
    • 2015: Males: 81 years, Females: 83 years
    • 2019: Males: 81 years, Females: 83 years

Avoidable Deaths in Great Britain

  • Office of National Statistics (2022): In 2020, 22.8% of all deaths (153,008 out of 672,015) were labeled as avoidable.

Major Causes of Premature Death (Under 75’s in England)

  1. Cancer
  2. Heart Disease
  3. Stroke
  4. Respiratory Disease
  5. Liver Disease

Rising Causes of Death (Under 75’s)

  • Suicide
  • Injury/Poisoning of Undetermined Intent
  • Accidental Poisoning
  • Land Transport Accidents

Importance of Longevity

  • WHO Statistics: Global life expectancy averages: Women - 76 years; Men - 71 years.
  • UK Statistics: Women - 80 years; Men - 75 years.
  • Highlighted: One in three deaths in England occurs before age 75; over 75% of these premature deaths arise from the top five causes of premature death.

Oral Health Statistics (WHO, 2023)

  • Oral Disease Prevalence: Most widespread chronic disease, affecting approximately 3.5 billion people globally.
  • Untreated Tooth Decay: Most prevalent health condition identified (Global Burden of Disease, 2019).
  • Service Availability: Low- and middle-income countries predominantly lack sufficient services for oral health prevention and treatment.

Common Risk Factors for Oral Disease and Other Chronic Conditions

  • Shared Risk Factors:
    • Diet
    • Tobacco Use (smoking/chewing)
    • Alcohol Consumption
    • Non-medical Factors: Social determinants impacting health outcomes.
Specific Risk Impacts
  • Cancer Risks from Tobacco & Alcohol: Includes increased risk for lungs, urinary tract, kidneys, mouth/throat.
    • Respiratory Diseases: Impacts from tobacco and diet.
    • CVD, Obesity, Diabetes: Driven by dietary patterns and lifestyle choices.
    • Oral Health Issues: Periodontal disease, dental caries, and dental erosion influenced by various risk factors.

Diet and Obesity

  • Definition of Obesity: Accumulation of abnormal or excessive fat adversely impacting health, resulting primarily from energy intake exceeding energy expenditure.
  • Statistics of Obesity in England: 61.9% of adults classified as overweight or obese; 28% of children (aged 2-15) similarly classified.
  • Health Risks of Overweight Individuals: Elevated risks for type 2 diabetes, heart disease, and certain cancers.

Oral Hygiene Guidelines (Department of Health Toolkit, 2021)

  • Reduction Recommendations:
    • Lower frequency and quantity of sugar and acidic drinks.
    • Use toothpaste with at least 1450 ppm fluoride.
    • Perform oral hygiene twice daily.
    • Avoid tobacco and alcohol usage.

Managing Sugar Intake

  • Types of Sugars: All sugars contribute to decay; common names include sucrose, fructose, and glucose.
  • Ingredients Reading: Higher placement of sugar in ingredients lists indicates higher sugar content.
  • Sugar Misconceptions: "No added sugar" does not imply the product is sugar-free; may still contain natural sugars.
Nutritional Data Example

[ \text{Typical nutrient values for products} ]

  • Breakdown for Mini Kiev per 100g:
    • Energy: 981kJ/234kcal
    • Fat: 13g
    • Of Which Saturates: 2.4g
    • Carbohydrate: 1.7g
    • Of Which Sugars: 3.4g
    • Protein: 0.4g
    • Salt: 0.16g

Effects of Sugar on the Body

  1. Brain: Sugar activates the brain's reward center with dopamine, potentially leading to addiction.
  2. Skin: Accelerates aging and can worsen conditions like acne.
  3. Liver: Transforms excess sugar into fat; excess comparable to alcohol overload.
  4. Kidneys: High blood sugar can lead to permanent damage by spilling into the urine.
  5. Mouth: Linked to tooth decay and gum disease.
  6. Heart: Contributes to artery hardening and heart tissue damage.
  7. Stomach: Disrupts gut health and microbiome balance.
  8. Pancreas: Triggers overproduction of insulin.
  9. Fertility Issues: High blood sugar affects reproductive functions in both genders.

Fermentable Carbohydrates

  • Definition: Includes sugars, starches, and fibers that serve as energy sources for bacteria in the large intestine, leading to possible negative oral health effects.
  • Examples: Certain fruits, vegetables, dairy, and whole grains.

Healthy Diet Guidelines (NHS Choices, 2022)

  • Base Meals on Starches: Favor wholegrain versions and consume potatoes with skins.
  • Fruit and Vegetable Intake: Aim for seven servings daily, with each serving defined as 80g.
  • Nutritional Benefits: Reduced risk for heart disease and cancer associated with higher fruit and vegetable consumption.
Fat Consumption Insights
  • Saturated Fat: Found in many processed foods such as cheese, sausages, and more; should be limited.
  • Positive Unsaturated Fats: Found in oils, fish, nuts, and seeds; beneficial for health.
Fish Consumption Recommendations
  • Weekly Intake: Consume two portions of fish weekly, including oily varieties rich in omega-3 fatty acids for heart health benefits.
Sodium & Hydration Recommendations
  • Salt Consumption: Approximately 75% of dietary salt comes from processed foods; moderation is vital to prevent high blood pressure.
  • Hydration: Recommended at 1.2 liters of water-based fluids daily to maintain body functions; adjustment needed for hotter climates or heavy manual labor.

Alcohol Use (NHS, 2023)

  • Long-term Effects: Heavy alcohol consumption can cause organ damage, including to the brain, heart, liver, and pancreas.
  • Increased Health Risks: Raises blood pressure and cholesterol, leading to heart attack and stroke vulnerabilities.

Oral Health Implications of Alcohol Consumption

  • Cancer Risks: Excessive alcohol intake significantly heightens mouth cancer risk, especially when combined with smoking.
  • Tooth Erosion: Alcohol mixed with fizzy drinks increases acid levels in the mouth.
  • Behavioral Risks: Alcohol can lead to violence and domestic abuse, which may cause facial trauma.

Effects of Alcohol on Oral Cavity

  • Reported Oral Health Issues (2019): Increased incidences of oral cancer, tooth decay, and erosion.
  • Emerging Evidence: Low certainty links between alcohol and periodontitis; possibly via impacts on bone density and saliva production.

Smoking and Tobacco Use

  • Public Health England Statistics (2016): 3,744 mouth cancer diagnoses in the UK.
  • Tobacco Forms: Includes shisha, smokeless tobacco, heat-not-burn tobacco, and conventional cigarettes.
Understanding Tobacco Combustion Effects
  • Tobacco Effects: Burning tobacco creates harmful chemicals not found in unburned products, significantly heightening cancer risk, particularly for lung and throat cancers.

Public Health Insights on Smoking

  • Health Risks of Smoking:
    • Heart: Doubles heart attack risk.
    • Lungs: Primary cause of lung cancer and COPD deaths.
    • Circulation Issues: Raises blood pressure and heart rate.
    • Fertility Impacts: Smoking can impair reproductive health.
    • Oral Cavity: Increases chances of cancers in the mouth and throat regions.
    • Skin Aging: Premature aging of skin by 10-20 years.

Helping Patients as Dental Professionals

  • Very Brief Advice (VBA):
    • Ask: Establish and record smoking status.
    • Advise: Suggest effective cessation methods.
    • Act: Refer to smoking cessation support or prescribe quit aids.

Guidelines on E-Cigarettes

  • NICE Guidance: Explains that while e-cigarettes are not licensed medicines, many find them helpful for quitting smoking. Caution that smoking remains harmful, and e-cigarettes are not risk-free.

General Alcohol Use Recommendations

  • Safe Drinking Limits: Regularly should not exceed 14 units per week; spread consumption over three or more days.
  • Recommendations for Reducing Intake: Incorporate drink-free days in the week.

Social Determinants of Health (SDH)

  • Influence of SDH: Health inequalities and access to care and education on health symptoms significantly follow a social gradient, with lower socioeconomic groups facing worse health outcomes.
  • Research About SDH: Findings indicate non-medical factors often outweigh healthcare access or lifestyle choices' impact on health outcomes.

Oral Manifestations of Diseases

Detailed Conditions
  • Median Rhomboid Glossitis: Erythematous patch, often asymptomatic, may respond to antifungal treatments; linked with smoking, dentures, corticosteroid use, HIV.
  • Angular Cheilitis: Multifactorial etiology, presenting as erythema; typically managed by antifungals or antibacterials.
  • Geographic Tongue: Benign condition with associations to psoriasis and certain diets; no treatment typically needed.
  • Herpes Simplex Virus: Characterized by episodic lesions, treated with acyclovir.
  • Possible Impacts of TB: Leads to oral ulcers, typically angular; bacterial infection spread via droplets.
  • Syphilis: Presents with a chancre; various stages produce distinct oral lesions and effects; treatable with antibiotics.

Conclusion

  • Healthy Lifestyle Promotion: Emphasize balanced diets and exercise for overall health improvement.
  • Reduction in Risk Behaviors: Decreasing tobacco and alcohol consumption reduces risks for systemic and oral diseases.
  • Role of Dental Professionals: Acknowledgment of the impact dental practitioners can have on patients' broader health issues, extending beyond dental hygiene.