PENOBSCOT NATION HEALTH DEPARTMENT
PREVENTION PROPOSAL
DENTAL
MAY 30, 2008
Background
The ** Tribe is a federally recognized tribe located in State. The 2008 tribal census is *** and the Indian Health Service User population is ***. However, the actual number of users for the Tribal Health Department is ***. Of this total number of users, the dental program treats approximately ** patients. According to the 2008 Tribal census 36.55% of the tribal population is between the ages of 35 and 54 years.
The Tribal Health Department is in the process of re-designing a more comprehensive community based dental health program. This is being done in relationship with the Logic Models that have been developed for the Tribal Council.
The overall Departmental Goal for all the is:
To improve the quality of life for all members of the ** Tribe by elevating the overall health status of each member to the highest level possible.
Problem
The Tribe ** Health Department is planning on expanding the periodontal prevention and treatment program. Currently, the Health Department employs a part time Dental Hygienist whose primary responsibility is to complete deep scaling for patients with periodontal disease. Currently, the dental program has approximately ** patients diagnosed with periodontal disease. Of these patients, ** have had osseous surgery and implants, ** have had osseous surgery and ** patients have 50% or more bone loss. Approximately ** patients who have localized 5-6 mm pocketing have completed non-surgical treatment. These patients are referred out to a Periodontist for an initial examination and treatment plan and then are referred out on an annual basis for evaluation. In an attempt to prevent the progression of periodontal disease, the dental department proposes to initiate the use of Arrestin for dental patients who have pockets of 5 mm or more, have acceptable homecare and who may or may not have had osseous surgery. The Dental Hygienist will see patients who fit these criteria on a 3-month basis and the Arestin will be placed in the appropriate areas. Oral hygiene instruction will be emphasized and patients will receive a new toothbrush, floss and topical fluoride to take home after each visit with the Dental Hygienist.
The success of the program will be based on the number of patients treated with Arestin and the amount of decrease on the levels of the pockets. This data will be tracked by the dental hygienist and reported to the Penobscot Tribal Council on an annual basis.
Objectives
1. At least 50% of patients with severe periodontal disease (2 or more sextants with a PSR score of 4) will receive follow up periodontal treatment (deep scaling or extractions)within 60 days of diagnosis.
2. At least 75% of patients who complete periodontal treatment will have an improved PSR score in at least 1 sextant.
Activities
1. Diagnosis and Initial treatment
At the initial dental examination and at recall appointments patients have a Periodontal Screening and Recording Score recorded. Any patient with a PSR score of 4 in 1 or more sextants will be considered a high risk periodontal patient. These patients will be given appropriate home care instructions as well as patient education on periodontal disease and possible systemic complications of periodontal disease. Patients will be treatment planned for appropriate scaling and root planing and to extract hopeless teeth.
2. Treatment
Initial periodontal treatment (extractions and deep scaling) will be completed within 60 days of diagnosis, pending appointment availability. Initial scaling and root planing will be evaluated within 30 days of completion and reevaluated. Treatment decision tree and protocol is attached.
3. Follow Up
All high risk periodontal patients will be recalled every 3 months. Progress will be tracked using an Excel spreadsheet.
Resources
All treatment will be done with existing Penobscot Health Department staff. Funds are requested to augment current Dental Department services.
BUDGET:
EQUIPMENT:
Stainless steel applicators x 2 $49.98/each $99.98
ARRESTIN:
$20.00/dental site x 48 sites $928.00
SUPPLIES:
Tooth brushes, floss, fluoride $972.02
TOTAL $2,000.00
Evaluation
Clinical progress will be tracked using:
1. Improvement in PSR scores
2. Improvement in OH scores
3. # of patients who receive recommended follow up care
Programmatic Considerations
Tracking high risk patients can be time consuming for staff. Adequate record keeping is necessary to measure the impact of the program but tracking should not have an undue impact on patient care. At the end of the year staff will examine:
1. Tracking systems
2. Adequacy of information gained from data tracked
3. How information has been used to improve patient care
Programmatic information will be gathered by the hygienist responsible for the program and presented to the dental staff. Staff input will be considered in improving the program. Both clinical and programmatic results will be provided to Penobscot Tribal Council
Initial Exam1. Complete Medical History
2. Evaluate Perio / PSR of 2’s or less / Treat and advise patient of further care needed
PSR of 3’s or 4’s
1. Perio chart
2. Debridement
3. Scaling & Root Planing
4. Prophy as needed
5. OHI
6. 3-6 month re-eval
Additional Treatment Needed
/ Perio Treatment completed
(No pockets > 5mm w/ BOP)
/ 1. Advise patient of additional treatment needed
2. Recall as needed
1. Scaling and Root Planing
2. Anesthesia as needed
3. OHI as needed
4. 3-6 month re-eval
Additional Treatment Needed / Perio Treatment completed
(No pockets > 5mm w/ BOP)
/ 1. Advise patient of additional treatment needed
2. Recall as needed
1. Evaluate OH
2. Rescale if subgingival calculus is present / OH adequate to sustain periodontal health
AND isolated pockets
OH not adequate to maintain periodontal health
/ Place Arrestin in pockets >5mm w/ BOP, Chlorhexidine rinse,
3-6 month recall
Review OHI, rescale as needed, 3-6 month recall
Additional treatment needed :
Refer to Periodontist for Evaluation
(Treatment protocol consistent with American Academy of Periodontology recommendations)
http://www.perio.org/resources-products/pdf/853.pdf