BOP Oral Health Services Current Therapies Current Challenges

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BOP Oral Health ServicesCurrent
TherapiesCurrent Challenges

• UCSF Dental School DPH Seminar Series
• November 12, 2007
• CDR (Select) Phillip D. Woods
• BOP National Periodontal Consultant
• Diplomate, American Academy of Periodontology
• Chief Dentist, MCC San Diego

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Quick Facts about the BOP

• BOP Inmates
• Average Age 37 yrs
• 93 Male
• 7 Female
• Ethnicity
• 32.1 Hispanic
• 69.9 Non-Hispanic

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Quick Facts about the BOP

• Sentence Imposed

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Quick Facts about the BOP
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Background

• Oral Health in America A Report of the Surgeon
  General (2000).
• Poor oral health is concentrated primarily among
  low-income, minority and immigrant populations.
• Access to dental care is major problem for these
  populations

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MCC San Diego

• The Metropolitan Correctional Center (MCC) San
  Diego, California is an administrative facility
  housing male and
• female inmates

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Delivery of Dental Care

• Length of Incarceration
• Short-Term Offender (12 months or less)
• Long-Term Offender
• (gt 1 year sentence)

• Level of Care
• Intake exams, patient education, extractions,
  temporary permanent fillings, pain relief.
• Above oral hygiene education, general
  dentistry, oral surgery, limited root canal and
  periodontal treatment, removable dentures.

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General Dentistry
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Periodontal Procedures Provided

• Dental Cleanings
• Periodontal Scaling
• Surgical Procedures for Long -Term Inmates
• Periodontal Maintenance

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Periodontal Therapies
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CPITN

• Community Periodontal Index of Treatment Needs
• World Health Organization
• Useful in public health surveys and screening
• Requires use of a Periodontal Probe
• Modified by American Academy of Periodontology as
  PSR System

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CPITN Codes, Diagnostic Features Tx
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Gingival Abscess
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Periodontal Abscess
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Pericoronal Abscess
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Necrotizing Ulcerative Periodontitis
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Whats Really a Dental Emergency?

• Dental Emergency
• Broken Jaw
• Swollen Face
• Knocked out tooth or other facial trauma
• Tooth abscess/tooth requiring extraction

• NOT a Dental Emergency
• My gums bleed
• I need a cleaning
• I have a cavity
• Id like a check-up
• My appointment slip says today and he didnt
  call me down!

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Dental Emergency
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We Need Your Help . . .

• Refer all Dental Emergencies to the Duty PA or
  phone me at extension 1552.
• Advise all other inmates with dental concerns to
  complete a Dental Sick Call form.

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MCC San Diego

• The Metropolitan Correctional Center (MCC) San
  Diego, California is an administrative facility
  housing male and
• female inmates

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Recent Trends in Prison Health Budgets and Prison
Staffing

• Reflect a significant decrease in net federal
  spending for healthcare as more funds are
  diverted for war against terror.
• New Prisons are coming online each year.
• Recent Changes in Staffing Guidelines.

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Crystal Meth A Growing Domestic Threat

• Crystal Meths Impact on Oral Health of Federal
  Inmates

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Crystal Meth A Recent Challenge to BOP Oral
Health Care Program
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What is Meth?

• Powerfully addictive synthetic stimulant that
  causes brain to release a surge of dopamine high
  lasts 6-24 hours.
• Two Forms
• Powder
• Rock (Crystal)

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Also Known as. . .

• Speed
• tina
• chalk
• ice
• crystal
• glass

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Crystal Meth
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How Prevalent is Meth Use?

• 12 Million kids aged 12 and older have used meth
  at least once (U.S. DHHS).
• 597,000 persons aged 12 and older used in the
  past month.

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Methamphetamine Prevalence of Abuse,Monitoring
the Future Survey, 2006
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Who Uses Meth?
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The Ravages of Meth Meth Mites
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Federal Drug Arrests for Meth Use

• For FY 2001 there were 4000 Federal Drug arrests
  for meth and amphetamine, representing 12 of all
  Federal Drug arrests.

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Where is Meth Coming From?

• Major suppliers in the West and Southwest are
  Mexican criminal gangs cooking in superlabs and
  bringing the product over the border for
  distribution.
• Local gangs and some private cookers are main
  suppliers in many communities.
• Methamphetamine is a money maker for local gangs
  and is often used in recruitment of members.

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Number of meth users in rehab per 100,000
state residents in 2003
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Is Meth Really a National Epidemic?

• SAMHSA Treatment Episode Data Sheet
• 1992 - 1 state reporting 2002 - 18 states
  reporting
• National Association of Counties
• 500 counties report meth is their biggest drug
  problem
• National Drug Intelligence Center (NDIC)
• Random sample of 3400 US DEA agencies 40 agree
• meth is their leading drug threat
• United Nations Meth is most abused hard drug on
  earth 26 million meth addicts world-wide

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Signs of Possible Meth Use

• Poor hygiene
• Chemical smell
• Tremor
• Bruxism (teeth grinding)

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Healthy Dental Picture

• Healthy Mouth
• Firm, pink or pigmented gums
• Follow the shape of the tooth
• Teeth are free of stains or tartar.

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Meth Mouth
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Meth Mouth
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Meth Mouth
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Kris is still in the process of getting ALL his
teeth removed. By age 25, no natural teeth will
remain.
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Meth Mouth
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Ralphs X-rays
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Difficult Extractions
Often, the gingiva will grow over the remaining
stumps of roots and extractions become extremely
difficult, as teeth have been reduced to
extremely soft mush by crystal meth use.   
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THE NET RESULT OF METH MOUTH
Dentures.
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      Many crystal meth users are unable to hold
jobs as they have no short term memory, making it
hard for them to learn new procedures, they are
unreliable, jittery, and paranoid. 
Additionally, severe decay in their teeth,
especially their front teeth where the smoke from
crank touches the mouth first, is readily
apparent when they speak a 'flashing red light'
of sorts, to any prospective employers.
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The U.S. National Strategy

• The Combat Methamphetamine Epidemic Act of 2005
• Limits sales of ephedrine/pseudoephedrine
• White House Office of National Drug Control
  Strategy for 2006
• Multi-pronged approach
• Congress
• Other countries exporting base ingredients
• Cooperation with Canada and Mexico

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Meth Mouth is becoming more and more prevalent
in current and former users of this extremely
addictive drug.  Teeth decay rapidly, causing
the destruction known as Meth Mouth.  It is
the culmination of years of crystal
methamphetamine use.
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Special Thanks

• Dean Jane Weintraub, UCSF School of Dentistry
• CAPT Nick Makrides, Chief Dentist, BOP
• CAPT Jeff Gaskin, Western Regional Consultant
• Rodel Leyba, HSA, MCC San Diego
• Debra Lacy, MD, CD, MCC San Diego
• http//www.pbs.org/wgbh/pages/frontline/meth
• Escapemeth.com
• Faces of Meth OregonLive.com