No Images? Click here In This Issue - April 2019
MESSAGE: Dr. Andrea Feller, Associate Medical Officer of Health April is Oral Health Month. Allow me to share some perspective I didn’t realize I was missing as a paediatrican and public health physician. Dental decay (cavities, caries) are the leading chronic disease in kids. As I think about it, I realize that more children have cavities than are overweight/obese. Caries are way more common than asthma, seasonal allergies, ADHD, and the list goes on. But/and (!) they are harmful, almost completely preventable, and there is a lot we can do easily in the office to help with this issue. In terms of harms, there are many including pain and missed school days. But for me, the clincher is that tooth decay is the leading cause of day surgery among children one to five years of age. This means use of anesthesia, which, while generally safe, is not something we choose to use in children if it can be prevented. Children’s airways are different, and anesthesia in kids has particular risks that don’t exist in healthy adults. When teeth form, the cells that make enamel (ameloblasts) get incorporated into the tooth itself. This is why we cannot make new enamel. The saliva does have a process that alters the pH in the mouth and can remineralize areas of enamel that are softening, and help neutralize the acids produced by bacteria in the biofilm on teeth, but this requires plenty of time between eating for the buffering system to work. With today’s diets and eating habits in children, that system often is overwhelmed. Cavities start as white marks at the gumline. All primary care practitioners can easily learn the basics of cariology and prevention. “Lifting the lip” while checking the oropharynx is a great way to assess the general oral health of a child. In addition, having your office apply fluoride varnish, especially for children under the age of 3, can go a long way towards preventing decay; estimates are 30 to 40 percent reduction. The US Preventive Services task force has shown that it is recommended for all physicians to apply varnish to all children twice a year. This is even more important in Niagara as we do not have fluoride added to our municipal water supplies. In this edition of the newsletter you will see more information around oral health supports in Niagara. FOR YOUR PATIENTS: Oral Health Month The Niagara Peninsula Dental Association and Niagara Region Public Health & Emergency Services have launched an awareness campaign for oral health month to promote the importance of fluoride treatments to prevent tooth decay since our tap water does not have fluoride added. Fluoride prevents cavities by making the tooth enamel (the outside of the tooth) stronger. In adults as well, fluoride can help teeth to repair or remineralize (restore strength in the tooth) themselves. It can reverse low levels of tooth decay and thus prevent new cavities from forming. Key Messages re: fluoride
Order promotional materials for your office to educate patients on the importance of oral health and how to access free dental services. Niagara’s Current Oral Health State School based dental screening rates continue to be unacceptably high with 39% of elementary aged students and 27% of kindergartners having at least one decayed, missing or filled (DMF) tooth (2017/2018) despite the increased access to various publicly funded preventive and treatment services. The emphasis on fluoride stems from our local decay data, presented above, and our local context. The Welland Water Treatment plant used to have fluoride added to water to optimize the levels, from about 1960 to 1999. The equipment started to break down, and so fluoridation ceased. No other water treatment plant serving Niagara has had fluoridation. Our multiple water treatment plants would need varying upgrades, and ongoing funding, in order to provide fluoridated water across Niagara. In our attempt to decrease dental caries, various community fluoride varnish programs (daycares, schools and primary care settings) have been implemented across Niagara. Over 40 primary care providers and/or other allied health professionals in 18 practices are currently applying fluoride varnish for free in Niagara. The application literally takes seconds to apply and can be seamlessly integrated into the well-baby visit schedule. Interested in learning how this can be incorporated into your practice? Send us an email to set up a free lunch and learn session. UPDATE: Zika Virus The Public Health Agency of Canada has updated the recommendation for prevention of sexual transmission of Zika. The previous recommendation was for returning male travellers to wait 6 months before trying for a pregnancy and to always use condoms correctly with their sexual partner for 6 months. This recommendation has been revised to 3 months based on new scientific evidence regarding the persistence of infectious Zika virus in semen. It is still advised that male travellers with a pregnant partner should continue to refrain from unprotected sex for the duration of the pregnancy Zika Virus Testing
Note: Testing of amniotic fluid, CSF or tissue must be pre-approved by a PHO microbiologist. Please contact PHO Laboratory Customer Service Centre at 1-877-604-4567 before submission. If you have any questions regarding the lab requisition or Zika testing, please call Public Health Ontario at 1-877-604-4567. IPAC REVIEW: Reprocessing Critical Medical Equipment To support our local health care professionals in meeting infection prevention and control (IPAC) standards, Niagara Region Public Health & Emergency Services has created a sterilization decision tree. This tool will help you navigate the process for packaging and releasing reprocessed medical instruments. To highlight the important role reprocessing critical medical instruments has in preventing infectious diseases risk to clients and staff, here are some tips for reprocessing your critical items
Staff must be trained on the proper operation of the sterilizer. Public Health Ontario offers on-line reprocessing modules to support staff with this training. Another helpful resource is the Best Practices for Cleaning, Disinfection and Sterilization of Medical Equipment/Devices In All Health Care Settings, 3rd edition. FREE CME TRAINING: Take A Bite Out of Rabies Family and Emergency Physicians, there is still time to register for this free event! May 2, 2019 6-8:30 p.m. (Registration 5:45 p.m. with dinner at 6:15 p.m.) Presented by Dr. Catherine Filejski, Public Health Veterinarian, Public Health Ontario and Dr. Jeffrey Remington, Family Physician Learning Objectives
Register online or call 905-668-8248 or 1-888-505-6074 ext. 7268 prior to April 26, 2019. This Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 1.5 Mainpro+ credits. This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada, and approved by Canadian Association of Emergency Physicians. You may claim a maximum of 2 hours (credits are automatically calculated). SURVEILLANCE UPDATE: Influenza A Slowly Declining
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