Section 3 - Adult health checks

Health check recommendations

• All people > 15 years of age annually

1. Procedure

• Ask the person the questions in Table 1. and perform a visual oral check
• Provide brief intervention if required
• Determine if the person requires a referral and place onto a follow-up and recall register

1. Visual oral check

• Involves looking at all aspects of the oral cavity; teeth, gums and cheeks
• Ensure room is well lit or use a torch and position the person comfortably
• Don gloves
• Lift the upper lip and lower the bottom lip to inspect surfaces of the outer teeth
• Use a tongue depressor to inspect the back of the oral cavity
• Observe teeth for alignment, frosting (early decay), brown (active decay) or black (inactive decay)
• Observe gums for colour, receding edges or bleeding
• Observe inner cheeks for colour, ulcers or trauma

2. Results ^1–6

• Gums should be pink with clearly defined and tight margins around each tooth
• Gums should be free of inflammation, swelling, bleeding, tenderness or pain
• Loose teeth, or gums that bleed spontaneously or while brushing are indicative of periodontal disease. See Table 2.
• Mucous membranes inside of the cheeks should be pink, red, smooth and moist

3. Brief intervention ^1–6

• Dental caries and periodontal disease affects > 50% of the Australian population. Aboriginal and Torres Strait Islander adults have the highest rate of missing teeth. Provide Resources 1–2.
• Those at high risk of Dental caries and periodontal disease are those:
  • who smoke tobacco products; smoking reduces blood supply to the gums and predisposes people to oral cancers
  • who drink alcohol excessively; alcohol reduces protective saliva flow
  • with poor Diet and nutrition
  • who are aged or intellectual or physical impaired
• Clean teeth using a soft toothbrush with standard fluoride toothpaste twice a day
• Brush all surfaces of the teeth i.e. the inside, outside, and chewing/biting surfaces
• Brush to the gum margins to prevent gum disease
• When finished, spit the toothpaste out. Do not swallow or rinse the mouth
• Brush prior to bed at night. Saliva flow is reduced when sleeping allowing decay causing bacteria to attack dry tooth surfaces
• Replace toothbrush every 3–4 months, or sooner if bristles become frayed
• Tooth decay causing bacteria can spread between family members. Use own toothbrush
• Use dental floss or interdental cleaning products to clean between the teeth
• Make healthy Diet and nutrition choices. Choose fruit, cheese and vegetables for snacks and tap water as the drink of choice
• Avoid sugary and acidic snacks and drinks
• In communities where access to fluoridated drinking water is limited, dental practitioners can advise on alternate sources of fluoride e.g. mouth rinses, high fluoride toothpastes

4. Referral

• For acute dental concerns (Table 2.) see the Primary Clinical Care Manual
• For non-acute concerns (Table 2.) see Dental caries and periodontal disease and refer to:
  • the MO/NP, visiting dental practitioner or private dentist
  • the free dental service (Resource 3.) for Queensland residents that hold a:
    • Pensioner Concession Card issued by Department of Veterans’ Affairs
    • Pensioner Concession Card issued by Centrelink
    • Health Care Card
    • Commonwealth Seniors Health card
    • Queensland Seniors Health Card

5. Follow-up

• Place the person on a recall register if required
• Ensure all referrals are actioned
• Provide the person with details for the next scheduled follow-up appointment

6. References

• All Chronic Conditions Manual references are available via the downloadable References PDF

7. Resources

1. Queensland Health Oral health promotion and resources
2. Office of the Chief Dental Officer
3. Public dental services