An estimated one in five children in America go without dental care each year and two thirds of states do not have effective policies in place to ensure proper dental health and access to care, according to a report by the Pew Center on the States.
The Cost of Delay: State Dental Policies Fail One in Five Children, released with support from the W.K. Kellogg Foundation and the DentaQuest Foundation, grades each state's policy responses to the urgent challenges in dental health among America's low-income children. February is National Children's Dental Health Month.
"Millions of children go without dental care each year but the good news is, it's fixable," said Shelly Gehshan, director of the Pew Children's Dental Campaign. "By enacting a handful of effective policies, states can help eliminate the long-term health and economic consequences of untreated dental problems among kids. Several states are leading the way—but all states can and must do more to ensure access to dental care for the 17 million children left out of the system."
Pew scored all 50 states and the District of Columbia, using an A-F scale, on whether and how well they are employing eight proven policy solutions to ensure dental health and access to care for children. These policies fall into four categories: cost-effective ways to help prevent problems from occurring in the first place; Medicaid improvements that enable and motivate more dentists to treat disadvantaged children; new workforce models that expand the number of qualified dental providers; and gathering data to gauge progress and improve performance.
Only six states merited "A" grades: Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina. These states met at least six of the eight policy benchmarks and had policies in place that met or exceeded the national performance standards. These high grades do not mean that all people in the state have access to quality dental care services. Severe access problems still exist in states that received "A" grades, but these states have policies in place needed to improve dental care.
Nine states received a grade of "B": Alaska, Colorado, Idaho, Illinois, Maine, New Hampshire, Ohio, Texas and Washington. Twenty states received a grade of "C" because they met four or fewer of the eight policy benchmarks. Six states and the District of Columbia earned a "D" grade: Alabama, Indiana, Mississippi, Montana, Nevada and Utah. Nine states earned an "F," meeting only one or two policy benchmarks: Arkansas, Delaware, Florida, New Jersey, Hawaii, Louisiana, Pennsylvania, West Virginia and Wyoming. No state met all eight targets. New Jersey ranked lowest in the nation, meeting only one benchmark.
There are many solutions that can be achieved at relatively little cost and the return on investment for children and taxpayers will be significant. Americans are expected to spend $106 billion on dental care in 2010. This includes many expensive restorative treatments – from fillings to root canals – that could have been mitigated or avoided altogether with earlier, easier and less expensive ways of ensuring adequate dental care when they were children.
The Pew report highlights four proven solutions that can improve both the dental health of children and their access to care:
• Sealants: Protective coatings applied to the teeth by a dentist or hygienist cost one third as much as filling a cavity and have been shown to prevent 60 percent of cavities. School-based programs are the most cost-effective strategy for providing sealants to disadvantaged children, yet this strategy is vastly underutilized.
• Community water fluoridation: Identified by the Centers for Disease Control and Prevention (CDC) as one of 10 great public health achievements of the 20th Century, fluoridated water counteracts tooth decay and strengthens teeth. Fluoride occurs naturally in water, but the level varies within states and across the country. In addition to being the most far-reaching preventive measure states can enact, fluoridation also offers an unmatched return on investment, saving $38 in dental treatment costs for every dollar spent. About 30 percent of the population on community water systems does not yet receive fluoridated water.
• Medicaid improvements: Making minor changes to this federal program can enable and motivate more dentists to treat low-income children. Only 38 percent of Medicaid-eligible children received dental care in 2007, largely because too few dentists are willing to treat them. The number of children receiving dental services more than doubled over just four years in several states that have increased Medicaid reimbursement rates.
• More dental providers: New professionals, similar to nurse practitioners in the medical field, can expand the number of qualified dental providers who can fill the unmet needs of children. A growing number of states are exploring new models that increase the involvement of physicians, hygienists, and new types of dental professionals.
DentaQuest Foundation
The DentaQuest Foundation is committed to optimal oral health for all Americans through its support of prevention and access to affordable oral health care, and through partnerships with philanthropies, policy makers and community leaders.
Tuesday, February 23, 2010
Saturday, February 13, 2010
Psychosocial Problems Are Common in Children With Dental Fear
Children and adolescents with severe dental fear often come from families with a turbulent background. It is also more common that they have had counselling contact with a psychologist. These are the conclusions of research carried out at the Sahlgrenska Academy at the University of Gothenburg, Sweden.
Annika Gustafsson, specialist in child dentistry, has studied children and adolescents of school age who have received specialist dental care because they develop many cavities and also suffer from severe dental fear. "I wanted to investigate how children and adolescents with dental behaviour management problems who received specialist dental care differed from patients of the same age within ordinary dental care. I also wanted to discover why they cancel appointments and fail to attend appointments more often," says Annika Gustafsson.
Just over 250 children and adolescents with dental behaviour management problems and their parents have completed questionnaires describing their family situation and everyday life. Their answers have been compared with answers from the same number of patients within ordinary dental care. "The children and adolescents with dental behaviour management problems suffered significantly more from dental fear, and they lived in families with lower social class and poor economy. Most often, they lived in single-parent families, they had fewer leisure activities and more psychosocial problems than patients within ordinary dental care," says Annika Gustafsson.
Their parents, in turn, stated that they also suffered from severe dental fear and had greater problems with anxiety and worry than parents of children and adolescents within ordinary dental care. "I believe that it has a negative effect on a child or adolescent if their parent does not want to go to the dentist with them due to the parent's own fear," says Annika Gustafsson, who has compared the number of cancelled appointments and appointments that they failed to attend for the children and adolescents with dental fear and for those in ordinary dental care. "Children and adolescents that avoided dental appointments had had contact with a psychologist or counsellor four times as often," says Annika Gustafsson.
She believes that it is important that these patients are met with respect and understanding within the dental care system. "We must also become better at discovering at an early age which children and adolescents need help and support. We should collaborate more closely with the social services," says Annika Gustafsson.
Dental fear
About 5% of Sweden's population suffer from severe dental fear. The very thought of dental care produces severe anxiety in these patients. The fear may have been caused by frightening experiences of dental care during childhood. Fortunately, many types of help are available, including medication for anxiety, nitrous oxide gas, hypnosis and -- in severe cases -- anaesthesia.
Annika Gustafsson, specialist in child dentistry, has studied children and adolescents of school age who have received specialist dental care because they develop many cavities and also suffer from severe dental fear. "I wanted to investigate how children and adolescents with dental behaviour management problems who received specialist dental care differed from patients of the same age within ordinary dental care. I also wanted to discover why they cancel appointments and fail to attend appointments more often," says Annika Gustafsson.
Just over 250 children and adolescents with dental behaviour management problems and their parents have completed questionnaires describing their family situation and everyday life. Their answers have been compared with answers from the same number of patients within ordinary dental care. "The children and adolescents with dental behaviour management problems suffered significantly more from dental fear, and they lived in families with lower social class and poor economy. Most often, they lived in single-parent families, they had fewer leisure activities and more psychosocial problems than patients within ordinary dental care," says Annika Gustafsson.
Their parents, in turn, stated that they also suffered from severe dental fear and had greater problems with anxiety and worry than parents of children and adolescents within ordinary dental care. "I believe that it has a negative effect on a child or adolescent if their parent does not want to go to the dentist with them due to the parent's own fear," says Annika Gustafsson, who has compared the number of cancelled appointments and appointments that they failed to attend for the children and adolescents with dental fear and for those in ordinary dental care. "Children and adolescents that avoided dental appointments had had contact with a psychologist or counsellor four times as often," says Annika Gustafsson.
She believes that it is important that these patients are met with respect and understanding within the dental care system. "We must also become better at discovering at an early age which children and adolescents need help and support. We should collaborate more closely with the social services," says Annika Gustafsson.
Dental fear
About 5% of Sweden's population suffer from severe dental fear. The very thought of dental care produces severe anxiety in these patients. The fear may have been caused by frightening experiences of dental care during childhood. Fortunately, many types of help are available, including medication for anxiety, nitrous oxide gas, hypnosis and -- in severe cases -- anaesthesia.
Wednesday, January 27, 2010
Older dental fillings contain form of mercury unlikely to be toxic
A new study, "The Chemical Forms of Mercury in Aged and Fresh Dental Amalgam Surfaces," on the surface chemistry of silver-colored, mercury-based dental fillings suggests that the surface forms of mercury may be less toxic than previously thought. It appears online in ACS' journal Chemical Research in Toxicology.
In the study, Graham George and colleagues note that mercury-based fillings, also called amalgams, have been used by dentists to repair teeth for well-over a century. In recent decades their use has become controversial because of concerns about exposure to potentially toxic mercury. However, mercury can potentially exist in several different chemical forms, each with a different toxicity. Prior to this report, little was known about how the chemical forms of mercury in dental amalgam might change over time.
Using a special X-ray technique, the scientists analyzed the surface of freshly prepared metal fillings and compared these with the surface of aged fillings (about 20 years old) from a dental clinic. Fresh fillings contained metallic mercury, which can be toxic. Aged fillings, however, typically contain a form of mercury, called beta-mercuric sulfide or metacinnabar, which is unlikely to be toxic in the body. The scientists found that the surfaces of metal fillings seem to lose up to 95 percent of their mercury over time. Loss of potentially toxic mercury from amalgam may be due to evaporation, exposure to some kinds of dental hygiene products, exposure to certain foods, or other factors. The scientists caution that "human exposure to mercury lost from fillings is still of concern."
In the study, Graham George and colleagues note that mercury-based fillings, also called amalgams, have been used by dentists to repair teeth for well-over a century. In recent decades their use has become controversial because of concerns about exposure to potentially toxic mercury. However, mercury can potentially exist in several different chemical forms, each with a different toxicity. Prior to this report, little was known about how the chemical forms of mercury in dental amalgam might change over time.
Using a special X-ray technique, the scientists analyzed the surface of freshly prepared metal fillings and compared these with the surface of aged fillings (about 20 years old) from a dental clinic. Fresh fillings contained metallic mercury, which can be toxic. Aged fillings, however, typically contain a form of mercury, called beta-mercuric sulfide or metacinnabar, which is unlikely to be toxic in the body. The scientists found that the surfaces of metal fillings seem to lose up to 95 percent of their mercury over time. Loss of potentially toxic mercury from amalgam may be due to evaporation, exposure to some kinds of dental hygiene products, exposure to certain foods, or other factors. The scientists caution that "human exposure to mercury lost from fillings is still of concern."
Thursday, January 21, 2010
Studies advise on fluoridated toothpaste use in children
Parents should use toothpastes that contain fluoride with a minimum concentration of 1,000 parts per million to prevent tooth decay in their children, says a new report. Preventing tooth decay can help reduce the need for extensive and costly dental treatments, including extractions.
But the authors, in a second related study, suggest that parents concerned about the risk of fluorosis – the discolouration or mottling of the teeth caused by excessive fluoride ingestion – should consult their dentist to discuss the benefits and risks.
Researchers for the Cochrane Oral Health Group, based at the School of Dentistry, The University of Manchester, have previously shown that fluoride toothpastes reduce dental decay by 24% on average compared to non-fluoride products.
The group's latest research, which involved 79 trials on 73,000 children worldwide, examined the effect of different children's toothpastes and found that those with fluoride concentrations less than 1,000 parts per million were only as effective as non-fluoride toothpastes at preventing tooth decay. Children's toothpastes range from 100ppm to 1,400ppm fluoride concentration.
The report suggests that brushing a child's teeth with a toothpaste containing fluoride before the age of 12 months may be associated with an increased risk of developing mild fluorosis. Swallowing large amounts of toothpaste may still cause fluorosis in children up to the age of six years when the permanent teeth are still developing, but using a small amount, carefully, will reduce these risks. After the age of six years, the teeth are fully developed and toothpaste can be used without fear of fluorosis.
Dr Anne-Marie Glenny, an author on the review, said: "It is very confusing for parents to know how to strike the right balance, which isn't helped by the fact that different companies use different concentrations of fluoride in their toothpastes aimed at children.
"From a public health point of view, the risk of tooth decay and its consequences such as pain and extractions is greater than the small risk of fluorosis. Children would have to swallow a lot of toothpaste over a long period of time to get the severe brown mottling on the teeth, as opposed to the more typical mild white patches.
"For children that are considered to be at a high risk of tooth decay by their dentist, the benefit to health of preventing decay is likely to outweigh the risk of fluorosis. In such cases, careful brushing of their children's teeth by parents with a small amount of toothpaste containing higher levels of fluoride would be beneficial. If in any doubt, we would advise parents to speak to their family dentist."
But the authors, in a second related study, suggest that parents concerned about the risk of fluorosis – the discolouration or mottling of the teeth caused by excessive fluoride ingestion – should consult their dentist to discuss the benefits and risks.
Researchers for the Cochrane Oral Health Group, based at the School of Dentistry, The University of Manchester, have previously shown that fluoride toothpastes reduce dental decay by 24% on average compared to non-fluoride products.
The group's latest research, which involved 79 trials on 73,000 children worldwide, examined the effect of different children's toothpastes and found that those with fluoride concentrations less than 1,000 parts per million were only as effective as non-fluoride toothpastes at preventing tooth decay. Children's toothpastes range from 100ppm to 1,400ppm fluoride concentration.
The report suggests that brushing a child's teeth with a toothpaste containing fluoride before the age of 12 months may be associated with an increased risk of developing mild fluorosis. Swallowing large amounts of toothpaste may still cause fluorosis in children up to the age of six years when the permanent teeth are still developing, but using a small amount, carefully, will reduce these risks. After the age of six years, the teeth are fully developed and toothpaste can be used without fear of fluorosis.
Dr Anne-Marie Glenny, an author on the review, said: "It is very confusing for parents to know how to strike the right balance, which isn't helped by the fact that different companies use different concentrations of fluoride in their toothpastes aimed at children.
"From a public health point of view, the risk of tooth decay and its consequences such as pain and extractions is greater than the small risk of fluorosis. Children would have to swallow a lot of toothpaste over a long period of time to get the severe brown mottling on the teeth, as opposed to the more typical mild white patches.
"For children that are considered to be at a high risk of tooth decay by their dentist, the benefit to health of preventing decay is likely to outweigh the risk of fluorosis. In such cases, careful brushing of their children's teeth by parents with a small amount of toothpaste containing higher levels of fluoride would be beneficial. If in any doubt, we would advise parents to speak to their family dentist."
Thursday, January 14, 2010
Dental Implants -- a Permanent Fix for Missing Teeth
Dental implants, rather than a fixed bridge or removable dentures, are an increasingly popular method of replacing teeth lost to an accident, gum diseases or tooth decay.
In an interview in the January issue of Mayo Clinic Women’s HealthSource, Sreenivas Koka, D.D.S., Ph.D., chair of Mayo Clinic Department of Dental Specialties, discusses the advantages of dental implants and what’s involved.
To place an implant, an oral surgeon or periodontist cuts open the gum to expose the jawbone and then drills a small hole in the bone for the metal cylinder that serves as the implant. “It’s almost like drilling a screw into the wall,” says Dr. Koka. The patient is under anesthesia.
Over the next three months, the area heals and the implant fuses with the jawbone. Patients may undergo a second procedure in which a post, called an abutment, is attached or screwed down into the implant. This can be done at the same time the implant cylinder is put in or after the area has healed.
In the final step, the dentist attaches a realistic-looking artificial tooth to the implant or to the post. The entire process takes about four months.
A big advantage, says Dr. Koka, is that an implant acts as a substitute for the roots of a natural tooth. “If you are missing a single tooth, this allows you to leave the other teeth around it alone,” says Dr. Koka. “With a bridge, you have to cut down the teeth on each side of the empty space so that a false tooth can be held in place by two crowns.”
Almost any adult in reasonably good health is a candidate for dental implants.
Dr. Koka says that patients often ask if osteoporosis would prevent them from getting dental implants. It doesn’t. Mayo Clinic research has shown that patients with osteoporosis or those taking oral bisphosphonates used to treat osteoporosis have about the same success rate as other patients. And the success rates for dental implants are high -- 90 to 96 percent.
In an interview in the January issue of Mayo Clinic Women’s HealthSource, Sreenivas Koka, D.D.S., Ph.D., chair of Mayo Clinic Department of Dental Specialties, discusses the advantages of dental implants and what’s involved.
To place an implant, an oral surgeon or periodontist cuts open the gum to expose the jawbone and then drills a small hole in the bone for the metal cylinder that serves as the implant. “It’s almost like drilling a screw into the wall,” says Dr. Koka. The patient is under anesthesia.
Over the next three months, the area heals and the implant fuses with the jawbone. Patients may undergo a second procedure in which a post, called an abutment, is attached or screwed down into the implant. This can be done at the same time the implant cylinder is put in or after the area has healed.
In the final step, the dentist attaches a realistic-looking artificial tooth to the implant or to the post. The entire process takes about four months.
A big advantage, says Dr. Koka, is that an implant acts as a substitute for the roots of a natural tooth. “If you are missing a single tooth, this allows you to leave the other teeth around it alone,” says Dr. Koka. “With a bridge, you have to cut down the teeth on each side of the empty space so that a false tooth can be held in place by two crowns.”
Almost any adult in reasonably good health is a candidate for dental implants.
Dr. Koka says that patients often ask if osteoporosis would prevent them from getting dental implants. It doesn’t. Mayo Clinic research has shown that patients with osteoporosis or those taking oral bisphosphonates used to treat osteoporosis have about the same success rate as other patients. And the success rates for dental implants are high -- 90 to 96 percent.
Dental Enamel: Ways to Give it a Boost
Tooth enamel is tough, harder even than skeletal bone. But even with good dental hygiene, the enamel protecting teeth may show signs of decay in older adults. The January issue of Mayo Clinic Health Letter covers what to look out for and what to do to promote an enamel-friendly setting in the mouth. According to the newsletter, two significant contributors to tooth decay are too little saliva and inadequate fluoride.
Too little saliva: Saliva helps repair the earliest stages of tooth decay. It supplies high levels of calcium and phosphate particles that enhance protection of the tooth’s enamel surface. In addition, saliva protects the mouth by washing away food and the sticky film of acid-producing plaque that can cling to teeth.
Because of saliva’s importance, dry mouth symptoms should be evaluated by a care provider. Dry mouth can be caused by medical conditions or their treatments. Examples include Sjogren’s syndrome, an autoimmune disorder, diabetes and HIV or AIDS. Dry mouth is a common side effect of many prescription and nonprescription medications, including some antidepressants and anti-anxiety medications, antihistamines, medications for high blood pressure, anti-diarrheals, muscle relaxants and medications for urinary incontinence and Parkinson’s disease.
For some people, medications or doses can be changed to minimize this side effect. When that’s not possible, chewing sugar-free gum sweetened by a naturally occurring sugar substitute called xylitol can help. Studies have shown that the frequent use of gum with high levels of xylitol can prevent cavities and even harden a tooth’s surface where a cavity has begun. Chewing gums that contain Recaldent also can help. This ingredient is a form of calcium phosphate that penetrates and binds to the tooth enamel. It’s found in Trident Xtra Care gum.
Inadequate fluoride: This mineral is an important enamel ally that can make teeth stronger and can enhance saliva’s remineralizing, anti-decay properties. Most people get adequate fluoride exposure through drinking fluoridated water and brushing twice daily with fluoride toothpastes.
But people who drink primarily bottled or filtered water may not be getting adequate fluoride. Even with adequate fluoride, dry mouth can throw off the normal balance teeth need to stay healthy.
A dentist may recommend fluoride treatment to protect and strengthen tooth enamel. Fluoride can be applied two to four times a year. Another option is nonprescription fluoride rinses available in drugstores.
Also helpful is limiting tooth enamel contact with acids that come from many foods and beverages. Examples include citrus fruits, tart candies, diet and regular sodas or sports drinks, fruit juices and wine.
Too little saliva: Saliva helps repair the earliest stages of tooth decay. It supplies high levels of calcium and phosphate particles that enhance protection of the tooth’s enamel surface. In addition, saliva protects the mouth by washing away food and the sticky film of acid-producing plaque that can cling to teeth.
Because of saliva’s importance, dry mouth symptoms should be evaluated by a care provider. Dry mouth can be caused by medical conditions or their treatments. Examples include Sjogren’s syndrome, an autoimmune disorder, diabetes and HIV or AIDS. Dry mouth is a common side effect of many prescription and nonprescription medications, including some antidepressants and anti-anxiety medications, antihistamines, medications for high blood pressure, anti-diarrheals, muscle relaxants and medications for urinary incontinence and Parkinson’s disease.
For some people, medications or doses can be changed to minimize this side effect. When that’s not possible, chewing sugar-free gum sweetened by a naturally occurring sugar substitute called xylitol can help. Studies have shown that the frequent use of gum with high levels of xylitol can prevent cavities and even harden a tooth’s surface where a cavity has begun. Chewing gums that contain Recaldent also can help. This ingredient is a form of calcium phosphate that penetrates and binds to the tooth enamel. It’s found in Trident Xtra Care gum.
Inadequate fluoride: This mineral is an important enamel ally that can make teeth stronger and can enhance saliva’s remineralizing, anti-decay properties. Most people get adequate fluoride exposure through drinking fluoridated water and brushing twice daily with fluoride toothpastes.
But people who drink primarily bottled or filtered water may not be getting adequate fluoride. Even with adequate fluoride, dry mouth can throw off the normal balance teeth need to stay healthy.
A dentist may recommend fluoride treatment to protect and strengthen tooth enamel. Fluoride can be applied two to four times a year. Another option is nonprescription fluoride rinses available in drugstores.
Also helpful is limiting tooth enamel contact with acids that come from many foods and beverages. Examples include citrus fruits, tart candies, diet and regular sodas or sports drinks, fruit juices and wine.
Saturday, December 26, 2009
Origins of Cavity-Causing Bacteria
Researchers have uncovered the complete genetic make-up of the cavity-causing bacterium Bifidobacterium dentium Bd1, revealing the genetic adaptations that allow this microorganism to live and cause decay in the human oral cavity. The study, led by Marco Ventura's Probiogenomics laboratory at the University of Parma, and Prof. Douwe van Sinderen and Dr Paul O'Toole of the Alimentary Pharmabiotic Centre at University College Cork, is published December 24 in the open-access journal PLoS Genetics.
Bifidobacteria, largely known as long-term beneficial gut bacteria, are often included as probiotic components of food to aid digestion and boost the immune system. However, not all species within the genus Bifidobacterium provide beneficial effects to the host's health. In fact, the Bifidobacterium dentium species is an opportunistic pathogen since it has been linked to the development of tooth decay. The genome sequence of B. dentium Bd1 reveals how this microorganism has adapted to the oral environment through specialized nutrient acquisition features, acid tolerance, defences against antimicrobial substances and other gene products that increase fitness and competitiveness within the oral niche.
This report identifies, through various genomic approaches, specific adaptations of a Bifidobacterium taxon to a lifestyle as a tooth decay-causing bacterium. The data in this study indicate that the genome of this opportunistic pathogen has evolved through only a small number of horizontal gene acquisition events, highlighting the narrow boundary that separates bacteria that are long-term residents on or in the human body from opportunistic pathogens.
Bifidobacteria, largely known as long-term beneficial gut bacteria, are often included as probiotic components of food to aid digestion and boost the immune system. However, not all species within the genus Bifidobacterium provide beneficial effects to the host's health. In fact, the Bifidobacterium dentium species is an opportunistic pathogen since it has been linked to the development of tooth decay. The genome sequence of B. dentium Bd1 reveals how this microorganism has adapted to the oral environment through specialized nutrient acquisition features, acid tolerance, defences against antimicrobial substances and other gene products that increase fitness and competitiveness within the oral niche.
This report identifies, through various genomic approaches, specific adaptations of a Bifidobacterium taxon to a lifestyle as a tooth decay-causing bacterium. The data in this study indicate that the genome of this opportunistic pathogen has evolved through only a small number of horizontal gene acquisition events, highlighting the narrow boundary that separates bacteria that are long-term residents on or in the human body from opportunistic pathogens.
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