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Entries in Dental Health (8)

Monday
Sep172012

Dental Care Has Decayed for Low Income Families

Comstock/Thinkstock(NEW YORK) -- Good dental care is increasingly becoming an unaffordable luxury for many Americans.

Last year, the Kaiser Family Foundation reported that 33 percent of people surveyed skipped dental care or dental checkups because they couldn't afford them. A 2003 report by the U.S. Surgeon General found that 108 million Americans had no dental insurance -- nearly 2.5 times the number for those who have no health insurance. And more than half of dental procedures are now paid for out of pocket.

As a result, many patients are now waiting until their dental problems are dire and their options become even more limited. Nancy Greenwalt, a dentist who runs several Smile Healthy dental clinics for low income patients in Illinois, said she's seeing an increasing number of patients who avoid the dentist for as long as possible, usually because they have no money to pay for services.

"A preventative checkup might cost a hundred dollars but once you find yourself in an emergency situation, it gets a lot more expensive than that -- and you may put your health at risk," she said.

Frank Catalanotto, the chair of the Department of Community Dentistry and Behavioral Science at the University of Florida, said patients who don't wind up using an uncredentialed dentist or can't find a low-cost clinic often seek help at hospital emergency rooms, where they are given pain medication and antibiotics but rarely treatment. They're usually told to go find a dentist. When they don't, Catalanotto said, they wind up back in the emergency room.

In Florida alone, there are 115,000 hospital ER visits for dental problems each year, according to the latest Pew research report on dentistry in America. Pew says taxpayers foot the $88 million dollar bill for these visits.

Even when a patient seeks care from a licensed dentist, their oral health is often too far gone for simple preventative dentistry to deal with. Greenwalt said that her clinics she's seeing an increasing number of patients -- some of them children as young as three -- who have so many rotten teeth that she admits them to the hospital and operates under general anesthesia in order to treat them. Once again, the taxpayer often picks up the bill.

A more sensible, less costly approach, said Catalanotto, would be to "increase oral literacy" by better educating consumers on the basics of oral hygiene. That way they could take more responsibility for their dental health.

He also said that in order to avoid dental tragedies, dentists will have to advocate that some of their work go to dental hygienists and other mid-level providers (analogous to physician's assistants) to deliver services to under-served and low-income communities. In most states, this is currently against the law.

Another solution may be to bring at least some of the illegal underground dental network into the fold. One of Catalanotto's University of Florida programs prepares foreign dentists to pass licensing exams so they can practice legally -- and safely.

Copyright 2012 ABC News Radio

Friday
Aug032012

People Still Have a Lot to Learn About How to Treat Their Teeth

iStockphoto/Thinkstock(NEW YORK) -- Americans are smart about a lot of things but taking care of their teeth isn’t one of them, according to the first oral health quiz by the American Dental Association.

Grading the responses to various questions from 1,500 adults, the ADA said the overall mark was a “D,” which might explain why 90 percent of people ages 20 to 64 have cavities in their permanent teeth.

Regarding the misconceptions people have about their teeth, the ADA says that nine out of ten adults believe that brushing after every meal is necessary while only two brushings a day are recommended.

Flossing, one of people’s least practiced activities, is important to do once a day, the ADA, says, not a couple of times a week as half the respondents said.

As far as replacing your toothbrush, two-thirds thought that doing it twice a year sufficed while the ADA suggests three-to-four times annually.

Meanwhile, about 75 percent of adults are unsure about what age a child should visit the dentist. The ADA says the rule of thumb is no later than six months after the appearance of the first baby tooth or no later than the first birthday.

One of the most common misconceptions is that sugar causes cavities, held by just over eight of ten of the survey’s respondents. Actually, it’s germs that feed on sugar, which produces the acid that weakens enamel to form cavities.

Speaking of cavity-causing germs, nearly 60 percent of adults aren’t aware that they can passed from person-to-person through pre-chewing food, sharing utensils or licking a pacifier.

Copyright 2012 ABC News Radio

Tuesday
Apr242012

16 Million Children on Medicaid Not Receiving Dental Care

Comstock/T​hinkstock(WASHINGTON) -- With more than 16 million low-income U.S. children on Medicaid not receiving dental care in 2009, according to the Pew Center on the States, dentists and ERs say they are treating very young patients with teeth blackened from decay, bacteria and multiple cavities.

"I see it in their eyes before they tell me it's that way," Dr. Gregory Folse told ABC News. "We are able to intervene and take the pain away from their teeth and it brings the spark back. And that's my goal."

Folse's Outreach Dentistry mobile clinic travels to schools around Louisiana, filling cavities and teaching children and parents about the importance of oral hygiene.

In 2007, Congress held a hearing on the issue of children's dental health after Deamonte Driver, a 12-year-old Maryland boy, died when a tooth infection spread to his brain. His mother, Alyce Driver, had been unable to find a dentist to treat him on Medicaid and could not afford to pay out of pocket.

At the time, Leslie Norwalk, then-acting administrator for the Centers for Medicare and Medicaid Services, called his death "a failure on many levels."

And although she said that these types of dental services were covered, many dentists said that Medicaid reimbursement rates are too low.

A study published in May 2011, demonstrated that despite efforts to boost the number of patients and providers in the Medicaid system, low-income families still had limited access to dental care -- except when they were able to pay cash.

The state of Florida got an F in children's dental health in a 2011 report from the Pew Center on the States. In 2009, according to Pew, only 25.7 percent of Florida children on Medicaid saw a dentist.

"The Medicaid rates are so low that dentists are not willing to participate in the Medicaid program," said Dr. Frank Catalanotto of the University of Florida, Gainesville, Community Dentistry. "You can't blame the dentists, really, because the cost of delivering the service is more than the reimbursement they receive."

Florida has some of the lowest rates. Ten pediatric dentists in four counties said they would not accept Medicaid -- even for a child whose face hurt. And more than half of Florida's counties -- 36 -- do not have one pediatric dentist who takes Medicaid, according to Pew.

Dentists say that ignoring teeth can mean life or death. An infection can kill or promote heart disease, stroke, diabetes and osteoporosis. Children who do not receive dental care can suffer root canals and extractions before they reach 10-years-old.

At the Caridad Center in Boynton Beach, Fla., Falguni Patel, a first-year resident in pediatric dentistry, said it made her sad that there were certain groups of children who suffered more than others.

"People think just because you have insurance that you're going to have access to care -- which is not the whole story," she said. "They're very few pediatric dentists that accept Medicaid in this area, so these children have nowhere to go even if they do have insurance. ... It's a big problem."

Copyright 2012 ABC News Radio

Tuesday
Mar062012

Preschool Mouths: Dental Disaster Zones

iStockphoto/Thinkstock(NEW YORK) -- Preschoolers across the country are increasingly getting fillings and extractions for extensive dental decay, sometimes requiring surgery and general anesthesia in an operating room, pediatric dentists report.

The trend, seen in families both rich and poor, points to neglect driven by several factors. Despite decades of emphasis on eliminating tooth decay with fluoride toothpastes and frequent brushing, many parents aren’t getting the message that dental care begins when a child’s first tooth comes in, and that a child should be brushing with fluoride by age 2.

Parents of all income levels indulge young children in too many sugary snacks and sippy cups filled with sugar-laden fruit juices, dentists say. Too often, they put toddlers to bed with a bottle of juice or milk. Saliva levels go down overnight, making the mouth even more acidic and allowing sugars in the drinks to eat into tooth enamel for hours at a time.

As a result, dentists are fighting more aggressively to counter the resulting decay, often treating cavities in baby teeth before the bad bacteria can spread elsewhere in the body or harm the adult teeth forming below them in the jaw.

“The myth has been for years, these are just baby teeth, they’re just going to fall out anyway,” said Dr. Amr Moursi, chairman of pediatric dentistry at NYU’s College of Dentistry. Moursi said the need for dental operating rooms at NYU exceeds the supply, forcing dentists to compete with cardiac surgeons and neurosurgeons for operating room time, and forcing patients to wait three to six months to have their dental surgeries scheduled. In addition, he said, it’s hard to find pediatric dentists with operating room privileges, which further squeezes the ability to treat children in need.

“There’s not enough operating rooms in the country equipped to do dental work,” he said.

Severe neglect of a child’s oral health most often occurs among poor families “trying to make ends meet, pay the rent; it’s not a high priority,” Moursi said. However, dentists also are seeing a troublesome trend of lax parenting among more well-off mothers and fathers who don’t enforce brushing-after-meals rules.

As parenting styles have shifted, there has been evidence of changes that “sometimes include a de-emphasis on oral health or anything that the child doesn’t necessarily want, whether that’s bath time, or practicing the piano, or eating their vegetables,” Moursi said. “That’s when we have the conversation: You’re the parent and it’s in their best interest. We give them some techniques to make it easier.”

Just Tuesday morning, Dr. Jonathan D. Shenkin, a pediatric dentist in Augusta, Maine, found six small cavities between the teeth of a 4-year-old girl during her first-ever appointment with a dentist. The child should have been seen by her first birthday. The girl’s mother was at a loss to account for all the decay in her daughter’s mouth, telling Shenkin that she thought she had her children doing everything right: “We don’t drink soda. They brush their teeth twice a day.”

But when he asked if the family uses fluoride toothpaste, she responded that they had just started to use it.

“Brushing with fluoride toothpaste is the most important thing you can do,” he said. Next, parents must pay attention to what their children eat and drink. Numerous well-intentioned parents tell him they only give their children “all natural” products, thinking those somehow are better for their dental health. However, many fruit juices contain just as much sugar as sodas, he said.

Although dentists prefer to spend their time on prevention, a parent’s decision to wait until a child is in pre-school before making a dental appointment is too late to prevent tooth decay that already may have begun, Shenkin said. “The kids coming into our offices at this age already have it at this point. There’s no way to turn back.”

“The goal should always be to treat in the office if possible,” Shenkin said. “The last resort should be going into the operating room under general anesthesia.”

By and large, the children going to the operating room tend to be lower-income children, he said. “When we talk about tooth decay, 80 percent of the disease is in 20 percent of the population…usually the lowest income population. The need for anesthesia disproportionately affects the Medicaid population.”

Although there aren’t good statistics establishing the extent of preschoolers requiring extensive dental work, Moursi said he’s seen a dramatic rise in the number of children with “really severe decay” warranting operating room treatment.

During an interview, he said he’d just received a phone call from an NYU pediatric dental resident who had examined a 4-year-old with several cavities, including one that had caused major facial swelling. “The infection had gone through the tooth, down into the surrounding bone of the jaw and spread up into the face under the eye,” Moursi said.

The child was going to be treated with powerful antibiotics, but might still require a trip to the operating room to extract the tooth, he said. In rare cases, such dental infections can spread to the brain, or into the heart and lungs, he said.

“When you have a 6-month wait to get into the O.R. and they’re all 3-year-olds, we know we have a problem,” Moursi said.

Copyright 2012 ABC News Radio

Wednesday
Jan182012

Calif. Clinic Brings Free Dental Care to Developmentally Disabled

Comstock/Thinkstock(MORENO VALLEY, Calif.) -- For most adults, a cavity calls for a quick prick of novocaine and a 20-minute filling. But for 40-year-old Tina Lumbley of Moreno Valley, Calif., the routine procedure was a day-long ordeal.

Lumbley has autism, a developmental disorder that makes the sounds, smells, tastes and bright lights of the dentist's office overwhelming.

"She would get so anxious and have meltdowns," Lumbley's mom, Marjorie, told ABC News. "When she was a child, we had a great pediatric dentist and she was fine. But as she got older, it just wasn't working."

Most dentists refused to take Lumbley after she turned 18. And the few who were willing would only treat her under general anesthetic, which raises the risk and price of the procedure.

Lumbley is not alone. Across the country, adults with intellectual disabilities suffer from a lack of access to dental care.

"It's the biggest health care problem in the country today," said Dr. Steven Perlman, professor of pediatric dentistry at Boston University School of Dental Medicine. "People with intellectual disabilities are the most medically underserved population we have, and dental care is by far the most unmet need."

Adults with disabilities are usually covered by Medicaid. But the reimbursement rate is so "pathetically low that no dentist wants to participate in the program," Perlman said. And they don't have to. Dental schools are not even required to teach students how to treat disabled patients.

"These kids are coming out of school with huge loans," said Perlman. "What are they going to do when they get out? I'll tell you who they're not going to treat: people who are poor or disabled."

In 2009, California dropped dental coverage for all adults on Medicaid. That prompted Marianne and Russell Benson to open We Care, a nonprofit that brings free dental care to people with disabilities.

Now Lumbley, with her parents, makes the hourlong trip to the Rancho Mirage-based dental clinic where she gets cleanings and fillings like any other patients, without general anesthetic. The clinic has four dentists and student volunteers from nearby Western University of Health Sciences College of Dental Medicine.

"They treat her with dignity and respect and expect her to come out with a beautiful smile," said Marjorie Lumbley. Other dentists, she recalled, suggested pulling her daughter's teeth. "Yes, Tina has a lot of challenges but she has a right to have decent teeth."

Having healthy teeth and gums not only looks good; it also guards against disease. And for people with disabilities who are unable to communicate, a minor toothache can quickly evolve into a major emergency.

Marjorie Lumbley said she's grateful for We Care but worries about the future, as her daughter's dental and medical needs will surely grow.

"They have all the same things that go along with people getting older, but they still have these needs that can't be met any other way," she said. "I think people forget what happens to them after they grow up. They're not cute anymore. She's 40 years old and she deserves good care."

Copyright 2012 ABC News Radio

Sunday
Nov132011

Dental Screenings Linked to Lower Heart Disease, Stroke Risk

iStockphoto/Thinkstock(ORLANDO, Fla.) -- Going to the dentist can be stressful, frightening and painful—but it may also help your heart.

Research presented Sunday at the American Heart Association's (AHA) annual conference in Orlando, Fla., suggests that not only do frequent dental cleanings ward off plaque and gum disease, but they can also reduce risk of heart disease and stroke.

"Periodontal, or gum health, as a risk factor for heart attacks and strokes, has been looked at several times over the past 10 years," said Dr. Thomas Gerber, an AHA spokesman and a professor of medicine and radiology at the Mayo Clinic. "Some prior studies found a relationship between gum disease and heart or other disease, whereas others didn't."

Gerber was not involved with the new research.

The exact mechanism of how gum disease may be linked to heart disease and stroke is unclear.

One thought is that poor dental hygiene leads to an overgrowth of oral bacteria. These organisms, fairly benign in the mouth, can get into the bloodstream through the gums and, once there, they can clump on blood vessel walls and grow into plaques that clog arteries and lead to heart attacks and strokes. Moreover, because these bacteria are foreign to the body, once they infiltrate the bloodstream, blood vessels think they are being attacked and try to kill them, just as they would an infection. This results in inflammation and swelling that narrows blood vessels and prevents adequate blood flow to vital organs like the brain and heart.

The recent study was less concerned with the details of why gum disease increases risk of heart disease and stroke, but whether the risk can be reduced through frequent dental visits.

"Poor oral hygiene has been associated with increased risk of cardiovascular disease," the study's abstract acknowledged. "However, the association between preventive dentistry and cardiovascular risk reduction remained underdetermined."

Dr. Zu-Yin Chen and colleagues at Taipei Veterans General Hospital in Taiwan followed more than 100,000 patients over a seven-year period, only half of whom had ever had their teeth cleaned.

They found that the participants who had ever had their teeth cleaned had a 24 percent decreased risk of heart attack and a 13 percent lower stroke risk compared to those who had never had a dental cleaning.

Not only did any dental cleanings reduce risk of heart disease and stroke, but Chen said in the news release, "Protection from heart disease and stroke was more pronounced in participants who got tooth scaling at least once a year," meaning that the more often people had their teeth cleaned, the lower their risk of heart disease and stroke.

Although the results suggest that preventative dental care can lower risk of heart disease and stroke, the study did not account for other cardiovascular risk factors that could have contributed to the association.

"We can't lose sight of the fact that most heart attacks and strokes are related to the so-called traditional risk factors, and those are high blood pressure, high cholesterol, high blood sugar, smoking, weighing too much and not exercising enough. It remains very important to take control of those risk factors," said Gerber. "People shouldn't think that by going to the dentist more often they're going to reduce their risk of heart disease."

Dr. Daniel Meyer, the American Dental Association's (ADA) senior vice president of science and professional affairs, agreed that it is too early to make that assumption, but stressed that "regular dental visits are important to diagnose and treat dental disease. Some conditions in the mouth may indicate disease elsewhere in the body, so by maintaining a schedule of regular dental visits, the dentist can certainly refer patients to physicians or other health care providers for evaluation for a potential systemic disease."

Clearly, science has yet to establish a direct cause and effect between dental hygiene and health, but researchers are continuing the quest.

In fact, a second study, also presented at this week's AHA conference, suggested that the number of teeth one has is associated with risk of heart disease, stroke and heart failure.

Most people have 32 teeth, wisdom teeth included. The study, conducted by dentist and researcher Anders Holmund at the Centre for Research and Development of the County Council of Gävleborg, Sweden, found that people with only 21 teeth had a 69 percent increased risk of heart attack, and those with the fewest teeth had a 2.5 times increased risk of congestive heart failure.

The researchers also looked at the gum disease, gingivitis, and found that people with gum bleeding had a 2.1 times increased risk of stroke, while those with gum infections had more than a 50 percent increased risk of heart attack.

"These studies appear to be done well, with large patient populations and long follow-up time," said Gerber of both studies, "but more research needs to be done before someone can definitively say there is a link between dental visits and heart health."

He encouraged people to continue following the American Dental Association (ADA) guidelines, which recommend visiting the dentist at least once every six months for a professional exam and cleaning.

Copyright 2011 ABC News Radio

Friday
Sep022011

Man Dies From Toothache, Couldn't Afford Meds

Stockbyte/Thinkstock(CINCINNATI) -- A 24-year-old Cincinnati father died from a tooth infection this week because he couldn't afford his medication, offering a sobering reminder of the importance of oral health and the number of people without access to dental or health care.

According to NBC affiliate WLWT, Kyle Willis' wisdom tooth started hurting two weeks ago. When dentists told him it needed to be pulled, he decided to forgo the procedure, because he was unemployed and had no health insurance.

When his face started swelling and his head began to ache, Willis went to the emergency room, where he received prescriptions for antibiotics and pain medications. Willis couldn't afford both, so he chose the pain medications.

The tooth infection spread, causing his brain to swell. He died Tuesday.

Calls to Willis' family were not immediately returned. University Hospital in Cincinnati, where Willis was admitted, did not comment, citing federal privacy laws.

"People don't realize that dental disease can cause serious illness," said Dr. Irvin Silverstein, a dentist at the University of California at San Diego. "The problems are not just cosmetic. Many people die from dental disease."

Willis' story is not unique. In 2007, 12-year-old Deamonte Driver also died when a tooth infection spread to his brain. The Maryland boy underwent two operations and six weeks of hospital care, totaling $250,000. Doctors said a routine $80 tooth extraction could have saved his life. His family was uninsured and had recently lost its Medicaid benefits, keeping Deamonte from having dental surgery.

Getting access to dental care is particularly tough for low-income adults and children, and it's getting tougher as the economy worsens. In April, the Kaiser Family Foundation reported that 33 percent of people surveyed skipped dental care or dental checkups because they couldn't afford them. A 2003 report by the U.S. Surgeon General found that 108 million Americans had no dental insurance, nearly 2.5 times the number who had no health insurance.

Trips to the dentist aren't the only expenses hard-up Americans are skipping. An August report by the Commonwealth Fund found that 72 percent of people who lost their health insurance when they lost their jobs said they skipped needed health care or did not fill prescriptions because of cost.

Dr. Jim Jirjis, director of general internal medicine at Vanderbilt University, said people, like Willis, without access to care often die of conditions that were much more common decades ago.

"He [Willis] might as well have been living in 1927," Jirjis said. "All of the advances we've made in medicine today and are proud of, for people who don't have coverage, you might as well never have developed those."

There are a number of free dental clinics in operation around the country, where dentists volunteer to provide care to those without health insurance. But even if Willis had access to a free dental clinic, Stream said he still may not have been able to get the care he needed for his infection. "The wait is often months at these clinics, and this young man died within two weeks of his problem," Stream said.

Silverstein operates three free dental clinics in the San Diego area. "We're overwhelmed right now," he said. "We can't take any new patients."

Copyright 2011 ABC News Radio

Friday
Jan072011

New Fluoride Recommendations Buck Decades-Old Dental Health Practices

Photo Courtesy - Getty Images(AUSTIN, Texas) -- After decades of touting the importance of fluoride, federal officials now say that many Americans may be getting too much of a good thing.

For years, parents have heeded their dentists' warnings and had their children take fluoride supplements or use fluoride toothpaste, in addition to whatever amount of the mineral they received from their tap water.

But Friday the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency announced that too much fluoride can cause fluorisis, a hypermineralization of tooth enamel that can result in the staining or pitting of teeth.

"In the vast majority of those affected, it's barely noticeable, even by dentists and oral health professionals," said Dr. Howard Koh, assistant secretary for health at HHS, "and that's why we believe making this adjustment now will promote health, improve oral health and reduce rates of fluorosis going forward."

HHS has proposed that the current recommendation be set at 0.7 milligrams of fluoride per liter of water, lowered from the previously recommended range of 0.7 to 1.2 milligrams.

Fluoride, when taken in moderate amounts, can help prevent cavities. The mineral has been added to toothpaste and to water to improve dental health. But some parts of the country, where the water is already rich in fluoride, have reported cases of fluorosis.

Dr. Griffin Cole, a dentist in Austin, Texas, said he has seen several cases of mild to severe fluorosis in his practice.

While he applauded the feds' proposal, he'd like to see the recommendations go even lower.

"I still don't think it's enough, honestly," he said. "I don't think there should be fluoride in the water at all.

"I think it's a nice move in the right direction," he said.

Cole said he began his dentistry career in the early 1990s, working for a dentist who was openminded about fluoride use and believed that his patients were getting too much.

Cole said he had never once prescribed fluoride supplements to his patients.

He cited studies from the past decade that have linked excess fluoride to not only fluorosis but to higher instances of bone cancer in the test subjects. He also said osteoporosis was an additional concern, since ingested fluoride is known to sit in a person's bones.

"Ingesting fluoride in any form does nothing for your teeth," he said. In cases of "rampant" tooth decay, applying a topical fluoride can improve dental health, but only minimally.

Fluoride, Cole said, molds to the tooth's enamel. So while it will aid in preventing decay, it can also make teeth brittle.

"When you see a case of somebody coming in with bad fluorosis, to restore those teeth you either have to crown them completely or at least do a veneer," he said. "So it's a very costly thing to fix."

Depending on the dentist and the region of the country, restoration could cost between $900 and $1,600 a tooth.

Koh said that in recognition of the multiple sources of fluoride available, HHS and the EPA also recommend that municipalities lower the levels of fluoride in their drinking water.

"The main issue of the very mild dental fluorosis in children is what we're addressing right now," he said, "and what we anticipate is that with this adjustment, we're going to lower that."

Copyright 2011 ABC News Radio







ABC News Radio