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Oral Health for Adults with Special Needs

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family dental | dentist in sun valley idahoThe Challenges Of Improving The Oral Health Of Adults With Special Needs

Article by Medical News Today

A comprehensive study using electronic dental records to profile the oral health status of adults with intellectual and developmental disabilities (I/DD) has concluded that access to specialized dental care alone is not sufficient to meet the community’s substantial oral health needs. The findings, published as the cover article in the August issue of The Journal of the American Dental Association, provide a foundation for further investigation into the significant oral health needs of adults with I/DD and the development of preventive oral health strategies.

The study of dental records of 4,732 people, led by dentists and public health professionals at Tufts University School of Dental Medicine (TUSDM) and Tufts University School of Medicine (TUSM), was conducted at the Tufts Dental Facilities Serving People with Special Needs (TDF), a network of Massachusetts dental clinics that provides oral health care to people with disabilities.

Each year, Tufts’ program, which is recognized by the Association of State & Territorial Dental Directors as a national model, serves more than 7,000 patients at seven clinics in Massachusetts. The findings released today are the first of a three-part study conducted by principal investigators John Morgan, D.D.S., associate professor in the department of public health and community service at TUSDM, and Paula Minihan, Ph.D., M.P.H., assistant professor in the department of public health and community medicine at TUSM.

“People with intellectual and developmental disabilities are more likely to have poor oral hygiene, periodontal disease and untreated tooth decay than the general population,” said Morgan. “Our findings highlight the need for greater awareness of the unique and complex dental health care needs of this population. The roles of the patient, care giver and dental provider are all vital in developing preventive strategies to improve oral health.”

Morgan and colleagues analyzed clinical and demographic data documented in electronic dental records over a one-year period. They investigated oral health conditions (e.g. dental caries (cavities), periodontal (gum) disease, etc.), age, gender, ability to receive dental examinations and procedures, level of disability, and type of residence. Of the 4,732 patients whose records were reviewed, 61% were reported to have a mild to moderate disability, and 39% were assessed as having a severe disability. Dental records revealed a high burden of oral disease, including dental caries (cavities), periodontitis (gum disease) and missing teeth.

Nearly 25% of the patients had a limited ability to accept any dental intervention and required specialized resources, such as general anesthesia. Almost 40% of all patients able to accept dental treatment required some form of behavioral assistance. These behavioral challenges pose difficulties for dental staff when providing diagnostic and therapeutic procedures. “Behavioral challenges present barriers to good oral health and overall health,” Morgan said. “Often patients with significant developmental disabilities cannot tolerate complex and time consuming dental treatments.”

“From a public health perspective, our findings signal the need for the development of best practices for dental treatment guidelines that promote and protect the oral health of this vulnerable population,” said co-investigator Aviva Must, Ph.D., professor and dean of public health and professional degree programs at TUSM. “Further research is required to identify and develop risk-based preventive interventions to manage oral diseases for people with intellectual or developmental disabilities and maximize the role of the dental professional, patient, and caregiver in promoting oral health.”

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A Link Between Obesity and Gum Disease

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Medical News Today reports:

dds dentist | dentist inObesity and Gum Disease

Impacting approximately one-third of the U.S. population, obesity is a significant health concern for Americans. It’s a risk factor for developing type 2 diabetes, heart disease, and certain forms of cancer, and now, according to an article published in the January/February 2013 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), it also may be a risk factor for gum disease.

“We know that being overweight can affect many aspects of a person’s health,” says Charlene Krejci, DDS, MSD, lead author of the article. “Now researchers suspect a link exists between obesity and gum disease. Obese individuals’ bodies relentlessly produce cytokines, proteins with inflammatory properties. These cytokines may directly injure the gum tissues or reduce blood flow to the gum tissues, thus promoting the development of gum disease.”

Half of the U.S. population age 30 and older is affected by gum disease – a chronic inflammatory infection that impacts the surrounding and supporting structures of the teeth. Gum disease itself produces its own set of cytokines, which further increases the level of these inflammatory proteins in the body’s bloodstream, helping to set off a chain reaction of other inflammatory diseases throughout the body.

Research on the relationship between obesity and gum disease is still ongoing.

“Whether one condition is a risk factor for another or whether one disease directly causes another has yet to be discovered,” says AGD Spokesperson Samer G. Shamoon, DDS, MAGD. “What we do know is that it’s important to visit a dentist at least twice a year so he or she can evaluate your risks for developing gum disease and offer preventive strategies.”

The best way to minimize the risk of developing gum disease is to remove plaque through daily brushing, flossing, rinsing, and professional cleanings.

“A dentist can design a personalized program of home oral care to meet each patient’s specific needs,” says Dr. Shamoon.

Tooth care | Dentist in Hailey

Tooth Decay Risk Lowered by Fluoride in Drinking Water

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Adults Who Consume Fluoride In Drinking Water At Decreased Risk For Tooth Decay

Tooth care | Dentist in HaileyFrom MNT- Medical News Today

A new study conducted by researchers at the University of North Carolina at Chapel Hill and the University of Adelaide, Australia, has produced the strongest evidence yet that fluoride in drinking water provides dental health benefits to adults, even those who had not received fluoridated drinking water as children.

In the first population-level study of its kind, the study shows that fluoridated drinking water prevents tooth decay for all adults regardless of age, and whether or not they consumed fluoridated water during childhood.

Led by UNC School of Dentistry faculty member Gary Slade, the study adds a new dimension to evidence regarding dental health benefits of fluoridation.

“It was once thought that fluoridated drinking water only benefited children who consumed it from birth,” explained Slade, who is John W. Stamm Distinguished Professor and director of the oral epidemiology Ph.D. program at UNC. “Now we show that fluoridated water reduces tooth decay in adults, even if they start drinking it after childhood. In public health terms, it means that more people benefit from water fluoridation than previously thought.”

The researchers analyzed national survey data from 3,779 adults aged 15 and older selected at random from the Australian population between 2004 and 2006. Survey examiners measured levels of decay and study participants reported where they lived since 1964. The residential histories of study participants were matched to information about fluoride levels in community water supplies. The researchers then determined the percentage of each participant’s lifetime in which the public water supply was fluoridated.

The results, published online in the Journal of Dental Research, show that adults who spent more than 75 percent of their lifetime living in fluoridated communities had significantly less tooth decay (up to 30 percent less) when compared to adults who had lived less that 25 percent of their lifetime in such communities.

“At this time, when several Australian cities are considering fluoridation, we should point out that the evidence is stacked in favor of long-term exposure to fluoride in drinking water,” said Kaye Roberts-Thomson, a co-author of the study. “It really does have a significant dental health benefit.” 

dental care | dentist in hailey idaho

Cavity Causing Bacteria easily Passed to Others

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Surprising news about passing cavity causing bacteria to others!

Delta Dental survey finds more oral health gaps
By DrBicuspid Staff

February 6, 2013 — In conjunction with National Children’s Dental Health Month, Delta Dental has released the findings of a new survey of nearly 1,000 caregivers.

dental care | dentist in hailey idahoThe 2013 Delta Dental Children’s Oral Health Survey shows that Americans are unaware that they can pass cavity-causing bacteria to children, and that they also need to improve on some critical children’s dental health habits, including basics such as brushing and flossing.

One in four caregivers said that their children received a filling for caries, and that among those who had restorative treatment in the past year, 53% had two or more restorations.

Some of the oral health habits reported that fall short of what’s recommended by dental professionals include the following:

75% of caregivers say they share utensils such as a spoon, fork, or glass with a child.
49% of Americans with a child 4 years or younger report that the child sometimes takes a nap or goes to bed with a bottle or sippy cup containing milk or juice.
For children who have visited the dentist, the average age at the first visit was 3 years old.
Only 58% of children had their teeth brushed twice a day, and 34% of children brush for less than two minutes.
43% of parents or caregivers report that their children’s teeth are never flossed, and of children whose teeth are flossed, only 23% are flossed daily.

Family Dentistry | James McElveen DDS

Dental Floss

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How Your Dentist Knows You Are Not Flossing

Family Dentistry | James McElveen DDSA recent survey by the American Dental Association found that just under half of all Americans floss their teeth daily.

What about the other half?

My guess is that they’re the ones who floss twice a year — right before their dental checkups. They think they can pull a fast one on us, but here’s a little secret: dentists can tell when you’ve been flossing and when you haven’t.

How Dentists Can Tell When You’re Not Flossing
The way we can tell if you’re not flossing is if your gums are bleeding. Although there are other, less common conditions that can make your gums bleed, gingivitis is the main cause. Gingivitis is when the gums are inflamed due to all of the bacteria in your mouth collecting right between the gums and the teeth.

The problem is that it takes about a week of daily flossing for gingivitis to go away and make it so your gums don’t bleed when they are cleaned.

The most authoritative book on the gums — that’s 1,328 pages dedicated to your gums! — states the following:

The presence of plaque for only 2 days can initiate gingival bleeding on probing, whereas once established, it may take 7 days or more after continued plaque control and treatment to eliminate gingival bleeding.

So, if you end up brushing and flossing really well right before your dental cleaning and exam, your teeth will be clean, but your gums will still show the main sign of inflammation: bleeding.

If you really want to trick your dentist into thinking you’re brushing and flossing regularly, you’ll have to do it for at least seven days before your visit. And if you’re gonna do that, why not simply brush and floss every day?

dentistry | James McElveen dds

Dental Insurance News

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An article from Dr Biscuspid, Practice management:

dentistry | James McElveen ddsWill ACA prompt some patients to drop dental insurance?

By Donna Domino, Features Editor

January 23, 2013 — While 5.3 million children will gain dental coverage in 2014 thanks to the Patient Protection and Affordable Care Act (ACA), up to 11 million adults could drop their own dental coverage when their children are covered separately, according to the National Association of Dental Plans. And parents who switch to dental coverage under their medical insurance may have to change dentists.

Currently, adult and children’s dental plans are mostly sold as group plans offered by employers. These dental plans are separate from medical plans. As one of the 10 essential health benefits under the ACA, pediatric dental benefits will be part of medical plans sold outside of the insurance exchanges. Pediatric dental plans also will be sold in insurance exchanges, both packaged with medical plans and as standalone dental plans.

While large companies (more than 50 employees — in 2016 this will increase to 100) won’t be affected by the upcoming changes in 2014, employees in small groups will have to decide this year how to get the dental benefits mandated for their children.

“We’re looking at 1 or 2 million additional children who will get new private dental coverage through small employer groups or exchanges.”

— Evelyn Ireland, National Association
of Dental Plans

What that means is the dental coverage that nearly 23 million children now have as part of their parent’s policy in the small group market will be duplicated by their medical coverage beginning in 2014, according to Evelyn Ireland, the executive director of the National Association of Dental Plans. About 5.3 million children are expected to gain dental coverage next year, mostly through public programs such as Medicaid or the Children’s Health Insurance Program (CHIP).

To avoid duplication, parents have to decide by the end of this year whether to take their children off their separate dental coverage. If they do, they may have to change dentists for the children, depending on which dentists are in the medical carrier’s network.

“I don’t think there’s any question that children’s coverage will be expanded, whether it’s through Medicaid, CHIP, or private programs,” Ireland told “Even though there are a lot of complexities and moving parts, by the time enrollment starts in the fourth quarter, we’re certainly going to increase the number of kids covered. We’re looking at 1 or 2 million additional children who will get new private dental coverage through small employer groups or exchanges.”

But while millions more children will gain access to dental care, many of their parents will probably drop their own dental coverage, she added.

“Our studies show that when children’s coverage is separated from their parents in the small group market, as many as half of the parents that are currently insured may drop their dental coverage for economic reasons,” Ireland noted. “We’re looking at potentially 10 to 12 million adults who may drop coverage because they can get their children covered separately. So they may decide to get their kids’ teeth fixed instead. And studies show if adults don’t have coverage, they don’t go to the dentist as often.”

What about insurance carriers?

From a dental insurer’s perspective, the changes will probably move some of their customers from group plans to individual plans, according to Joanne Fontana, an actuary who tracks health insurance for the actuarial and consulting firm Milliman. This marks the first time there will be a need for pediatric-only plans, she pointed out.

“Some dental insurers aren’t too anxious to jump into the individual marketplace,” Fontana “With the exchanges, you have an individual marketplace where people will be purchasing pediatric oral care, so insurers will be making sure they position themselves and their product so they can attract business. It’s also important to understand that people on the exchanges may look a little different than the group of people that have historically been covered under employer-sponsored plans.”

The kind of coverage employers will offer once the exchanges are in place remains to be seen, she added.

“I think dental is still viewed by employers as a value-added benefit, and you want to offer good benefit packages to your employees,” Fontana said. “The broader issue is, are employers going to keep offering any kind of coverage, or are they going to say, ‘Nope, go buy medical and dental coverage wherever you want.'”

The ACA provides subsidies for those with lower incomes (under 400% of poverty level) who opt for coverage in the exchanges, but only if an employer doesn’t provide adequate coverage, Ireland pointed out.

“The exchanges are not a way for individual consumers to dump coverage provided through their employer and go on exchanges,” she said.

Separate consumer cost-sharing limits for medical and dental plans will be applied to coverage purchased through the exchanges. Starting this year, annual out-of-pocket expenses for medical will be capped at $12,500 for a family of four and $6,250 for individuals, either for medical expenses only or when medical with dental coverage are included together in a policy. When dental is purchased separately, a “reasonable out-of-pocket limit” (OOP) is required under the proposed rules. The NADP has suggested $1,000 as a standard OOP limit, Ireland noted.

The rules set strong incentives for consumers to use dentists and medical providers who are in-network because OOP costs for out-of-network providers are not counted toward the consumer’s OOP limits, she said.

Also, changes in orthodontic coverage provided through small employers will require a demonstration of medical necessity. Milliman estimated that only about 30% of orthodontic claims now meet that standard, Ireland said.

Notably, there will be no annual limits on children’s dental coverage purchased through exchanges or small employers. But annual limits will remain in place for children’s dental coverage purchased through large employer groups.

Consumers will more often take their children to a network dentist — especially for orthodontia — so that their out-of-pocket costs will count toward annual caps, Ireland said.

“We’re certainly going to increase the number of children covered and that’s the goal,” Ireland noted. “The problem is that separating children from their parent’s coverage could result in a shift in their choice of providers, and that could result in a net loss of adult coverage, so we could end up with a net loss of people covered for dental benefits — which could translate into less dental demand.”

sensitive teeth care| James McElveen DDS

Sensitive Teeth – A Natural Treament

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An article from Medical News Today:

sensitive teeth care| James McElveen DDSNature-Inspired Advance For Treating Sensitive Teeth

Taking inspiration from Mother Nature, scientists are reporting an advance toward preventing the tooth sensitivity that affects millions of people around the world. Their report on development of the substance, similar to the adhesive that mussels use to attach to rocks and other surfaces in water, appears in the journal ACS Applied Materials & Interfaces.

Quan-Li Li, Chun Hung Chu and colleagues explain that about 3 out of every 4 people have teeth that are sensitive to hot, cold, sweet or sour foods and drinks. It occurs when the hard outer enamel layer on teeth and the softer underlying dentin wear away, stimulating the nerves inside. Some sugar-free gums and special toothpastes can help reduce that tooth hyper-sensitivity. However, Li and Chu cite the need for substances that rebuild both enamel and dentin at the same time. To meet that challenge, they turned to a sticky material similar to the adhesive that mussels use to adhere to surfaces. They reasoned that it could help keep minerals in contact with dentin long enough for the rebuilding process to occur.

They describe laboratory tests that involved bathing human teeth with worn-away enamel and dentin in liquid containing the sticky material and minerals. Teeth bathed in the sticky material and minerals reformed dentin and enamel. However, teeth bathed just in minerals reformed only enamel. The gooey substance “may be a simple universal technique to induce enamel and dentin remineralization simultaneously,” they concluded.