Top 4 Tips for Antibiotics Use

The Centers for Disease Control and Prevention (CDC) says that antibiotic resistance is one of the world’s most pressing public health problems. According to the CDC, an estimated 50 percent of antibiotic prescription use in hospitals is inappropriate or unnecessary.(1)

Other studies have found that dentists also may prescribe antibiotics unnecessarily.(2-3) During “Talk About Prescriptions Month,” Delta Dental advises people to be responsible about how they use antibiotics.

Antibiotics are powerful medicines that fight bacterial infections. They work by killing bacteria or preventing them from reproducing until the body’s immune system can fight off the rest of the infection. When prescribed and taken correctly, their value in helping cure or prevent the spread of disease is significant. Contrary to popular belief, antibiotics do not fight infections caused by viruses such as the common cold, flu and bronchitis.

Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. These resistant germs can then be spread to others and over time, an antibiotic resistant strain of bacteria can become a community problem. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.

Dentists mainly prescribe antibiotics for the management of infections in and around the mouth, which are usually caused by bacteria. They are sometimes used after oral surgery as a preventive measure or to treat a toothache. Most common dental infections take the form of a toothache and require some type of treatment, like a filling, root canal therapy, or tooth extraction. Antibiotics cannot cure a toothache and are not always necessary after routine oral surgery.

Individuals who are taking antibiotics should keep a few things in mind:

Take the entire prescription: Even if your condition is improving and you feel cured, finish the prescription. If you stop too soon, some bacteria can survive and reinfect.

Only take antibiotics to treat a bacterial infection: People instinctively want to take medication to make them feel better, even if they just have the flu or common cold. Antibiotics only work on bacteria, however, and the common cold is usually a virus.

Don’t save the bottle for future reuse: Antibiotics degrade when they are stored for months at a time, rendering them ineffective. Check with your pharmacy for appropriate disposal of expired medications.

Don’t share your antibiotics with others: Antibiotics are prescribed for specific purposes. Your doctor will typically check for potential adverse interactions or drug allergies before prescribing.

1 “Antibiotics: Will they work when you really need them?” Centers for Disease Control and Prevention. http://www.cdc.gov/getsmart/campaign-materials/week/downloads/factsheet-Monday-GetSmart-week.pdf. Accessed September 2012.

2 Zadik Y and Levn L. Clinical Decision Making in Restorative Dentistry, Endodontics, and Antibiotic Prescription. Journal of Dental Education January 1, 2008 vol. 72 no. 1 81-86

3 Dar-Odeh NS, Abu-Hammad OA, et.al. Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag. 2010; 6: 301–306.

Sealing a Smile Packs a Preventive Punch

Why is 80 percent of tooth decay found in only 25 percent of children, disproportionately kids from low-income families?1 The answer is multifold and complex, but Delta Dental believes that school-based dental sealant programs are a large part of a workable solution.

Dental sealants are a critical but underutilized component of preventive dentistry. The one-two punch of sealants and fluoride (in toothpaste and water) along with a proper diet can almost totally prevent new tooth decay.

National surveys by the Centers for Disease Control and Prevention (CDC) indicate that only 38 percent of children and teenagers ages 12 to 19 have dental sealants. This number is much lower among children from low-income families and certain races/ethnicities with higher tooth decay rates who would benefit most from sealants.1

Dental sealants can save families time, money and the discomfort of dental fillings. Sealants are thin, plastic coatings applied to the pits and grooves of teeth to protect them from the bacteria and foods that lead to tooth decay. First and second permanent molars are the most likely to benefit from sealants, so it’s best if the sealant is applied soon after those teeth appear, before they have a chance to decay (usually ages 6 and 12).

A sealant is virtually 100 percent effective if fully retained on the tooth, and studies have shown they remain intact 92 to 96 percent of the time after one year and 67 to 82 percent after five years. Sealants should be checked at each regular dental appointment and can be reapplied if they are no longer in place. 2

Sealants delivered through school-based programs have been shown to decrease tooth decay by 60 to 65 percent.3 Using school-based sealant programs at lower-income schools has proven to be highly effective in improving the oral health of those schoolchildren. Studies of children in either Medicaid programs or with private dental insurance show that placement of sealants on first and second permanent molars reduced the need for future cavity fillings.

1 Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. MD: National Center for Health Statistics. Vital Health Stat. 2007 Apr. 11 (248):1-91. Available from: http://www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf

2 Griffin SO, Kolavic-Gray S, et al. Caries Risk in Formerly Sealed Teeth. Journal of the American Dental Association April 2009 vol. 140 no. 4 415-423.

3 Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence on Interventions to prevent dental caries, oral and pharyngeal cancers and sports-related craniofacial injuries. Am J Prev Med 2002; 23(1 suppl):21-54. http://www.thecommunityguide.org/oral/oral-ajpm-ev-rev.pdf. Accessed March 14, 2012.

Help Your Teeth Age Gracefully with You

Advances in medical technology, public health, personal health knowledge and greater access to health insurance are some of the key factors helping people in the U.S. today live longer and in better health than previous generations. The most recent data indicate that life expectancy from birth is at an all-time high of nearly 78 years, with women at 80.5 and men at 75.5 years.1

Improvements in oral health are also significant, and adults 65 and older are keeping more of their natural teeth for their entire lives than previous generations. During National Healthy Aging Month, Delta Dental is advising older adults that practicing good oral health habits is more important than ever.

The popular idiom “long in the tooth” references how gums wear away in the aging process, leaving the root of the tooth exposed. The tooth root is much softer and more prone to dental decay than the enamel that covers the tooth crown. Dental disease is cumulative over a lifetime, so almost all adults ages 65 and older have had dental caries in their permanent teeth.2 Older adults who take any one of several hundred medications that can cause a decrease in saliva should be especially careful because a lack of saliva brings a much higher risk for tooth decay.

Smart dental hygiene is important even for those seniors who have lost their regular teeth. Besides helping ensure dentures and other prosthetic replacements fit properly, dentists can catch life-threatening diseases like oral cancer early when they are at a more treatable stage.

Studies show that individuals with dental insurance are far less likely to have unmet dental needs than those with insurance, and are also more likely to get regular dental exams.3 However, once individuals retire they often neglect to purchase ongoing dental coverage. Medicare does not provide dental coverage but individual plans are available for purchase. Seniors can also check to see if membership in any national organizations or associations qualifies them to purchase dental benefits.

1 The 2012 Statistical Abstract.. The National Data Book. Data Source: U.S. National Center for Health Statistics, National Vital Statistics Reports (NVSR), Deaths: Preliminary Data for 2008, Vol. 59, No. 2, December 2010. Accessed August 27, 2012 at:http://www.census.gov/compendia/statab/2012/tables/12s0104.pdf

2 “Dental Caries (Tooth Decay) in Seniors (Age 65 and Over).” National Institute of Dental and Craniofacial Research. http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesSeniors65older. Accessed August, 2012.

3 Bloom B, Simile CM, Adams PF, Cohen RA. Oral health status and access to oral health care for U.S. adults aged 18–64: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(253). 2012.

Top Five Best Oral Health Practices at School

It may seem like a mindless matter, but packing an apple instead of a sugary snack in a child’s lunch this fall can help improve oral health and educational performance. After all, children eat more than 20 percent of their meals at school during the academic year. So Delta Dental, the nation’s largest dental benefits provider, reminds parents to make good decisions when packing a child’s school lunch.

Overconsumption of sugar harms a child’s oral and overall health. Snacks like cookies, candy and chewy fruit snacks mix with bacteria in the sticky plaque that constantly forms on teeth to generate acid, which can wear away enamel and cause tooth decay. While sweets may provide a temporary jolt for kids, that sugar rush soon turns into a crash and kids are left feeling lethargic. That is not the kind of mental state kids need to prepare for an afternoon of classes.

Instead, Delta Dental recommends these top five oral health best practices:

• After breakfast, before leaving for school, make sure your child brushes well with a fluoridated toothpaste. Brushing immediately following a meal helps clean teeth and eliminates halitosis (bad breath).

• Fill a child’s lunch box with healthy lunch food and snacks such as lean meats, whole grain breads, low-fat yogurt or cheeses, apples, bite-size carrots and baked chips or whole-grain crackers. Besides being packed with nutrients, certain fruits and veggies can even help clean the teeth and gums. Make treats a treat. Serve sugary sticky snacks like cookies, cake and brownies and candy only in moderation. Room parents should discuss bringing in healthy snacks along with sugary treats for birthdays and other classroom parties.

• If a child chews gum and the school allows it, chewing sugar-free gum for a few minutes in between lunch and afternoon classes can help stimulate saliva to buffer the acid and help dislodge food particles from the mouth. Gum containing the natural sweetener, Xylitol, is a particularly good option since studies have shown that consistent exposure to Xylitol can reduce cavity-causing bacteria in the mouth.

• Children with braces should try to brush or rinse well with water after lunch. Children who wear removable retainers should clean them well after each meal and rinse out their mouths.

• Before the school year starts, schedule a dental visit to make sure there are no problems to distract a child during the school year. Ask the dentist about sealants as a way to protect children’s teeth from cavities. Sealants – a thin coating of bonding material applied over the chewing surface of molar teeth – act as a barrier to cavity-causing bacteria.

Make Dentist Visits the Rule for Back-to-School

Along with an annual physical, clothes and backpacks, Delta Dental suggests adding a visit to the dentist to your child’s back-to-school list this fall. Dental professionals recommend biannual visits for most children, and the end of summer is an ideal time because it follows a season in which kids have indulged in treats like soda, ice cream and cotton candy.

A dental visit is important because a dentist can diagnose potential oral health problems such as tooth decay or gum disease and apply preventive measures as needed, including teeth cleaning, fluoride treatment, dental sealants, and instruction on good dental hygiene habits. Making sure children get a clean bill of oral health before the school year allows them to return to class flashing a happy and healthy smile. Conversely, untreated dental problems can be painful and embarrassing, and can harm a child’s educational and social development. In 2007, for example, the State of California estimated that seven percent of their more than seven million schoolchildren (504,000) missed at least one day of school because of a dental problem. 1

Unfortunately, access to sufficient dental care is not nearly what it needs to be for children from poor and uninsured families. A study from the Pew Center on the States found that two-thirds of states in the U.S. do not have adequate policies in place to ensure access to proper preventive dentistry, particularly for those children that lack appropriate access to care. 2 Instead, programs like mobile dental units that visit schools and school-based dental sealant programs are playing a critical part in improving the oral health and quality of life of low-income, American children.

Ultimately, good oral health for children starts at home with proper dental hygiene and diet. The daily one-two punch of brushing twice a day with a fluoride toothpaste and flossing once is still the foundation for maintaining healthy teeth and gums. Very young children (ages one to five) are particularly prone to tooth decay and parents should supervise (or actually brush) to make sure they do a good job. A diet light on sugary snacks and drinks and rich in fruits and vegetables goes a long way toward maintaining good oral and overall health.

1(Source: 2007 California Health Interview Survey) UCLA Health Policy Research Brief – Unaffordable Dental Care Is Linked to Frequent School Absences, 2009 Pourat N and Nicholson G. http://www.healthpolicy.ucla.edu/pubs/files/Unaffordable_Dental_Care_PB_1109.pdf

2The Cost of Delay: State Dental Policies Fail One in Five Children. Pew Center on the States. http://www.pewtrusts.org/uploadedFiles/Cost_of_Delay_web.pdf.

Five Ways to Help Your Children Brush Better

Poor and infrequent brushing may be some of the biggest obstacles preventing children in the United States from having good oral health. That’s one of the key findings from a recent survey1 of American children’s oral health, conducted on behalf of Delta Dental Plans Association, the nation’s leading dental benefits provider.

While nearly two out of five Americans (37 percent) report that their child’s overall oral health is excellent, more than a third of survey respondents (35 percent) admit their child brushes his or her teeth less than twice a day.

Among those who rate their child’s oral health as less than excellent, only 56 percent say their child brushes his or her teeth for at least 2 minutes, which is the amount of time dentists typically recommend spending on each brushing.

While the American Association of Pediatric Dentistry recommends daily flossing, nearly half (48 percent) of the survey respondents whose children have teeth say they have never been flossed; only 22 percent report their child’s teeth are flossed daily.

Getting small children to brush properly can be a challenge, but here are some ideas that can help:

• Trade places: Tired of prying your way in whenever it’s time to brush those little teeth? Why not reverse roles and let the child brush your teeth? It’s fun for them and shows them the right way to brush. Just don’t share a toothbrush. According to the American Dental Association, sharing a toothbrush may result in an exchange of microorganisms and an increased risk of infections.

• Fun Toothbrush Holder/Toothbrush: Another way to get children brushing is by utilizing oral health gifts like robot, tree or animal-shaped toothbrush holders that stick to walls. Kids like the characters and the holder provides a sanitary storage spot for their toothbrushes and toothpaste. Remember to apply just a small dab of toothpaste to the brush since the amount of fluoride in children’s toothpaste is still adult strength.

• Take turns: Set a timer and have the child brush his or her teeth for one minute. Then reset the timer and brush their teeth for the final minute.

• Call in reinforcements: If children stubbornly neglect to brush or floss, maybe it’s time to change the messenger. Call the dental office before the next checkup and let them know what’s going on. The same motivational message might be heeded if it comes from a third party, especially the dentist.

1 Morpace Inc. conducted the 2011 Delta Dental Children’s Oral Health Survey. Interviews were conducted by email nationally with 907 primary caregivers of children from birth to age 11. For results based on the total sample of national adults, the margin of error is ±3.25 percentage points at a 95 percent confidence level.

Before Your Due Date, Schedule a Date With a Dentist’s Office

Most pregnant women recognize how important their own overall health is for their baby’s health, but may ignore a critical component – their oral health. In fact, a survey of American children’s oral health conducted on behalf of Delta Dental found that nearly 4 out of 10 American mothers neglect to visit a dentist during pregnancy, which is significant to helping prevent harmful oral and overall health problems for themselves and their babies. Dentists can identify and treat teeth and gum problems, lowering the risk for more serious, ongoing health problems for both a mother and her baby.

While having a healthy mouth is always important, pregnancy can intensify dental problems. Hormonal changes during pregnancy can exaggerate the way gum tissue reacts to plaque, increasing the risk for gingivitis, the first stage of periodontal (gum) disease. Some studies have suggested that pregnant women with moderate-to-severe gum disease may be more at risk to give birth to low-weight or pre-term babies, who are at risk for many serious diseases.

Dental hygiene habits are controllable, but some pregnancy side effects may wreak havoc on a woman’s oral health. For instance, nausea and vomiting affect 80 percent of all pregnant women.2 The stomach acid from vomiting can erode tooth enamel – making teeth sensitive and more vulnerable to decay. A woman may also feel less willing to follow her usual pattern of regular brushing and flossing.

Most moms-to-be also experience cravings. The additional snacking can lead to increased tooth decay. Giving into cravings for sugary foods can be worse for expectant mothers’ teeth, since sugar is a major cause of tooth decay.

Along with visiting the dentist, Delta Dental offers the following tips to help prevent oral health complications during pregnancy:

• Brush your teeth twice daily with fluoride toothpaste and floss once daily.
• Limit foods containing sugar to mealtime only. If you do indulge one of those cravings, drink a glass of water while snacking and brush your teeth once you’re done.
• Choose water or low-fat milk to drink and avoid carbonated beverages.
• Opt for fruit rather than fruit juice to meet the recommended daily fruit intake.
• If you suffer from “morning sickness,” rinse your mouth out with water and baking soda solution afterward. The combination will neutralize the acid. Also brush your teeth gently and if you chew gum, use the kind with xylitol as the main sweetener.

1 Morpace Inc. conducted the 2011 Delta Dental Children’s Oral Health Survey. Interviews were conducted by email nationally with 907 primary caregivers of children from birth to age 11. For results based on the total sample of national adults, the margin of error is ±3.25 percentage points at a 95 percent confidence level.

2 American Academy of Family Physicians, Nausea and Vomiting of Pregnancy, 2003.

Delta Dental Encourages Major League Baseball to Quit the Spit (Tobacco)

While smokeless tobacco has not been completely banished from baseball, Delta Dental applauds Major League Baseball (MLB) and the Major League Baseball Players Association (MLBPA) during Oral, Head and Neck Cancer Awareness Week for making a positive step toward completely eliminating tobacco’s visibility from impressionable young fans. Under a recent agreement, MLB players, managers and coaches will no longer be able to carry a smokeless tobacco tin or package in their uniforms during games or when fans are in stadiums. Additionally, they will be prohibited from “chewing” during televised interviews, at autograph signings and other fan events.

Smokeless tobacco has been banned from Minor League Baseball since 1993 and from collegiate athletics since 1994. The surge of support for an outright ban on smokeless tobacco has a website, and players like Boston Red Sox outfielder Adrian Gonzalez and Chicago White Sox pitcher John Danks have recorded public service announcements speaking out against smokeless tobacco. Joe Garagiola, an 84-year-old former tobacco chewing-MLB catcher and current broadcaster, is the chairman of NSTEP, the National Spit Tobacco Education Program. NSTEP is a 17-year-old program operated by Oral Health America that educates baseball players of all ages about the dangers of chewing or “spit” tobacco.

The American Cancer Society estimated that more than 39,000 people were diagnosed with oral cancer and nearly 8,000 people died of the disease in 2011, and that men are twice as likely as women to be diagnosed.Tobacco use is considered a major risk factor for the development of oral cancers. Whether they like it or not, athletes serve as role models for impressionable children and teens. The Centers for Disease Control and Prevention (CDC)’s 2009 Behavioral Risk Factor Surveillance Study found that more than 11 percent of male high school students and four percent of male middle school students were current smokeless tobacco users.2 Though smokeless tobacco has been banned in all venues by the NCAA and MILB, a significant number of young players get hooked on the habit earlier in life.

Delta Dental puts its support and resources behind this message. Delta Dental of Tennessee, for instance, leveraged their sponsorship with the Memphis Redbirds (Triple-A affiliate of the St. Louis Cardinals) to present Oral Cancer Awareness Night at AutoZone Park. The event included oral cancer screenings performed by teachers from the University of Tennessee Health Science Center’s College of Dentistry.

Delta Dental wants the professional baseball community to be aware of the inherent risks and dangers of smokeless tobacco use, and the influence that the actions of professional baseball players have on their youthful fans. We ask that – for their own health and that of their young fans – players pause next time before throwing in a dip. We applaud the progress that MLB has made in limiting tobacco use in the sport but would support a complete ban on smokeless tobacco during games when so many young fans are watching attentively.

Below is a video in which Dr. Kohn explores the relationship between smokeless tobacco use and oral cancer.

1 American Cancer Society. Oral Cancer Fact Sheet. Accessed February 2012. http://www.cancer.org/acs/groups/content/@nho/documents/document/oralcancerpdf.pdf

2 Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2000–2009. Morbidity and Mortality Weekly Report 2010;59(33):1063–8

You Booze, You Lose: Excessive Drinking Harms Oral Health

People most often associate the health risks of excessive alcohol drinking with damage to the liver or stomach lining. But during Alcohol Awareness Month, Delta Dental warns that alcohol abuse can also prove harmful to oral health.

It is estimated that each year in the United States there will be more than 30,000 new cases of oral cancer diagnosed and about one person every hour will die from this disease.1  Heavy alcohol consumption is a risk factor for oral cancer.* According to the American Cancer Society, about 70 percent of oral cancer patients consume alcohol frequently.Tobacco smoking (i.e., cigarette, pipe or cigar smoking), particularly when combined with heavy alcohol consumption, has been identified as the primary risk factor for approximately 75 percent of oral cancers in the U.S. Using tobacco with alcohol poses a much greater risk than ingesting either substance alone. According to the National Institute on Alcohol Abuse and Alcoholism, there are approximately 17.6 million adults who are alcoholics or have alcohol problems.3 

People with alcohol problems also tend to neglect other healthy habits like eating properly or taking care of daily hygiene. A small 2003 study conducted at an alcohol rehabilitation center found that residents had a higher incidence of periodontal (gum) disease and cavities.4

Drinking, like most other things, is best done in moderation for both your oral and overall health and well-being. Some epidemiological studies suggest a heart protective association for low-to-moderate average alcohol consumption.5  Indeed, sipping alcoholic beverages like red wine (which contain heart-healthy antioxidants like resveratrol) may be beneficial for lowering LDL cholesterol and helping prevent clogging of arteries.6

*According to the Centers for Disease Control and Prevention (CDC), heavy drinking for men is typically defined as consuming an average of more than two drinks per day. For women, heavy drinking is typically defined as consuming an average of more than one drink per day.

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1 National Institutes of Health. NIH Fact Sheets. Oral Cancer – updated February 14, 2011. Accessed March 30, 2012. 

Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282-7.

3 Medline Plus – Alcoholism http://www.nlm.nih.gov/medlineplus/alcoholism.html. Accessed March 30, 2012.

4 Araujo MW, Dermen K, Connors G, Ciancio S. Oral and dental health among inpatients in treatment for alcohol use disorders: a pilot study. J Int Acad Periodontol. 2004 Oct;6(4):125-30.

5 Di Minno MN, Franchini M, Russolillo A, Lupoli R, Iervolino S, Di Minno G. Alcohol dosing and the heart: updating clinical evidence. Semin Thromb Hemost. 2011 Nov;37(8):875-84. Epub 2011 Dec 23.

6 Wu JM, Hsieh TC. Resveratrol: a cardioprotective substance. Ann N Y Acad Sci. 2011 Jan;1215:16-21.

H2O: Oral Health Opportunity

In 1931, Dr. Frederick McKay concluded his 30-year investigation into why some children in Colorado had brown stained teeth but very little tooth decay. He discovered that water supplies with high levels of fluoride – a water-born mineral found in rocks and soil – caused the discoloration of tooth enamel and prevented tooth decay. [1] However exciting that moment of eureka must have been for Dr. McKay, it’s doubtful he ever imagined that adding fluoride to drinking water would eventually be named “one of 10 great public health achievements of the 20th century” by the Centers for Disease Control and Prevention (CDC).

During National Public Health Week, Delta Dental encourages community leaders to support the fluoridation of their local water systems. Dr. McKay’s discovery was a boon for preventive health. It’s one of the easiest, most reliable ways to bolster the oral health of an entire community. Research studies have demonstrated how fluoride helps strengthen tooth enamel and remineralize teeth that have already been damaged by the early effects of tooth decay.

Although most community water supplies had naturally-occurring fluoride in their water, it was usually at too low a level to help prevent tooth decay, and sometimes at such a high level that it would damage the tooth surface and cause staining and pitting. It took scientists almost two decades after McKay’s discovery to determine the right balance between decay prevention and tooth staining. In 1945, Grand Rapids, Mich., became the first U.S. city to add fluoride to their water supply to prevent tooth decay in the population. The results were so dramatic – a sixty percent drop in tooth decay rates in the children – that other communities began adopting the practice. Today, almost 75 percent of the U.S. population using public water systems – nearly 200 million people – has access to fluoridated water.

Fluoride has not been without its detractors, however, as some people object to any additives to drinking water even when the effects are beneficial. Others proclaim that fluoride has harmful effects, although a large body of scientific studies over the years has not supported those concerns. It is widely known that fluoride can protect teeth across an entire lifetime. The brown staining noticed by McKay – now called severe fluorosis – only occurs when the teeth are developing below the gumline during early childhood. That is why early researchers looked for the proper balance of fluoride to put in water that would both help prevent tooth decay and eliminate risk for severe fluorosis among children.

With the economy struggling, many communities are unable or unwilling to fund community water fluoridation projects. In response, several Delta Dental member companies have helped provide funding for community fluoridation projects. It’s an important dental initiative that Delta Dental is proud to support in the interest of improving public oral health.

To see a video for additional information on this important public health subject, please click here.

[1]The Story of Fluoridation by the NIDCR.  http://www.nidcr.nih.gov/oralhealth/topics/fluoride/thestoryoffluoridation.htm. Accessed February 2012.