ACA’s Exchanges Offer Opportunity to Improve Dental Health

As the Affordable Care Act’s Exchanges begin to enroll people across the country, a seemingly minor provision in the law is bound to make a big difference in combating the most widespread disease children experience today: tooth decay.Federal legislators wanted to tackle this issue head-on, and saw fit to make children’s dental coverage one of the ten essential health benefits for people getting coverage on the Exchanges.

There are many options for new customers purchasing dental benefits for their kids on the Exchanges. Consumers will now be able to choose from stand-alone dental plans, which is the way dental benefits have traditionally been provided, and from health plans with dental coverage wrapped up inside.

In fact, besides health plans covering major medical benefits, stand-alone dental plans are the only other type of coverage that can be sold on the Affordable Care Act’s Exchanges. Our goal is to help parents get access to great coverage so they can get their kids to the dentist for the care they need. Delta Dental member companies are offering children’s plans in most of states across the country in 2014, with more offering coverage in their states in 2015.

Parents will be able to shop for dental coverage not only for their children, but also for themselves. Family plans can be sold on most Exchanges as long as the pediatric coverage is also included in the plan. Recent studies show that parents with dental plans go to the dentist.2 And when they do, they are likely to bring their children. Ultimately, we hope that Delta Dental and other carriers can do their part to reduce dental disease across the country.

1 Oral Health in America; A Report of the Surgeon General (Executive Summary). National Institute of Dental and Craniofacial Research. http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm 

2007 NADP Consumer Survey. National Association of Dental Plans. http://www.ineeddentalbenefits.com/wp-content/uploads/2008/07/nadpemployerwhitepaper.pdf

Ozone in Dentistry

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One simmering controversy in dentistry has to do with ozone, but nothing to do with the layer that surrounds our planet. Rather, it’s a new and controversial alternative form of dental treatment. Some dentists are convinced that delivering ozone gas, a powerful naturally-occurring oxidant, into a decaying tooth can halt or even reverse the process altogether.

Dental caries, otherwise known as cavities, are bacterial infections that erode and destroy tooth structure due to the acid that is produced every time food is consumed. Ozone is toxic to certain bacteria, so the theory goes that injecting ozone into a carious lesion might reduce the number of cariogenic bacteria.

Ozone (O3) is formed from oxygen (O2) splitting into two oxygen molecules (O1) under various conditions, including an electrical discharge like a lightning strike. Then these single molecules collide with O2 oxygen to form ozone. If you have ever noticed a different scent in the air after a lightning storm, it is likely that you are smelling the higher concentration of ozone. In fact, the word ozone is derived from the Greek word “ozein,” which means “to smell.”

Ozone can exist in gas, liquid or solid form, and has long been used in industrial and medical applications. The extra oxygen molecule on ozone is loosely bound, excited and readily available to jump off, attach to, and oxidize other molecules. This oxidation process can destroy a variety of microorganisms. Ozone-based sterilizers are often used for some instrument and equipment sterilizing applications in hospitals. Ozone is also used by some municipal water systems to kill bacteria in the water.

Proponents argue that dentists can use ozone to start a process that removes bacterial waste products, halts dental cavities and begins a process of repair through accelerated remineralization of damaged teeth. According to them, bacteria, viruses and fungi lack antioxidant enzymes in their cell membranes, so those harmful antibodies are destroyed when ozone ruptures their cell membrane. Healthy cells, on the other hand, are unaffected by therapeutic levels of ozone because they have antioxidant enzymes in their cell membranes.1 Those in the dental community in favor of ozone therapy say dentists are utilizing it for periodontal therapy, root canal treatment, tooth sensitivity, canker sores, cold sores and bone infections, among other things.1

It’s an interesting idea and a pretty straightforward concept. Any treatment that not only saves or protects a tooth from decay but avoid the use of needles and anesthetic would be a welcome addition to a dentist’s treatment options. Unfortunately, despite some promising evidence of effectiveness against decay-causing bacteria in laboratory studies, the current evidence base for ozone therapy in dentistry is insufficient to conclude that it is an effective or cost-effective addition to the management and treatment of caries. At this time, the U.S. Food and Drug Administration (FDA), which assesses new drugs and medical devices for safety and efficacy and regulates their use and marketing in the U.S., has not cleared any ozone-generating devices for use in dentistry.

Ultimately, not enough is known as this time and some high quality clinical trials research is necessary. Biased research and inconsistent outcome measures have made researchers unable to confidently conclude that the application of ozone gas to the surface of decayed teeth halts or reverses the decay process. Therefore, at this time, ozone therapy for treatment the prevention and control of tooth decay is not considered a viable alternative to current treatment methods in the world of evidence-based dentistry.2

1 American College of Integrated Medicine and Dentistry. http://www.ozonefordentistry.com/DentalO.html Accessed July 10.

2 National Center for Biotechnology Information. Ozone Therapy for the Treatment of Dental Caries. http://www.ncbi.nlm.nih.gov/pubmed/15266519 Accessed July 10.

3 Rickard GD, Richardson RJ, Johnson TM, McColl DC, Hooper L . Ozone therapy for the treatment of dental caries.  Cochrane review.   2008 http://summaries.cochrane.org/CD004153/ozone-therapy-for-the-treatment-of-dental-caries#sthash.qfFibqsE.dpuf

Image courtesy of webelements.com

Don’t Bottle Up the Oral Health Benefits of Fluoridated Water

Nearly 60 percent  of caregivers say they are more likely to give children bottled water than tap water, potentially depriving kids of fluoride that is critical to good oral health. In addition, according to the 2013 Delta Dental Children’s Oral Health Survey,1 more than twice as many caregivers say bottled water is better for children’s oral health than tap water – an opinion at odds with evidence-based dentistry and more than six decades of public health experience.

Fluoride actually helps to repair (remineralize) tooth surfaces that are damaged by the acid produced by certain bacteria in the mouth, which prevents cavities from continuing to form.2 Since U.S. cities began adding fluoride to water supplies more than 65 years ago, tooth decay has decreased dramatically.3 This result led the Centers for Disease Control and Prevention (CDC) to name water fluoridation “one of the 10 great public health achievements of the 20th century.”4

Unfortunately, only 17 percent of parents believe that tap water is better for their children’s oral health than bottled water.1 Some bottled waters do contain fluoride but usually not in the optimal amount.5  Fluoride in the water provides decay-preventive benefits for the teeth of both children and adults, which makes it the most cost-effective way for communities to improve overall oral health.

The key to fluoride’s protective benefit is by having a little fluoride on your teeth throughout the day. Brushing teeth with a fluoride toothpaste at least twice a day, drinking fluoridated water and limiting frequent between-meal snacking on sugary or starchy foods will help keep most children and adults tooth decay-free.

If children don’t drink fluoridated water, Delta Dental offers these ways to get more fluoride into their diet:

  • Fluoridated toothpastes, mouth rinses and/or professionally-applied gels or varnishes. These products can help strengthen teeth by hardening the outer enamel surface. With toothpaste and rinses children tend to swallow much of what they put in their mouth. So fluoride toothpaste use should start about age 2 and fluoride rinses probably not until about ages 6 or 7.
  • Dietary fluoride supplements, such as tablets, drops or lozenges, which are typically available only by prescription and are intended for children typically older than 6 months living in areas without fluoridated water in their community.
  • Bottled water that states on the label that it contains the right amount of fluoride.

As with other vitamins and minerals, it’s important to get enough, but not too much. When young children whose teeth are still developing under their gums (up to about age 9) get too much fluoride, their teeth may erupt with faint white lines or patches called dental fluorosis. The CDC has reported an increase in dental fluorosis over the past couple of decades. Inappropriate swallowing of toothpaste and children living in fluoridated areas that also receive fluoride supplements are believed to play a major role in this increase.

For advice on the proper amount of fluoride specifically recommended for your child, consult with your dentist. The recommendation will depend on your child’s age, how much fluoride naturally occurs in your local water and your child’s risk for tooth decay.

How Does Your Smile Score?

In the past, almost everyone developed tooth decay, and as people aged, tooth loss from decay and gum disease was routine. Today, thanks to scientific advances and preventive therapies like community water fluoridation, fluoride toothpaste and dental sealants, there has been dramatic and continuing improvement in the oral health of Americans. Many people still suffer from oral disease problems, however, and risk for oral disease varies among all people.

The good news is that if you know your specific risk factors for tooth decay, gum disease and oral cancer, you can take simple preventive action to avoid these problems. That’s why Delta Dental, the nation’s largest dental benefits company, is helping people assess their risk for diseases and take steps to prevent or treat them.

Through a partnership with a leading risk and disease analytic software designer, PreViser Corp., Delta Dental has launched myDentalScore, a risk assessment tool that provides leading edge technology to evaluate your oral health. By taking just a few minutes to answer some simple questions online, you will receive an easy to understand oral health scores report that estimates your risk of tooth decay, gum disease and oral cancer. Once you have your score in hand, you can use myDentalScore to get valuable oral health advice and print out your report to bring to your next dental examination.

myDentalScore

Click on the above photo to visit mydentalscore.com/deltadental and access our quick, user-friendly survey. The survey asks a series of questions about your personal habits, past history of dental disease and treatment, and current symptoms of oral disease to assess your risk level for tooth decay, gum disease and oral cancer. After taking the risk assessment survey, you’ll receive a risk score for each problem area. You can bring this report to your dentist to verify your risk levels and, if needed, develop strategies to lower your risk for oral disease and improve your oral health. No personal health information (PHI) is ever revealed, and the survey can be taken anonymously. You can also visit oralhealth.deltadental.com for more oral health information. Find out your smile scores today, and take steps to protect it for a lifetime!

Traits of Toothpaste

Toothpaste – it has been the foundation of the most basic of daily oral health routines dating back to ancient civilizations. But, how many people today actually know what makes up the concoction that we dab on our toothbrushes and scrub all over our teeth every morning and night? You’ll be happy to know that we’ve come a long way since the use of crushed bones and oyster shells, ashes, burnt eggshells and powder of ox hoof.

Toothpastes, also called dentifrices, are pastes, gels or powders that help remove plaque and strengthen tooth enamel. So, what are all of those substances listed on the side of the tube? The paste or gel itself takes its form from abrasives, water, humectants and binders. Other ingredients like detergents or surfactants; preservatives; flavor, color, and sweetening agents; fluoride; calcium phosphate; anti-bacterials; whiteners; and other agents may be added to provide certain properties to each specific toothpaste forumulation. All of these ingredients can be important for not only helping to prevent dental disease but also for giving the toothpaste the taste, appearance and feel in the mouth that makes a person want to brush with it.

Let’s take a closer look at some of the most common ingredients you will find in your toothpaste and why they are there.

Fluoride is the key active ingredient in toothpaste that has been demonstrated in numerous clinical trials to prevent tooth decay. Fluoride affects the bacteria that cause tooth decay, but its primary action is to incorporate into the tooth structure (enamel and dentin) making the tooth more resistant to acid attack by decay-causing bacteria. It actually repairs (remineralizes) the tooth enamel that gets damaged by the acid producing bacteria present in almost everyone’s mouth. Without fluoride in the toothpaste, the cavity-preventing benefit from brushing your teeth is severely limited. Very few people brush thoroughly enough to prevent cavities by brushing alone. Over-the-counter (OTC) toothpaste in the U.S. contains fluoride at approximately 1,100 parts-per-million (ppm). There are several different fluoride formulations and all are effective in helping to prevent tooth decay. Other remineralizing agents such as amorphous calcium phosphate have demonstrated some decay prevention ability and are now being added to some toothpastes.

Mild abrasives remove food debris and stains, as well as the sticky plaque that is always forming on the teeth. The goal is to make them abrasive enough for efficient cleaning, but not so abrasive as to damage the tooth enamel or the softer dentin or cementum that makes up the tooth root surface. Common abrasives you may see on your tube include calcium carbonate, sodium bicarbonate (baking soda), dehydrated silica gels, hydrated aluminum oxides, magnesium carbonate, phosphate salts and silicates.1

Humectants are organic compounds that hold water and help the toothpaste maintain its moisture even when exposed to air. Examples include glycerol, propylene, glycol and sorbitol.1

Binders or thickeners help keep the whole mix together in a nice paste or gel and stabilize this form. They provide the texture and flow to get the toothpaste onto the brush and keep it there. These include natural xanthum gums, seaweed colloids (carrageenan) and synthetic cellulose.1

Flavor, color and sweetening agents make brushing enjoyable by providing visual appeal, pleasing taste and fresher breath. Specific ingredients vary, but common flavorings include spearmint and peppermint, though nowadays there seems to be toothpaste available in flavors for every taste including strawberry, bubblegum, vanilla, green tea, fennel and bacon – even scotch and bourbon. For a sweet taste, artificial sweeteners like saccharin or natural sweeteners like xylitol are added since they do not promote tooth decay.

Antibacterial agents are added to reduce plaque growth, the sticky bacterial-laden film that forms constantly on the teeth and can eventually cause tooth decay and/or gingivitis and more serious gum diseases if not brushed away regularly. Some anti-plaque agents include triclosan and cetylpyridinum chloride.

Detergents in toothpaste create foaming action that helps the toothpaste coat the teeth. The foam helps reduce surface tension on the tooth, and makes cleaning easier and food particles or debris less likely to reattach to the tooth before it can be spit out. They include sodium lauryl (dodecyl) sulfate (SLS) and sodium N-Lauryl sarcosinate. 1 Some toothpaste users have been reported to develop canker sores as a result of an allergic reaction to SLS, but SLS-free toothpastes are available.

Preservatives prevent the growth of microbes in the toothpaste. Methyl paraben and sodium benzoate are also commonly found in food and beverage products.

Whiteners, desensitizers and tartar preventers Other agents appear in toothpastes that make specific claims for whitening (carbamide peroxide or hydrogen peroxide); desensitizing sensitive root surfaces (potassium nitrate, arginine bicarbonate/calcium carbonate complex); and preventing tartar/calculus buildup (tetrapotassium pyrophosphate/tetra and disodium pyrophosphates, sodium hexametaphosphate). Even though some whitening toothpastes contain similar chemicals to those used in dental office bleaching, these toothpaste products work primarily by removing surface stains and don’t typically change the basic tooth shade like bleaching strips or bleaching treatments at a dental office.

For best tooth decay prevention, we recommend brushing with fluoride toothpaste at least twice a day. So, when is the best time to become one with your favorite toothpaste? Preferably right before bed and in the morning, but soon after meals is also very effective.

1 American Dental Association. Toothpaste. http://www.ada.org/1322.aspx Accessed January 2013.

The Tooth Fairy Loosened Her Purse Strings in 2012

How much are kids getting for lost baby teeth these days? The average gift from the Tooth Fairy was $2.42 last year, up 32 cents from $2.10 in 2011, according to The Original Tooth Fairy Poll® sponsored by Delta Dental.1 The most common amount left under the pillow was $1 (51 percent).

According to the poll, the Tooth Fairy was even more generous with kids who lost their first tooth, leaving more money for the first tooth in 46 percent of homes. On average, the amount given for the first tooth was $3.49.

Leaving gifts from the Tooth Fairy is a great way to help make losing teeth less scary and enjoyable for kids. Delta Dental encourages parents to use the Tooth Fairy as an opportunity to talk about good oral health even before a child loses the first tooth. Caring for baby teeth is important, as they help children chew and speak properly and hold space for permanent teeth.

In 2012, the Tooth Fairy visited nearly 90 percent of U.S. homes with children who lost a tooth. Delta Dental suggests the following ways parents can use the Tooth Fairy as a teachable moment:

• Introduce the Tooth Fairy early on. Kids will start losing baby teeth around age 6. Before this age, parents can teach kids about the Tooth Fairy and let them know that good oral health habits and healthy teeth make her happy. Use this as an opportunity to brush up on a child’s everyday dental routine. Kids not wanting to brush and floss? Remind them the Tooth Fairy is more generous for healthy baby teeth, not teeth with cavities. This will help get kids excited about taking care of their teeth.

• Leave a note reinforcing good habits. A personalized note from the Tooth Fairy could be nearly as exciting for kids as the gift itself. Parents should include tips for important oral health habits that the Tooth Fairy wants kids to practice, such as brushing twice a day, flossing once a day and visiting the dentist twice a year. And, of course, parents should give the Tooth Fairy a special name. After all, Flossie or Twinkle is a bit more exciting than just Tooth Fairy!

• Give oral health gifts. Although the Tooth Fairy left cash for kids in 98 percent of homes she visited, two percent of children received toys, candy, gum or other gifts. Consider forgoing cash and providing oral health gifts instead, like a new toothbrush or fun-flavored toothpaste. For readers, there are numerous children’s books about Tooth Fairy adventures in bookstores or online. The days of jamming a tiny tooth underneath a huge pillow and making the Tooth Fairy blindly grope around under a heavy sleeping head are gone. Special pillows with tiny, tooth-sized pockets attached are now available online, with themes ranging from princesses to ninjas and beyond. Some of the pillows can even be customized with your little gap-toothed child’s name. Or if a parent, er, ahem, the Tooth Fairy, is feeling generous, kids could receive both cash and a new toothbrush.

For more information, visit http://www.theoriginaltoothfairypoll.com. To get a sense of the taste and style choices of the Tooth Fairy and for some fun ideas, parents can follow her on Pinterest at http://www.pinterest.com/origtoothfairy.

New Survey: Kids Need Brushing up on Oral Health

Although cavities are nearly 100 percent preventable, more than one out of four American caregivers reported that their children had a cavity filled in the past year. This was among the findings of a new survey1 of nearly 1,000 caregivers released today by Delta Dental in conjunction with National Children’s Dental Health Month. Among children who had a cavity in the past year, 53 percent had two or more cavities.

The 2013 Delta Dental Children’s Oral Health Survey shows that not only are Americans unaware they can pass cavity-causing bacteria to children, but they also need to brush up on some critical children’s dental health habits, including basics such as brushing and flossing.

Parents and caregivers need to teach good oral health habits to children at a young age to help prevent cavities. Baby teeth are very important. They help children chew and speak properly and hold space for permanent teeth. If a child has healthy baby teeth, chances are he or she will have healthy adult teeth.

These are some of the oral health habits that fall short of what’s recommended by dental professionals:

• Survey shows: Seventy-five percent of caregivers say they share utensils such as a spoon, fork, or glass with a child.
• Delta Dental recommends: Parents and caregivers should eliminate saliva-transferring behaviors – such as sharing utensils and toothbrushes and cleaning a pacifier with their mouths – all activities which can pass harmful bacterial to a child.

• Survey shows: Forty-nine percent of Americans with a child four 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.
• Delta Dental recommends: Parents and caregivers should not put a child to bed with a bottle of milk, juice, sweetened water or soft drinks, which can lead to baby bottle decay. Instead, caregivers should fill the bottle with water.

• Survey shows: For children who have visited the dentist, the average age at the first visit was 3 years old.
• Delta Dental recommends: Children should first visit the dentist within six months of getting the first tooth – and no later than the first birthday.

• Survey shows: Only 58 percent of children had their teeth brushed twice a day and 34 percent of children brush for less than two minutes.
• Delta Dental recommends: Children’s teeth should be brushed twice a day for at least two minutes each time. Parents should assist with this task until the kids are about 6 years old.

• Survey shows: Forty-three percent of parents or caregivers report that their children’s teeth are never flossed, and of children whose teeth are flossed, only 23 percent are flossed daily.
• Delta Dental recommends: Once any two teeth are touching, caregivers should floss, or help the child floss, once a day.

1 Morpace Inc. conducted the 2013 Delta Dental Children’s Oral Health Survey. Interviews were conducted nationally via the Internet with 926 primary caregivers of children from birth to age 11. For results based on the total sample of national adults, the margin of error is ±3.2 percentage points at a 95 percent confidence level.

Vote for Good Oral Hygiene

My fellow citizens: If you are like most Americans, a toothbrush, a tube of toothpaste and a spool of dental floss are long-standing incumbents in your bathroom cabinet.

During Dental Hygiene Month, another candidate, mouthrinse (also known as mouthwash), is vying for a spot beside the aforementioned daily use products. Should you welcome it to this exclusive club?

For its part, mouthrinse has long campaigned on a cosmetic platform of simply reducing or eliminating bad breath and making your mouth feel fresh. The cosmetic mouthrinse caucus has a large and loyal following. People who use it like that it eliminates bad breath, morning mouth and pesky food particles when used after meals, and that it promises to meld easily into your morning or evening routine. These are noble ideals.

More recently, a new ideology, therapeutic mouthrinse, has tried to distance itself from the cosmetic party line. Therapeutic mouthrinse has on its slate active ingredients like fluoride to fight cavities, and anti-microbial agents (such as hydrogen peroxide) to combat plaque, gingivitis and other gum diseases.

Every candidate has its critics, however, and mouthrinse is no different. Some point out that cosmetic mouthwash has too limited an agenda, that it just masks bad breath but doesn’t reduce cavities, gingivitis or plaque. Others have questioned the harmful effects of some mouthrinse products’ high concentration of alcohol content (ranging anywhere from 6.6 percent to 26.9 percent). A small but vocal contingent believes that factor could be a risk for oral cancer, but so far the overall evidence does not support that conclusion.

These criticisms have led mouthwash to position itself as a dental hygiene populist product that can appeal to all people, introducing non-alcoholic varieties to please even the harshest critics. It has also rolled out exciting new flavors (like cinnamon, bubblegum and orange) to appeal to a block of voters who want fresh breath but desire more than just the taste of mint.

“Mouthrinses are not a substitute for brushing or flossing but they might be a useful addition to your daily oral hygiene routine,” said Dr. Bill Kohn, DDS, a mouthrinse campaign expert and Delta Dental’s vice president for dental science and policy. “At a minimum, most mouthrinses will at least provide temporary relief from bad breath. Check with your dentist if you have persistent bad breath or to see if you would benefit from a mouthrinse that has fluoride or anti-bacterial agents to protect against cavities or periodontal diseases.”

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.