How Many Dental X-Rays Do Your Kids Need?

Young Teen at DentistFebruary is National Children’s Dental Health Month, the perfect time to take your kids to the dentist for one of their regular visits. But before you do, Delta Dental encourages you to be well-informed about how often your child should have dental X-rays.

The purpose of X-rays is to allow dentists to see signs of disease or potential problems that are not visible to the naked eye. They are should be suggested after the dentist has done a clinical exam and considered any signs and symptoms, oral and medical history, diet, hygiene, fluoride use and other factors that might suggest a higher risk of hidden dental disease.

However, all X-rays use ionizing radiation that can potentially cause damage. Though it is spread out in tiny doses, the effect of radiation from years of X-rays is cumulative. The risks associated with this radiation are greater for children than for adults. So be sure that your dentist checks your child’s teeth, health history and risk factors before deciding an X-ray is necessary.

“X-rays are an important tool for dentists to diagnose dental diseases. However, they do not need to be part of every exam,” said Dr. Bill Kohn, DDS, Delta Dental Plans Association’s vice president of dental science and policy. “They should be ordered only after the dentist has examined the mouth and has determined that X-rays are needed to make a proper diagnosis. In general, children and adults at low risk for tooth decay and gum disease need X-rays less frequently.”

Ideally, your dentist should adhere to the guidelines established by the U.S. Food and Drug Administration and the American Dental Association. The following chart, adapted from those guidelines, gives a basic timeline for recommended frequency of X-rays by age group. Keep in mind that multiple factors such as the child’s current oral health, future risk for disease, and developmental stage determine need, and some children will require more X-rays, and some fewer.

Ages

First visit

Routine recall visit

Routine recall visit

Active tooth decay or   history of cavities (Increased Risk)

No active tooth decay   or history of cavities (Low Risk)

Young children(ages 1 – 5),   with no permanent teeth Personalized exam which may consist of bitewing X-rays of back teeth (if no gaps exist between teeth that allow the dentist to examine the sides of teeth) and select individual X-rays, usually of front teeth. Bitewing X-rays every six to 12 months Bitewing X-rays every 12 to 24 months
Older children (ages 6 – 12), with some or all permanent teeth Personalized exam consisting of bitewing X-rays of back teeth and select individual X-rays, usually of front teeth; or a panoramic X-ray. Bitewing X-rays every six to 18 months Bitewing X-rays every 12 to 36 months
Adolescent, with permanent teeth but no wisdom teeth Personalized exam consisting of   bitewing X-rays of back teeth and select individual X-rays; or a panoramic X-ray; or a full mouth survey of X-rays if evidence of widespread oral disease. Bitewing X-rays every six to 18 months Bitewing X-rays every 12 to 36 months

Many people believe that if their dental plan pays for a certain number of X-rays, they should take advantage of that benefit. For most patients, however, this yearly X-ray exposure is excessive and unnecessary. Don’t let your insurance coverage dictate your decision. If you have questions or concerns related to dental X-rays, discuss them with your dentist.

 

Source: http://www.fda.gov/downloads/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/ MedicalImaging/MedicalX-Rays/UCM329746.pdf  (Accessed February 11, 2014).

Certain Kids Could Benefit From More Fluoride

Fluoride is a mineral that helps teeth become more resistant to decay (cavities). You can help prevent your child from getting cavities by making sure they drink fluoridated water and brush at least twice daily with fluoride toothpaste. For many children, this daily fluoride exposure is enough to protect them for a lifetime.

But, has your child had a cavity in the past three years? If you answered yes, he or she is likely at higher-risk for tooth decay in the future. If your child is at higher risk for future tooth decay, you should also talk to your dentist about prescription-strength fluoride that can be applied in their office two or more times per year. Unfortunately, many higher-risk children are not receiving this protective treatment.

Although 2.5 million of the children Delta Dental covers are considered to be at higher-risk for cavities, 70 percent of them did not receive the recommended two or more fluoride treatments per year.1 The great news is that many of Delta Dental’s benefits plans cover preventive care, like two fluoride treatments per year, at 100 percent.

Take a look at your plan and make sure you are using preventive treatments to their full advantage – most are simple, painless and inexpensive. They can save your child from future pain and discomfort that often accompany tooth decay, and save you from paying for expensive fillings, crowns, or root canals. Delta Dental knows that you are doing your best to keep your family healthy, and that’s why we want to help you assess your child’s risk for oral disease and give you the information you need to help take steps to prevent or treat them. Delta

Dental’s myDentalScore risk assessment tool provides you with leading edge technology to evaluate your family’s oral health. By taking just three minutes to answer a few simple questions, you will receive an easy to understand oral health scores report that tells you exactly where your child stands for risk of oral diseases. Once you have the report, consult with your dentist to determine the best treatment patterns for your child’s oral health needs.

For answers to all of your oral health questions and to access the myDentalScore risk assessment tool, visit Delta Dental’s oral health education website at oralhealth.deltadental.com.1

1The Preventive Dental Care Study is a landmark claims study of Delta Dental’s more than 90 million dental claims that investigated whether higher-risk children and adults were receiving the preventive care they needed. For more information on the study, visit deltadental.com/pdcstudy.

Kids Need to Brush Longer and More Often

Poor and infrequent brushing may be major obstacles keeping children from having excellent oral health and are the areas that cause caregivers the greatest concern.

A survey1 of American children’s oral health found that while nearly two out of five Americans (37 percent) report that their child’s overall oral health is excellent, more than a third of the survey respondents (35 percent) admit their child brushes his or her teeth less than twice a day. Parents and caregivers recognize the frequency as “not enough,” despite the fact that nearly all of those surveyed (96 percent) with children up to age 6 say they supervise or assist with brushing.

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 two minutes, which is the amount of time dentists typically recommend spending on each brushing.

Getting children to brush regularly, and correctly, can be a real challenge. Here are some easy ideas to encourage brushing:

  • 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 remember, do not 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.
  • Take turns: Set a timer and have the child brush his or her teeth for 30 seconds. Then you brush their teeth for 30 seconds. Repeat this at least twice.
  • 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.


Don’t Let Meds Desert Older Adults

Novelist C. S. Lewis once wrote, “How incessant and great are the ills with which a prolonged old age is replete.” Indeed, the Centers for Disease Control and Prevention (CDC) reports that about four out of every five older adults suffer from a chronic condition, and half have at least two.1

Often, those chronic conditions are treated with a variety of prescription medications. During National Healthy Aging Month, Delta Dental, the nation’s largest dental benefits provider, cautions older adults to guard against a dangerous side effect of more than 400 prescribed and over-the-counter medications – dry mouth.2

As it is medically defined, dry mouth is the result of a reduction of salivary output or quality. But dry mouth is more than just irritating and mildly uncomfortable; it can also increase the risk of tooth decay, gum disease and other oral infections. Many medications that treat chronic illnesses – such as hay fever, heart disease, Parkinson’s disease, high blood pressure (hypertension) and depression – are known to have dry mouth as a side effect.3

The New York Times recently attributed the dry mouth that results from many prescription medications as a major contributor to the rapidly deteriorating oral health of nursing home residents.4 The American Dental Association (ADA) has even advocated for warning-label information on these types of “xerogenic” medications to promote awareness of the potential oral health complications associated with drug-induced dry mouth.3 According to the ADA, chronic dry mouth is a common adverse effect for each of the following medication groups:3

  • Cardiovascular medications (such as diuretics or calcium channel blockers)
  • Anticholinergic agents for treatment of urinary incontinence (e.g., oxybutynin and tolterodine)
  • Tricyclic antidepressants (e.g., amitriptyline)
  • Anti-psychotic agents (e.g., chlorpromazine)
  • Anti-Parkinson’s medications (e.g., benzatropine)
  • Anti-allergy medications (e.g., antihistamines)

If your mouth becomes dry after taking a medication, you may want to mention it to your physician. Sometimes, an equally effective substitute medication can be prescribed that does not have the same side effect. To help you maintain good oral health and stimulate saliva, your dentist might suggest sipping water or sucking on ice chips frequently, avoiding alcohol, caffeine and tobacco products, chewing sugar-free gum or sucking on sugar-free candies.

1 Centers for Disease Control and Prevention. Healthy Aging at a Glance (2011). Centers for Disease Control and Prevention.  http://www.cdc.gov/chronicdisease/resources/publications/AAG/aging.htm

 2 U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

3 Warning Label Information on Medications Associated with Xerostomia (Dry Mouth). American Dental Association. http://www.ada.org/sections/newsAndEvents/pdfs/ltr_dry_mouth_110427.pdf

4 Nursing Homes’ Dental Problems. New York Times. http://www.nytimes.com/video/2013/08/05/health/100000002374631/nursing-homes-dental-problems.html?smid=tw-share

“Dry Mouth.” National Institute on Aging, National Institute of Dental and Craniofacial Research, National Institutes of Health, March 20, 2010. http://www.nidcr.nih.gov/OralHealth/Topics/DryMouth Accessed 2010.

Are Two Annual Dental Visits One Too Many – or Not Enough?

For decades, conventional wisdom held that certain dental procedures were best practices and were right for all people. You brushed your teeth after every meal (or at least morning and night) flossed daily, and visited the dentist twice a year. At each visit, you got an exam, X-rays and a cleaning. If you were a child, you could add on a fluoride treatment and perhaps sealants on your molar teeth.

However, thanks to advances in molecular medicine, genetics and other areas of research, health care in general (including oral health care) is being transformed from a system of treating disease in a one-size-fits-all manner to one that provides predictive, proactive, preventive and personalized care. Oral health care advances also allows for a more customized and tailored approach to each person’s individual situation.

Sure, basic prevention activities like brushing with fluoride toothpaste, flossing and drinking fluoridated water regularly is important for all. Based on risk factors, however, some people are considered at higher risk and some at lower risk for developing oral diseases like tooth decay, periodontal (gum) disease or oral cancer. Your risk for disease may help you determine what level of more costly professional services may be most beneficial. People with a history of good oral health, good dietary and oral hygiene habits, and no genetic red flags may need to only visit the dentist once a year or less. Conversely, those with a history of disease and other risk factors may need two or more routine visits each year.

A recent study published in the Journal of Dental Research looked at individual’s risk for periodontal disease and concluded that for low-risk individuals, “the association between preventive dental visits (dental cleaning) and tooth loss was not significantly different whether the frequency was once or twice annually.”1 It went on to recommend evaluating genetic tendencies for gum disease with conventional risk factors (smoking and diabetes) when assessing how often a patient needs to visit the dentist.1 While this study looked specifically at gum disease risk, risk factors are also established for other oral problems such as tooth decay and oral cancer.

In response to the JDR study, the American Dental Association released a statement to “remind consumers that the frequency of their regular dental visits should be tailored by their dentists to accommodate for their current oral health status and health history.” 2

For those who are unaware of their personal risk factors, Delta Dental provides an online tool (myDentalScore) that can help you self-assess your level of risk for gum disease, tooth decay and oral cancer. This self-assessment will provide you with valuable information to help you have a good discussion with your dentist about the best mix of self-care and professional care for you as an individual.

Ultimately, Delta Dental encourages consumers to honestly evaluate themselves and seek the kind of dental care that will be most beneficial to their oral health.

Patient Stratification for Preventive Care in Dentistry.  http://jdr.sagepub.com/content/early/2013/06/05/0022034513492336.abstract

2 American Dental Association. American Dental Association Statement on Dental Visits.  http://www.ada.org/8700.aspx

How to Handle Tooth Trauma

As children head back to school, it is important to remember that dental emergencies can happen any time, any place. According to the 2013 Delta Dental Children’s Oral Health Survey,1 one out of 10 children ages 10 or 11 have had a tooth emergency such as a knocked-out tooth, chipped tooth or a loosened permanent tooth at home or at school.

A knocked-out permanent tooth is a true dental emergency, and there’s a good chance it can be saved if you know what to do and act quickly. The primary concern should be getting the child in to see a dentist. Time is crucial if you want the dentist to be able to reinsert and salvage the natural tooth. Ideally, a child needs to be seen within 30 minutes of the accident.1

Whether a tooth is knocked out at school or home, here are several steps to ensure it is saved – or at least in optimal condition – by the time the child can see the dentist.

  • First, check to make sure the child doesn’t have a serious head, neck or other orofacial injury (i.e., a concussion, broken jaw, etc.).
  • Don’t worry about replacing a displaced baby tooth. Trying to reinsert it could damage the permanent pearly white coming in behind it.
  • To avoid infection, the tooth should be held by the crown, not the root. The crown is the part of the tooth visible to the naked eye. You want to leave the root intact, and touching it with bare hands could pass bacteria.2
  • Rinse any debris off of the tooth under room temperature water. Don’t scrub the root! Once the tooth is free of loose dirt and debris, try to reinsert it, asking the child to hold it in place using a piece of gauze if necessary. 3
  • If the tooth cannot be successfully reinserted, it needs to stay moist until the child can visit a dentist. Store the tooth in a clean container and cover it with milk or room temperature water to prevent it from drying out. 4 These liquids aren’t ideal but are often the only ones readily available. If you are a school nurse or your child frequently plays contact sports, purchase an emergency bag  handy with a save-a-tooth kit in it (available at most drugstores.) These contain a solution that is better at preserving any live cells on the tooth root until the dentist can put the tooth back into the socket.

In most cases, tooth injuries are not life threatening. But they can have long-lasting effects on the child’s appearance and self-confidence, so it is important to act quickly in the event of a dental emergency.

1Morpace 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 error is ±3.2 percentage points at a 95 percent confidence level.

2“Saving a Knocked-Out Tooth.” American Association of Endodontists. http://www.aae.org/patients/patientinfo/references/avulsed.htm. Accessed 2010.

3 “Medical Encyclopedia: Broken or Knocked Out Tooth.” U.S. National Library of Medicine and the National Institutes of Health, February 22, 2010. www.nlm.nih.gov/medlineplus/ency/article/000058.htm. Accessed 2010.

4“Dental Emergencies.” American Dental Association. http://www.ada.org/370.aspx Accessed 2010.

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

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