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.


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.

Delta Dental’s Top 5 Oral Health Resolutions for 2013

With a new calendar year on the horizon, many people are engaging in that time-honored American tradition of making resolutions, vowing to improve certain aspects of their lives.

For individuals who aspire to better their oral health in 2013, Delta Dental offers the following suggestions to help make these resolutions work.

• Brush/floss regularly: The uncomplicated daily one-two punch of brushing twice a day with fluoride toothpaste and flossing once is still the foundation for maintaining healthy teeth and gums. The sooner you can brush following a meal, the better. The longer food stays stuck to your teeth, the more acid is produced that erodes tooth enamel.

• Visit a dentist in 2013: Don’t delay making an appointment for a check-up. Dentists do more than just check and clean teeth. They can also check for signs of serious oral health problems like oral cancer and gum disease, answer questions and provide advice for adults and children and alert patients to signs of potential medical conditions.

• Avoid tobacco products: According to the Centers for Disease Control and Prevention (CDC), half of the cases of severe gum disease in U.S. adults can be attributed to cigarette smoking, and the prevalence of gum disease is three times higher among smokers than non-smokers.1 Consuming products like cigarettes, cigars and smokeless tobacco is arguably the single most destructive oral health habit.

• Eat sweets in moderation: It was ancient Greek philosopher Aristotle who advised, “Moderation in all things” and that axiom rings especially true for sweet snacks. Tooth decay occurs when candy, cookies, sodas and other sweets, or simple carbohydrates like those in chips or crackers mix with bacteria in the sticky plaque that constantly forms on teeth to produce acid, which can destroy tooth enamel. Whenever possible, stick to having sweets with dinner and brush afterward if possible. Limit sugary snacks because the more times during the day that your teeth are exposed, the longer the acids attack.

• Wear a mouthguard during contact sports: It’s not just kids who play contact sports these days. Millions of adults participate in competitive sports leagues in which there can be significant risk of contact. Though there is insufficient evidence to suggest mouthguards prevent concussions, they do absorb and distribute the forces that impact the mouth, teeth, face and jaw when an athlete takes a shot to the face. Wearing a mouthguard can prevent chipped, fractured, displaced or dislodged teeth, fractured or displaced jaws, TMJ trauma, and lacerations to the lips and mouth that result from the edges of the teeth.

1 Preventing Cavities, Gum Disease, Tooth Loss, and Oral Cancer – 2011 At a Glance. http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm. Accessed 2012.

Don’t Beware the Dentist’s Chair

The U.S. Centers for Disease Control and Prevention (CDC) estimates that 26 million Americans suffer from diabetes. Even more troubling, another 57 million – about a fourth of U.S. adults – have pre-diabetes, which means their blood sugar levels are higher than normal, but not yet high enough to be classified as diabetes. Delta Dental is reminding Americans during “National Diabetes Month” that regular dental visits are crucial for people with diabetes.

According to the American Diabetes Association, controlling blood sugar levels is a key to preventing many serious complications of diabetes such as heart disease, kidney disease and stroke. Research also suggests a two-way relationship between serious periodontal (gum) disease and diabetes. Not only are people with diabetes more susceptible to severe gum disease, but it may have the potential to affect blood glucose control and contribute to the progression of diabetes.1 People with diabetes tend to develop periodontal disease earlier in life, and more severely. Instead of losing their teeth from gum disease in their 60s, they might begin losing teeth in their mid-40s. Smokers with diabetes are especially at-risk for gum disease and tooth loss.

Unfortunately, studies have found that people with diabetes see their dentist less often than those without the disease.2 Dentist visits are crucial because oral diseases such as tooth decay and gum disease are often reversible if they are diagnosed early and preventive treatments are delivered. Dentists will also check for other common mouth conditions that afflict people with diabetes such as dry mouth, ulcers and infections. Mouth conditions may also be a sign that other medical conditions exist elsewhere in the body. Depending on their findings, the dentist might advise patients to seek medical attention.

Daily brushing and flossing, regular dental check-ups and good blood glucose control are the best defenses against periodontal disease. In addition, quitting smoking may be the most important thing that people can do to protect their oral and overall health. The good news is that with proper dental hygiene at home and regular visits to the dentist (at least twice annually), there’s no reason people with diabetes should have worse oral health than people without.

1 American Diabetes Association. News and Research. http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/oral-health-faqs.html Accessed October 2012.

2 Macek MD, Tomar SL. Dental care visits among dentate adults with diabetes and periodontitis. J Public Health Dent. 2009 Fall;69(4):284-9.

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.”

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.