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.

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.

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.

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.”

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.

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.