Diabetes can cause gum disease and tooth decay

Though it's commonly known that diabetes can affect organ function and eyesight, an oral-health expert points out that the disease can also cause tooth decay and gum disease.

"Diabetics with uncontrolled glucose levels tend to develop more gum disease and may lose more teeth than diabetics who have good control of their glucose levels," writes Dr. John Novak, associate director of University of Kentucky's Center for Oral Health Research, in an op-ed piece for the Lexington Herald-Leader. A high carbohydrate/sugar diet can also lead to high levels of sugar in the blood, which can hamper the way the body deals with infection, he writes. Gum disease may be the result because the gums are inflamed by the increased levels of bacteria living in the mouth.

Diabetes can also cause dry mouth, which "creates the perfect environment for the growth of bacterial plaque and for fungal infections such as thrush," he writes. To avoid these problems, Novak recommends brushing teeth and gums twice a day with a fluoride toothpaste, flossing every day and using fluoride mouth wash before going to bed.

Signs of tooth decay or gum disease include tender gums that bleed easily when brushing or flossing; teeth sensitive to hot or cold temperatures; loose or broken teeth; sores, ulcers or a burning sensation in the mouth; and bad breath or a bad taste. (Read more)

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Like nurse practitioners in medical field, dental profession needs mid-level providers, expert argues

With 50 million Americans living in poor or rural areas where there are no dentists to go to — and that number expected to rise by more than 5 million if the Affordable Care Act stands — states and the federal government should be training dental therapists to help solve the problem, argues Louis W. Sullivan, a physician and former secretary of the Department of Health and Human Services, in an op-ed piece in The New York Times.

"We have two years to prepare before millions of children will be entitled to access to dental care," he writes of the impending eligibility expansion under the ACA. "Access means more than having an insurance card; it means having professionals available to provide care. Public officials should foster the creation of these mid-level providers — and dentists should embrace the opportunity to broaden the profession so they can expand services to those in need."

Dental therapists provide preventive care and "routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist's office," Sullivan writes. While they are "common worldwide," only Alaska and Minnesota allows them to practice. Legislation is pending in five other states. Generally, dentists have been opposed to such changes.

Sullivan points to Alaska as a model example for how these therapists can fill gaps in places like remote villages "only accessible by plane, snowmobile or dogsled, where high school seniors once graduated with full sets of dentures." In 2003, the state sent students to New Zealand to be trained as therapists. Now, therapists serve 35,000 Alaskans. They "travel to small clinics and schools, often carrying their equipment with them. They consult with a supervising dentist from the region but do most procedures themselves. Many were raised in the communities in which they now work, so they understand the culture," Sullivan writes.

Sullivan points out dental disease is the No. 1 chronic childhood disease in the country, responsible for more children needing treatment than asthma. In 2009, more than 830,000 visits to the emergency room were due to preventable dental problems across the nation, he points out. But dentists are in short supply and will be even harder to see if the ACA is upheld by the U.S. Supreme Court. "In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay," he writes. (Read more)

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Effort to boost oral health in nursing homes gets tangled up with industry's attempt to insulate itself from lawsuits; both bills die

A bill to get nursing-home residents better dental services "appears to be dead after the Senate added language from another bill designed to shield the nursing-home industry from litigation," Deborah Yetter reports for The Courier-Journal.

House Bill 510 would have created a pilot project for the state's two dental schools to create "a program to provide better oral-health services to nursing home residents," Yetter writes. "But on Wednesday, the Senate Health and Welfare Committee added language from another bill that had stalled in the House that would require people who want to file malpractice lawsuits against nursing homes to first submit the complaint to a 'medical review panel'." (Read more) 

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State starting free training for dentists in pediatric dentistry

One of the many problems with Kentucky's oral health is that not enough dentists are willing to accept children as patients, or lack proficiency in treating children when they are around age 1, the recommended time for a child's first dental visit.

Next week, the state Department of Public Health will start to offer free continuing education for dentists and other oral-health professionals who need or want training in pediatric dentistry, funded by a federal grant.

The Access for Babies and Children to Dentistry (ABCD) program will have one-day training sessions in Lexington on Friday, April 6, at the Embassy Suites on Newtown Pike next to the interstate, and in Somerset on Wednesday, April 11, at the Hampton Inn on US 27. Both sessions will start at 8:30 a.m. The sessions offer 8 continuing education units out of a possible 20 in the program.

For more information about the training, and to register for it, contact Meghan Towle at Meghan.Towle@ky.gov or 502-564-2154.

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More young kids going under anesthesia to fix bad dental problems

Preschoolers are increasingly having to undergo extensive surgery to get fix the cavities they've gotten from lack of brushing, get root canals or have teeth extracted.

Five years ago, the Centers for Disease Control and Prevention found the number of preschoolers with cavities had increased — the first time that had happened in 40 years. "Dentists nationwide say they are seeing more preschoolers at all income levels with 6 to 10 cavities or more," reports Catherine Saint Louis for The New York Times. "The level of decay, they added, is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake." (Times photo by Stuart Isett)

"We have had a huge increase in kids going to the operating room," said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Me., and a spokesman for the American Dental Association. "We're treating more kids more aggressively earlier."

Causes for the increase can be linked to lots of snacking and juice or other sugary drinks before bedtime; kids drinking bottled water rather than tap water; a lack of knowledge that infants should go to the dentist by age 1 to be assessed for cavity risk.

Parents can sometimes confused dental decay with teething and don't realize there is a problem until teeth break or the pain becomes so bad the child cannot sleep. (Read more)

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As with health care reform, dentistry should move from volume to value, report urges

Dentists should be paid according to the outcomes of their patients and should be monitored more closely given that there is great variability and expense when it comes to dental care, a new report argues.

"I think there is broad consensus that the current oral health system doesn't meet the needs of a significant portion of the population," said Paul Glassman, professor of dental practice at University of the Pacific Arthur A. Dugoni School of Dentistry and lead author of the report "Oral Health Quality Improvement in the Era of Accountability."

The report, funded by the W.K. Kellogg Foundation and the DentaQuest Institute, was released as the U.S. healthcare system is undergoing a transition from the "pay-for-performance" model to "value-based care." The paper argues oral health should likewise move in the same direction and make the transition from "volume to value."

The report found dentistry is the second-highest out-of-pocket health care cost after prescription medicines, and, like health care in general, its cost is increasing, reports Laird Harrison for Medscape News. Another issue is the government just pays for about 6 percent of dental care nationally, the report found, leaving people to pay for care themselves.

While expensive, the care dentists give can be inconsistent, the report found. Though Glassman said dentistry is not lacking in standards, there is limited evidence of the best practice for most dental procedures, the report found.

Another issue, the report contends, is dentists are paid according to what they produce, not by how successful they are in their outcomes. As such, dentists are resistant to change since there are few incentives to implement quality improvement programs. "If the question is 'what's the optimum system for providers,' then many feel the optimum system is what we have now," Glassman said. "If the question is 'what's the optimum system for the public,' then you will come to a different set of assumptions."

To help improve the system, the report recommends a number of proposals, including:

• The increased use of electronic health records

• Development and use of measures for oral health outcomes

• Tying incentives to the oral health of the population being served

• Relying more on allied dental professionals and non-dental professionals

It also suggests relying more heavily on telemedicine, with Glassman envisioning "hygienists and dental assistants going into schools, nursing homes, and other areas with underserved populations to deliver preventive care," Harrison reports. "Dentists, monitoring from afar with access to dental charts stored on the Internet, could gain more patients."

Steven Silverstein, director of the graduate program in dental public health at the University of California San Francisco, said the report was "outstanding" and agreed that the care dentists give can be inconsistent, saying, "If you ask 10 dentists to look at a patient you will get 10 different opinions." Part of the problem, he said, is 98 percent of dentists either practice alone or with one or two partners.

Silverstein did take issue with the fact that the report did not mention the high cost of dental education; didn't take cosmetic dentistry into account; and it did not explain how reform could lower the cost of dental care. (Read more)

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Smile Kentucky! celebrates 10 years and more than 100,000 children helped

Smile Kentucky! celebrates its 10-year anniversary tomorrow, representing $1 million in free dentistry and benefiting more than 100,000 students.

"It's a wonderful program," said Arleta Watkins of Bullitt County Schools. "I've had children who've never had a dental exam before. They get that service for free."

The program serves children in Louisville and nearby counties. Since it began, more than 127,000 students in 143 schools and 11 counties have received classroom dental education, 35,000 kids have gotten free dental screenings at school and nearly 3,000 children have received free treatment.

Smile Kentucky! works with 30 elementary schools in Jefferson and surrounding counties each fall. Students receive dental education, and children in grades 3 to 6 get a free dental screening. Children without dental insurance or medical care get free treatments by going to the University of Louisville's School of Dentistry or private dental offices in February.

"Dental pain and infection is one of the leading causes of missed days at school and affects a child's ability to concentrate," said John Sauk, dean of U of L's School of Dentistry.

U of L is one of 30 agencies on the steering committee. Other founding partners include the Louisville Water Co.,  the Louisville Dental Society, Colgate, Sullivan Schein Dental, Northwest Area Health Education Center and the Bullitt County Health Department.

For more information about Smile Kentucky!, click here.

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FDA wants to reduce standard for fluoride in public drinking water

Lowering the amount of fluoride in drinking water, as proposed in January by the Food and Drug Administration, will increase medical expenses and harm the poor and the poorly educated the most, a mother writes in an op-ed piece in the New York Times.

Jane E. Brody delves into the concept of fluoridation, pointing out its benefits. "In the early years, rates of tooth decay among the young dropped by 60 percent in communities that adopted fluoridation," she writes. "Every $1 invested in fluoridation saves approximately $38 in dental treatment costs."

Though fluoride was initially thought to become incorporated into developing teeth, it was later found that its benefit is topical, meaning it works on teeth already formed. "Fluoride, which is present in saliva and concentrates in dental plaque, inhibits the action of acid on tooth minerals," she writes. "It also promotes remineralization by sticking to tooth surfaces, where it attracts calcium ions present in saliva."

Still, there remains controversy about whether or not fluoride is safe, with the substance being accused of causing everything from heart disease to Alzheimer's disease. "None of these supposed risks has ever been established in scientifically valid studies," Brody writes. "The only proven risk, a condition called fluorosis, which results in white and sometimes brownish markings on the teeth from too much fluoride, rarely results from a normal intake of fluoridated water."

Since fluoride is also available in other substances, like toothpaste, the FDA proposed reducing the amount of fluoride in public drinking water to 0.7 milligrams per liter, from a range from 0.7 to 1.2 milligrams. Brody feels the move is a mistake: "Fluoridation confers the greatest benefit to those who need it most: the poor and poorly educated and those with limited access to regular dental care," she writes. "In the years ahead, removal of fluoride from drinking water will almost certainly cost taxpayers millions of dollars in increased Medicaid expenditures." (Read more)

In Kentucky, there is 100 percent fluoridation in public drinking water systems, though perhaps half a million residents get their water from wells, springs or cisterns.

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Evidence grows of links between oral health and overall health

"The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole," The Wall Street Journal's Melinda Beck writes in her Health Journal column. "Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue—sometimes long before a patient knows anything is wrong. There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications." (WSJ graphic; click on it for larger version)

Beck adds, "Such findings are fueling a push for dentists to play a greater role in patients' overall health. Some 20 million Americans — including 6 percent of children and 9 percent of adults — saw a dentist but not a doctor in 2008, according to a study in the American Journal of Public Health this month."

Beck urges her readers not to be fooled by shiny white teeth. "In fact, many dentists worry that people who whiten their teeth may have a false sense of complacency, since their teeth can still be harboring tooth decay and serious gum disease," she writs. "Even people who have no cavities can still have inflamed and infected gums." She quotes Mark Wolff, an associate dean at the New York University College of Dentistry: "Whiteness and the health of your teeth are totally unrelated." (Read more)

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3 universites and federal agency join to improve oral health in Appalachian Kentucky

With money from the Appalachian Regional Commission and some of their own, three very different Kentucky universities will collaborate "to enhance sustainable, collaborative dental health education and care" in the state's eastern coalfield, where both are sorely lacking, they announced in a press release.

Morehead State University, the private University of Pikeville, and the University of Kentucky's College of Dentistry will design the Appalachian Rural Dental Educational Partnership Plan "to train more dentists to practice in rural areas and give them the tools necessary to set up thriving dental practices in Eastern Kentucky," the release said. The funding is $400,000 from ARC, $127,293 from UK, $82,035 from UPike and $47,873 from Morehead State.

“The majority of Eastern Kentuckians have struggled to sustain quality dental health, and one of the barriers to maintaining good dental health is poor access of quality dental care,” state Department for Local Government Commissioner Tony Wilder said. His agency handles ARC matters in Kentucky.

Said new UK President Eli Capilouto, a dentist by trade, “We know that if we can break a cycle of poor health, we can begin to break cycles of poverty. Cycles of despair can become legacies of hope. We also, increasingly, know that partnerships and greater collaboration are the best – and, perhaps, only – way to address major challenges.” He called the project a unique partnership among a federal agency, a governor and “the state’s flagship institution, Kentucky’s public institution dedicated to serving the people of Eastern Kentucky, and a critically important college with deep roots in Eastern Kentucky.” (Read more)

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Appalachian Regional Commission conference in Prestonsburg Sept. 7-9 to focus on improving access to health care

Featuring the insight of 42 federal, state and local health experts, officials and community leaders, the Appalachian Regional Commission's Healthy Families: Healthy Future conference will be held Sept. 7-9 in Prestonsburg.

The keynote address will look at different ways access to quality health care can be expanded. It will be given by Marcia Brand, deputy administrator of the Health Resources and Service Administration. HRSA is the primary federal agency for improving access to health-care services for people who don't have insurance, are geographically isolated, or are medically vulnerable.

Other conference topics include childhood obesity and diabetes; substance abuse in adolescents; improving access to dental care for children; health information technology; and Appalachian perspectives on infant mortality reduction.

The conference will be at Jenny Wiley State Resort Park in Prestonsburg. To register, click here. Online registration ends Wednesday, Aug. 31.

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Oral health grant for 25,000 Appalachian children should be beginning of statewide effort, Al Smith says

In an op-ed piece, veteran Kentucky journalist Al Smith praised the recent announcement that 25,000 Eastern Kentucky children in 16 counties will receive preventive dental care this school year.

The project, funded by a $1 million grant from the Appalachian Regional Commission and $250,000 in state funds, will involve painting the teeth of those children with a special varnish that prevents tooth decay. As co-founder of the Institute for Rural Journalism and Community Issues and former federal cochair of the ARC, Smith has pushed long and hard for the improvement of oral health in Kentucky.

He spoke of the grant announcement in conjunction with discussions of the continued $900 million expansion of the University of Kentucky's Chandler Medical Center. "Obviously, the bricks and mortar go to serve extremely important life saving and health purposes, but the ARC pilot treatments of children's teeth should persuade all Kentuckians that this care is essential for every county," he wrote.

The project is called Healthy Smiles and was announced by Gov. Steve Beshear last week. "Over the course of 2011-2012 school year, two protective fluoride tooth varnish treatments and educational materials for healthy dental practices will be offered to children in the first through fifth grades at selected schools," Smith summarized.

Counties that will benefit from the project are Bell, Breathitt, Clay, Elliott, Floyd, Harlan, Jackson, Knott, Knox, Lee, Magoffin, Menifee, Owsley, Perry, Russell and Wolfe.

The Institute for Rural Journalism and Community Issues told Beshear about Kentucky's serious oral health deficits when he was running for governor four years ago, Smith said in his op-ed piece. That assessment showed "that half of Kentucky's children had decay in their baby teeth; and nearly half of children ages, 2, 3, and 4 had untreated dental problems," Smith wrote.

Cavities and loss of teeth create problems in later life, Smith asserted. He referred to statements made by Dr. Steve Davis, interim commissioner of public health, who said Kentuckians looking to join the military may be turned away if they have a mouthful of oral health problems: "The Navy, particularly, takes seriously the warning that a sailor stricken by a toothache in the depths of the sea could mishandle a task on a sub and send the craft plunging to the bottom." For a Word version of Smith's op-ed, click here.

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Promising tooth varnish that prevents tooth decay will be applied to 25,000 students in 16 Kentucky Appalachian counties

Using an innovative fluoride technique, about 25,000 children in 16 Appalachian Kentucky counties will receive preventive dental care at school, under a $1.25 million pilot project announced by Gov. Steve Beshear yesterday. The counties are Bell, Breathitt, Clay, Elliott, Floyd, Harlan, Jackson, Knott, Knox, Lee, Magoffin, Menifee, Owsley, Perry, Russell and Wolfe.

In the Smiling Schools program, children in first to fifth grades "will have their teeth painted with two fluoride treatments over a four- to six-month period," reports Mike Wynn of The Courier-Journal. "Fluoride prevents and reverses the early affects of tooth decay and slows the progress of existing problems."
(Photo by James Mann, The Winchester Sun: Emily Havens of Clark County gets the treatment)

The University of Kentucky Dental School will examine the children before and after the tooth varnish treatments to assess the effectiveness of the program. Results of a project that Beshear said inspired the program are promising. About 3,000 children in Clark County had their teeth painted with the varnish and decay rates in a group of sixth graders fell dramatically. By the third year of the treatment, decay rates had fallen from 50 percent to 14.5 percent, one of the lowest rates in the state, said dentist Rankin Skinner, who spearheaded the project.

In 2001, Kentucky children had tooth decay in their baby teeth almost twice as often as the national average, Beshear said Thursday. More than 46 percent of children ages 2 to 4 went untreated that year. "The impact of these dental problems is much more than just an uneven smile or a poor national image, Beshear said. "Dental problems affect overall health and development — everything from nutritional choices to speech development to performance in school." (Read more)

Rachel Parsons of The Winchester Sun reports that the impetus for the project was a December 2007 New York Times story about Kentucky's poor dental health, particularly that of children. Prompted by his son who read the story, Will Hodgkin of the Clark County Community Foundation contacted Skinner, who had learned of the varnish while completing a study in Ecuador, where dentists had noted big decreases in decay rates after using the substance on teeth. The foundation funded treatment for all preschool and elementary students in 2008-09, and the program is now run by the Clark County Health Department. (Read more)

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Tooth varnish saving smiles in Clark County

To protect about 3,000 Clark County children from tooth decay, local dentists and volunteers headed to schools to apply a fluoride varnish earlier this month. "We knew this material worked, although it was a new material, and there wasn't a lot of research on it at the time," dentist Rankin Skinner told The Winchester Sun's Rachel Parsons.

Skinner became concerned after learning that Kentucky children have more tooth decay than anywhere else in the country, a fact he gleaned from a Christmas Eve 2007 article in The New York Times. The same day, one of Skinner's friends read the article by Ian Urbina and called him to come up with a plan. "Skinner had recently completed a study on tooth decay in Ecuador, and the participating dentists had seen great improvement in oral health using a material new to the market at that time called amorphous calcium phosphate," Parsons reports.

Local dentists and the Clark County Community Foundation, of which Skinner's friend was a member, got together to get the varnish in Clark County. Twice a year, the dentists go to elementary and pre-schools to apply it on students' teeth, such as those of Emily Havens (above, Sun photo by James Mann). "We wanted to get the material on there as soon as the teeth came in," Skinner said. "There's just too much decay out there to be fixed. We knew we needed a preventative program."

Dentists found evidence of tooth decay in half the students the first year, but noted an 11 percent drop in decay in sixth-grade students after the first year. They track progress annually and conduct full exams on sixth-grade students to check for cavities. If any are found, parents are informed. Students are also given tooth brushes at the beginning of each school year. (Read more)

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Pew gives Ky. a "C" for looking after dental health of children

Kentucky received a "C" grade from the Pew Children's Dental Campaign for meeting the dental health needs of children, the same grade it was given last year.

The Courier-Journal reports the state met or exceeded four of eight benchmarks: The majority of Kentuckians (99.4 percent) have fluoridated community water supplies; the state pays medical providers for early preventive dental health care; the state tracks data on children's dental health; and the percentage of Medicaid-enrolled children getting dental care (40.8 percent) exceeds the national standard of 38.1 percent.

The state fell short of Pew's standards when it came to offering sealant programs at high-risk schools; allowing hygienists to place sealants without a dentist's prior exam; and authorizing new primary-care dental providers. Kentucky also lost points because the rates it pays to dentists for providing Medicaid services is below the norm — only 52 percent, compared to the national average of 60.5 percent.

None of the 50 states assessed in the report met all eight benchmarks. Seven states received an A and 20 states received a B. "An A does not stand for 'all done,'" said Shelly Gehshan, director of the Pew Children's Dental Campaign. "It means a state has the key ingredients in place, but it still needs to monitor progress and explore new ways to improve children's access to dental health." Florida, Hawaii, Indiana, Montana and New Jersey received an F.

More than 20 states improved their grades over 2010. "These gains were achieved primarily by adopting policies to reimburse physicians for preventive dental services, expanding water fluoridation and increasing the percentage of Medicaid-enrolled children who receive care," the report reads. (Read more)

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