The New Zealand Ministry of Health was shocked with the results of a research carried out among the dental hospitals of the country for the last 20 years.
In its review of dental admissions to hospitals, a Ministry-commissioned report found a fourfold increase in admissions between 1990 and 2009, with the biggest spike in admissions from children aged under 8.
Moreover, children as young as 18 months, who only start cutting teeth, have them completely rotten, and they should be pulled out. Some child’s teeth are dissolved down to the gum line and are bleeding.
The reason as it turned out is that parents feed their toddlers soft drinks through sipper bottles, and chocolate biscuits.
Principal dental officer for Nelson Marlborough District Health Board Rob Beaglehole recently extracted 11 teeth from a 3-year-old whose parents had let him drink Coke from a sipper bottle to “keep him happy”.
Another 3-year-old needed four stainless steel crowns, had four teeth pulled and was given four fillings the child’s parents put Milo in a baby bottle to sip on overnight.
All these procedures, performed under general anaesthetic , cost the Nelson Marlborough DHB about $4000 each.
Each year 35,000 children aged under 12 have rotten teeth extracted because of excessively sugary diets – mainly from sugary drinks and other junk foods.
Struggling through school with the pain and distraction of rotting teeth could cause behavioural and development problems, while the early loss of baby teeth could cause adult teeth to grow irregularly and trigger the need for braces and other orthodontic interventions, Beaglehole said.
Georgia are now able to have their day in court after the state board of dentistry ordered several to shut down because they’re not licensed dentists.
The ruling affects customer service-oriented businesses that give customers trays filled with a lightening gel, not over-the-counter strips sold in stores.
A federal judge ruled Tuesday that a Savannah woman can sue Georgia’s dental board, which ordered her business to close or face punishment.
If you search online for teeth whitening in Atlanta most results are for dental offices. That’s because under Georgia’s Dental Practice Act, teeth whitening services are considered dentistry and anyone else who is not a dentist and is offering it is committing a felony.
Atlanta resident Jim Valentine ran a successful teeth whitening business called White Smile USA from 2007 to 2010.
He said the active ingredients in his product are the same as the ingredients in products sold at drug stores over the counter. The difference is at his business the customer gets a gel-filled tray and sits under a whitening light.
“We were selling hydrogen peroxide, that’s it. So until they can regulate that, they can’t stop whitening,” Valentine told Channel 2’s Amy Napier Viteri. “If you have a custom tray made from a dentist, it’s minimum $300. This was basically $99.”
Valentine said from the beginning several state dental boards tried to shut him down.
“They’re dentists and it’s hurting their marketplace,” Valentine said.
After costly litigation and a weak economy, Valentine said he went under.
Tuesday a federal judge in Atlanta ruled a Savannah woman can sue Georgia’s dental board to reopen her business after the board ordered she shut down in 2014.
The Georgia Dental Association sent Viteri a statement that read:
“When it comes to teeth whitening services, there are safety concerns that must be addressed with the skills and professional diagnosis of a licensed dentist. A discolored tooth may signal dental problems, such as an abscess, that may not be detected by an untrained individual. Often an X-ray is needed to determine the proper treatment, and timely treatment can make a difference in keeping or losing the tooth if it is dissolving away.
“In addition, improper application of chemicals in the mouth can damage fillings and inflame gums and the palate. Dark teeth can also be caused by tooth decay or leaking fillings, which are not affected by bleaching but need another type treatment. A dentist examines the current condition of the mouth and existing fillings, and is able to treat any side effects that may be related to a future treatment or change in oral condition. Consider a patient who has tooth colored fillings. Whitening does not change the color of the fillings, so the patient may look worse if those are not identified by a dentist, or the patient may have to spend much more money to replace the old fillings in order to match the different color of the bleached teeth. Whitening done improperly can damage some restorations which can not only cause cosmetic issues but can lead to more serious dental conditions, such as avoiding the proper treatment for tooth decay or abscesses while performing treatment that may not be needed.
“Lastly, everyone needs a dental home with a professional who knows what is normal for that individual, and what to do if some abnormal problem arises. A dentist will work with a patient to determine if they are an appropriate candidate for cosmetic services based on the state of their current oral health and their desire for a beautiful smile. Cosmetic services are only one part of the oral health care a dentist can provide.”
“If it’s more convenient than I am totally for businesses selling it,” Atlanta resident Mary Agramonte told Viteri.
“They’re going to lose in court which is going to cost the taxpayers of Georgia, me included, more money on this issue,” Valentine said.
Viteri contacted Georgia’s dental board and a representative told her they do not comment on pending litigation.
An attorney for the Institute for Justice, which is handling the businesswoman’s case, said they expect to bring their case against the board within the year.
A large team of researchers with members from institutions in Italy, Germany and Australia has found what they claim is the earliest example of dental cavity manipulation. In their paper published in the journal Scientific Reports, the team describes their work on studying the tooth from a 14,000 year old human skeleton uncovered back 1988, and the techniques they used to show that the marks they found were caused by human intervention.
Cavities occur when parts of teeth decay—in modern times, the fix requires drilling out the decayed matter and filling the resultant hole with a hard material that will stay put preventing further damage or decay. People living during the Late Upper Paleolithic were not so lucky, they had to suffer, or undergo cavity manipulation from a friend using a sharp piece of flint—at least according to the researchers working on the teeth of a skeleton unearthed in Italy over twenty five years ago. No one noticed at the time that a cavity in one tooth appeared to have undergone treatment, or repair. The skeleton was dated back to 13,820 to 14,160 years old and his approximate age at death was placed at 25.
Upon noticing that it appeared that the cavity had been cleaned, the team decided to take a closer look. They studied the surface inside the cavity with an electron microscope—that revealed grooves and ridges that appeared to be caused by scraping. The team then conduced several experiments on teeth that were subjected to rocks, wood and other abrasive material to see if they could replicate the grooves and ridges found in the ancient tooth—marks made by sharpened flint, they found, matched nearly exactly. The evidence suggests that the young man underwent the first found example of corrective dentistry—someone had dug around in his cavity with a sharpened piece of flint attempting to remove the decayed matter and thus, most likely, alleviating a tooth-ache.
The finding predates other examples of known early dentistry, such as a tooth with a beewax filling from approximately 6,500 years ago and evidence of dental drilling that occurred approximately 9,000 years ago. The researchers suggest it marks a major milestone in dental cavity manipulation and shows that early people combined manual dexterity with creative thinking to alleviate suffering due to tooth decay.
More information: Scientific Reports 5, Article number: 12150 DOI: 10.1038/srep12150
Lindsay Argyle M ’15 has plenty of reasons to smile.
The certified dental hygienist officially completed her master’s degree in community health from SUNY Cortland last week when she presented her culminating project on a national award-winning program she helped develop. Her work, which relied on second-year students from SUNY Canton’s dental hygiene program educating schoolchildren in Rome, N.Y., earned recognition from the American Dental Hygienists Association (ADHA) earlier this summer at the organization’s annual session in Nashville, Tenn.
The Student Member Community Service Award sponsored by Colgate recognized a collective effort.
“The national award really is a reflection of both the (SUNY Canton) students’ hard work and dedication to their community and the quality education I received at SUNY Cortland,” said Argyle, of Fayetteville, N.Y.
An adjunct instructor in SUNY Canton’s dental hygiene program, housed in Rome, she also serves as the dental hygienist for Family Health Network’s local school health program, educating children throughout Cortland County on the importance of taking care of their teeth and other oral health services.
As Argyle finished all of her other master’s coursework in December, she saw a way for one quality program to fulfill two needs: the service component of a SUNY Canton community health course for undergraduates and her own capstone project at the College. SUNY Cortland Associate Professor of Health Jena Nicols Curtis encouraged Argyle, who collaborated with Kasey Penoyer, the community health instructor at SUNY Canton.
Lindsay Argyle M ’15
“It all went together,” Argyle said. “In my master’s courses at Cortland, I structured the framework to attempt an oral health promotion or tooth brushing program. After collaboration with Kasey and learning of the need for a community outreach program for the Canton students, I thought, why not structure one program that combines the two?”
The award-winning work started as an oral needs assessment among youngsters in Oneida County. It involved 16 dental hygiene students educating and screening more than 100 second graders at Bellamy Elementary School in the Rome City School District on vital habits such as proper brushing and flossing techniques as well as how to make food choices to ensure oral health.
Schoolchildren who showed signs of tooth decay were given referrals to a dental provider. Others took a field trip to SUNY Canton’s teaching clinic, where many received a dental exam, x-rays and sealants if they were eligible, as well as a fluoride treatment.
Dr. Terrence Thines, the chief of dental surgery for SUNY Upstate Medical University’s dental residency program, and two residents offered dental exams. Dental supply providers GC America, Dentsply, Patterson Dental and Ultradent donated products. And the Cortland College Foundation provided additional funding for the community outreach project.
“Our assessment showed that there was a large percentage of the students who were covered by insurance —including Medicaid — but the percentage indicating a dental visit within the past year was around 30 percent,” Argyle said. “Our needs assessment revealed unmet needs that included dental decay and issues with access to care.
“That’s what this project was about: providing much needed dental health education, identifying gaps in access to care, providing some free preventative services where care was needed, and providing appropriate referrals for problems that may have otherwise gone undetected. It was beneficial for all parties involved.”
The national honor proves as much.
If you plan to retire soon, add this item to your to-do list: a visit to the dentist before your dental insurance disappears.
Retirees transitioning to Medicare are often surprised to learn that the program does not cover routine dental care or more complex procedures.
Overall, 40 percent of the 65-plus population has some form of dental benefit, according to the National Association of Dental Plans. For seniors who use Medicare Advantage managed care plans, about half offer very limited coverage for cleanings and exams. A small percentage of seniors have dental insurance from a former employer, and Medicaid covers dental care for low-income residents in some states, although benefits vary. Some buy individual commercial plans or have coverage through an association such as AARP.
But most seniors just pay for dental care out of pocket – the mean expense for Americans age 65 and older was $870 in 2012, according to the Agency for Healthcare Research and Quality, a research arm of the U.S. Department of Health and Human Services.
The costs can be far higher for more complex procedures. The average cost of a crown in New York City is $2,500; a periodontal procedure in Los Angeles costs $1,700, according to Fairhealthconsumer.org , a service that tracks prices of healthcare and health insurance.
Those numbers help explain why 34 percent of seniors had not seen a dentist in two years in 2010, and 22 percent had gone without care for the past five years, according to the Kaiser Family Foundation (KFF).
“Dental care is conspicuously absent from the health care coverage for older adults,” says Dora Fisher, director of older adult programs at Oral Care America, a nonprofit group that advocates for better oral health.
Medicare celebrates its 50th anniversary later this month, and adding basic dental coverage is on the wish list of many health policy experts reflecting on the program’s future.
Research shows clear links between poor oral health, diabetes and heart disease. One out of four Medicare beneficiaries has edentulism – that is, they no longer have any of their natural teeth, according to KFF; that can cause other health issues, such as nutritional deficiencies and problems with speech.
Premiums for private plans, are reasonable – PPO plans cost around $15 per month, Ireland says. But individual coverage is not as robust as group dental plans. “Most have waiting periods before coverage for major procedures begins, and the dollar caps on coverage may be lower,” she says.
Ireland adds that dental insurers have been negotiating with the federal government to offer individual standalone dental plans (independent of health insurance) through the Affordable Care Act insurance exchanges, and she hopes expanded offerings will start showing up in 2016 or 2017.
Dental plans are available on many exchanges now, but they can only be purchased along with general health insurance. That effectively cuts out seniors, who are covered by Medicare.
Consumer advocates are pushing for Medicare to pay for dental care made necessary by other procedures that the program does cover. The Center for Medicare Advocacy (CMA), a non-profit legal organization, has filed lawsuits on behalf of cancer patients who have been denied coverage for dental procedures made necessary due to aggressive radiation of the head and neck.
“Medicare covers what happens to the patient’s eyes even though it doesn’t provide routine eye care – but there’s no coverage for this type of extreme dental care, and people are ending up in the hospital with infections,” says Margaret Murphy, an associate director and attorney with CMA. The Centers for Medicare and Medicaid Services did not respond to requests for comment.
The litigation has not been successful so far, but CMA has not given up. “We’re trying to figure out where to go with it next,” Murphy says.
What started as a toothache from a lost filling became a raging infection that landed Christopher Smith in the emergency room, then in intensive care on a ventilator and feeding tube.
“It came on so quickly and violently. I was terrified,” says Smith, 41, of Jeffersonville, Ind., who lacked dental insurance and hadn’t been to a dentist for years before the problem arose last month. “I had no idea it could get this serious this quickly.”
Smith is one of a growing number of patients seeking help in the ER for long-delayed dental care. An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds. ADA officials, as well as many dentists across the nation, say the problem persists today despite health reform.
“This is something I deal with daily,” says George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville . “And there is not a week that goes by that we don’t have someone hospitalized…People still die from their teeth in the U.S.”
Often, what drives people to the ER is pain, “like a cavity that hurts them so much they can’t take it anymore,” says Jeffrey Hackman, ER clinical operations director at Truman Medical Center-Hospital Hill in Kansas City, who’s noticed a significant rise in the number of dental visits over the last five years.
Limited insurance coverage is a major culprit; all but 15% of dental ER visits are by the uninsured or people with government insurance. The Affordable Care Act requires health plans to cover dental services for children but not adults; federal officials say “essential” benefits were based on services included in employer-sponsored medical plans. Medicaid plans for adults vary by state and often cover only a short list of basic dental services. Medicare generally doesn’t cover dental care at all.
By law, ERs have to see patients even if they can’t pay. But although they often provide little more than painkillers and antibiotics to dental patients, they cost more than three times as much as a routine dental visit, averaging $749 a visit if the patient isn’t hospitalized — and costing the U.S. health care system $1.6 billion a year.
“If we were going to the dentist more often, we could avoid a lot of this,” says Ruchi Sahota, a California dentist and consumer adviser for the ADA. “Prevention is priceless.”
Access a challenge
But federal figures show four in 10 adults had no dental visit in the past year, and one big reason is cost. Just over a third of working-age adults, and 64% of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out-of-pocket.
Meanwhile, the 10% of adults with Medicaid dental plans struggle to find dentists to take them; studies have shown that less than 20% of dentists accept Medicaid in some states, largely because reimbursements dip as low as 14% of private insurance reimbursement last year. Add to that a shortage of more than 7,000 dentists in the United States.
Americans who go without care pay a price. More than a quarter of working-age adults, and one in five seniors, have untreated cavities, and 19% of seniors have lost all their teeth. When poor people do get care, dentists say they usually get only basic services.
“I take out teeth every week that could have been saved with restorative work,” Kushner says.
Besides lacking coverage, dentists say people tend to ignore dental problems until things get really bad, which can happen outside of business hours and send them to ERs.
When money’s tight, “dental care is something people put off to the very end,” failing to realize it’s crucial to overall health, says Michael McCunniff, chairman of the University of Missouri-Kansas City Department of Public Health and Behavioral Science.
Smith learned the hard way just how crucial oral health is.
The reggae vocalist and part-time security system installer says he’d been without dental insurance for a couple of years, and hadn’t been to a dentist for longer than that, when a filling fell out of a bottom left molar on June 6. He tried to fix it with a do-it-yourself kit, but the temporary filling came out during a concert that night. He tried to numb it with Anbesol the next day, but the pain got worse as his jaw swelled, and he drove to the emergency room at 4 a.m. the following morning.
Doctors there referred him to a nearby dentist, who saw the worsening infection and sent him back to the ER, where his tooth was removed. At home, the infection drained into his neck, making it difficult to breathe — prompting a third trip to the ER. As he sat in the waiting room, the swelling doubled. “I could feel my windpipe close,” he recalls.
Doctors admitted him, cut into his neck to insert a drain for the infection and gave him strong antibiotics — and kept him in the hospital for a week.
A day after returning home, all he felt up to doing was resting with his dachshund, Sinatra. The scar in his neck was visible, and his still-swollen jaw made it impossible to open his mouth all the way.
Dentists say patients can be much better served by getting regular care in the community, where many issues that bring people to ERs can be handled and serious problems prevented. Community health centers with dental clinics offer one longstanding alternative for low-cost care, and another newly-touted option involves university dental school clinics.
The University of Maryland School of Dentistry, for example, has a pre-doctoral clinic, where students provide a range care under the close supervision of faculty, and a walk-in clinic for people with urgent needs.
An ADA report last year found that dental ER visits had fallen between 2012 and 2014 in Maryland amid state reforms such as increased Medicaid reimbursement for dentists and a larger provider network — inspired in part by the 2007 death of a 12-year-old boy from a brain infection that began as a toothache.
The ADA also points to ER referral programs across the nation to get patients into dental-school treatment. Officials say there currently are 125 such programs, up from eight a year ago. In Kansas City, patients at Truman have only to walk across the street when they’re referred to the University of Missouri clinic.
“An emergency physician can provide some temporary care — things like pain medication and antibiotics — but rarely are we able to definitively treat the underlying cause of dental problems,” says Truman’s Hackman. “We know that through the ER referral program, a good proportion of them are getting definitive care. We’ve certainly seen far fewer repeat visits.”
Ultimately, some dentists say they’d like to see dental care among the services insurers are required to cover. The ADA pushed this idea as the health reform law was being written and is now advocating for increased coverage for adult dental care under Medicaid. Some dentists say they’re encouraged that some states expanding Medicaid have started seeing more recipients going to dentists.
Smith says ER staff helped him sign up for Indiana Medicaid, and now that he’s been referred to a dentist who has agreed to take him, he plans to get regular checkups and take meticulous care of his teeth at home.
McCunniff says that’s a much better plan — for all Americans — than forgoing care and frantically seeking help in the ER. “All that does is put a Band-Aid on the problem,” he says. “It doesn’t cure it.”
Patients can spot trouble with new dental implants
Patients with new dental implants may be able to detect signs of trouble early enough to help prevent complications that can damage gums and bone, a British study suggests.
When researchers asked 75 people who received dental implants in the past year if they had complications such as bleeding, pus or loose replacement-tooth “roots,” they expected clinicians to routinely catch problems that the patients missed.
But that didn’t happen.
Because the mouth is a very sensitive part of the body, it’s not surprising that patients and clinicians had a similar opinion about post-implant oral health, said Bruno Chrcanovic, a researcher in odontology at Malmo University in Sweden who wasn’t involved in the study.
That doesn’t mean patients are forever in the clear, however, or that all problems can be easily detected without regular dental checkups, he said.
“Some patients have the feeling that they understand the problem and can properly deal with it by themselves,” Chrcanovic said by email. “It is not always true.”
About 3 million people in the U.S. have dental implants, and another 500,000 implants are placed each year, according to the American Academy of Implant Dentistry.
Implants are artificial tooth roots – typically titanium posts – inserted into the bone of the jaw to replace missing teeth. An implant with an attached crown, functions like a normal tooth and can help preserve the jaw structure and prevent bone loss, unlike bridgework or dentures.
While generally safe, dental implant procedures, like any surgery, are not risk-free. Patients can develop damage to blood vessels, nerves, sinuses or other teeth. They can also get a serious condition known as peri-implantitis, a bacterial infection that can lead to inflammation around the post and bone loss.
The study, co-authored by Dr. Simon Wright of the Implant Centers of Excellence in the U.K., tested a hypothesis that patients can’t perceive the difference between successful and unsuccessful implants. Wright didn’t respond to emails seeking comment.
Patients who received implants from one of two dentists at the practice within the previous one to 11 months were asked to complete questionnaires and have an exam to see if their responses lined up with what clinicians saw in their mouth.
The patients ranged in age from 23 to 92 years old, and none of them was treated as part of the National Health Service, the U.K.’s publicly funded health system.
Researchers focused on five areas of post-implant health: aesthetics, loose restorations, bleeding or pus, fractured implants and what’s known as occlusion, when the upper and lower teeth collide when the mouth is closed.
On all five of these variables, there wasn’t a significant difference of opinion between the patients and the dentists, according to the results published in the British Dental Journal.
Patients perceived fractures in 5.3 percent of restorations, whereas dentists detected fractures in 1.4 percent.
For loose restorations, patients thought this of 14.7 percent of implants, while dentists found 13.3 percent of restorations to be loose.
With occlusion, patients reported this 1.3 percent of the time, but dentists found it during 5.3 percent of exams.
Patients may have been fairly accurate in assessing their own oral health because they were educated on the potential risks before implant surgery and then taught proper implant care after the procedure, the researchers note. The study is also too small to draw conclusions about a broader patient population.
Patients who aren’t well educated may struggle to spot complications and also be less likely to continue with routine checkups, said Dr. Frank Strietzel, an oral health researcher at Charity Medical University Berlin.
“If the patient will not follow the advice of the dentist, there is a risk of undetected inflammation around the implants,” Strietzel, who wasn’t involved in the study, said by email. “A dental implant is a foreign body like a prosthesis, which requires regular observation.”
Source: Fox News