Booster Shots

Oddities, musings and news from the health world

Category: Dental Care

Dentists? They're strangers to 1 in 4 California kids

July 7, 2010 | 12:14 pm

Exam It's not a pretty picture, the overall state of dental care for California's kids. That's because too many of them -- one-quarter, to be exact -- don't have it. Yep. One in 4 have never even been to a dentist.

That attention-grabbing statistic is from a dental-care study released Wednesday and published in the July issue of the journal Health Affairs. It analyzed care -- or, rather, lack thereof -- for children ages 11 and under in the so-called Golden State.

The researchers, from the UCLA Center for Health Policy Research and the California HealthCare Foundation, found that the picture is especially bleak for Latino and African American kids, regardless of whether they have private insurance or public insurance (Medicaid for the Children's Health Insurance Program). 

The abstract of the study states:

"Poor oral health has important implications for the healthy development of children. Children in Medicaid, especially Latinos and African Americans, experience high rates of tooth decay, yet they visit dentists less often than privately insured children. Even Latino and African American children with private insurance are less likely than white children to visit dentists and have longer intervals between dental visits. Furthermore, Latino and African American children in Medicaid are more likely than white children in Medicaid to have longer intervals between visits. These findings raise concerns about Medicaid’s ability to address disparities in dental care access and, more broadly, in health care."

That seems safe to say.

The full study, Racial and Ethnic Disparities in Dental Care for Publicly Insured Children, can be accessed through the California HealthCare Foundation website.

-- Tami Dennis

Photo credit: Getty Images


Help your heart. Brush your teeth twice a day.

May 28, 2010 |  7:00 am

Toothbrush
Good oral hygiene includes, at a minimum, brushing your teeth twice a day and visiting the dentist every six months. People who do that will not only be rewarded with better dental health, they are also less likely to develop heart disease, a study finds.

In recent years, researchers have connected the dots between inflammation in the gums and inflammation in other parts of the body, such as the heart. A study released online Friday in the British Medical Journal suggests that consistent brushing of the teeth may be a significant strategy to reduce the risk of heart disease. Researchers analyzed data from 1,100 Scottish adults and found that people who reported less frequent brushing had a 70% extra risk of heart disease, although their overall risk of heart disease was still relatively low. This association was apparent after adjusting for other factors that contribute to heart disease, such as obesity, smoking and family history of heart disease.

The people who brushed fewer than twice a day were more likely to test positive for chemical markers of inflammation in the blood, such as C-reactive protein and fibrinogen.

Overall, periodontal disease is linked to a 19% increased future risk of heart disease. But, the authors said, it's not entirely clear yet whether gum inflammation contributes to heart disease or is a marker for it.

-- Shari Roan

Photo credit: Al Seib  /  Los Angeles Times


Acupuncture can calm anxious dental patients, study finds

March 29, 2010 |  4:01 pm

If you’re the type who gets anxious about visiting the dentist, you might think the last thing you’d want would be a bunch of extra needles. Apparently, you’d be wrong.

Dentist A small study being published in Tuesday’s edition of the journal Acupuncture in Medicine found that dentists who administered acupuncture to their nervous patients succeeded in calming their fears. That allowed all 20 subjects to complete their necessary dental exams and treatment. Without acupuncture, only six of the patients were able to get even partial treatment.

The patients in the study initially scored an average of 26.5 on the Beck Anxiety Index (a score above 26 indicates “severe anxiety”). Five minutes after acupuncture, their average anxiety score dropped to 11.5. The acupuncture focused on two points on the head (GV20 and EX6), and the needles stayed in throughout the patients' dental procedures.

The researchers, from England and Denmark, noted that 5% of people in Western countries have “pronounced dental anxiety” and an additional 20% to 30% have “moderate dental anxiety.” They pointed out that while such patients can be treated with sedatives, hypnosis, biofeedback and other behavioral therapies, those approaches are “time consuming and demand psychotherapeutic education and skills.”

One might think that considerable education and skill are also needed to administer acupuncture safely and effectively, though the researchers didn’t discuss the training involved.

Apparently, the combination of acupuncture and dental work is still uncommon here in the states. But in the U.K. there is such a thing as the British Dental Acupuncture Society.

-- Karen Kaplan

Photo: If this picture gives you the heebie-jeebies, perhaps some acupuncture needles will do the trick. Photo credit: Yang Liu/Corbis


Going through two tubes a week of Poligrip? You might want to reconsider.

February 18, 2010 |  4:36 pm

Zinc Denture wearers tend to want their dentures to stay in place. As this is not a fleeting or a temporary need, they must use adhesives for the long term. Some of them likely and perhaps understandably use too much.

Don't, says GlaxoSmithKline. The problem is zinc, specifically the neurological problems that too much of the mineral can cause and the fact that some adhesives contain it.

In a consumer advisory issued today, the maker of Super Poligrip cautioned against "long-term excessive use of zinc-containing denture adhesives."

The company says its three zinc-containing Super Poligrip products (Original, Ultra Fresh and Extra Care) are "safe to use as directed." But, to err on the side of caution, it will begin offering zinc-free versions.

Here's more on the products in question and the ensuing change.

And to understand why all the fuss, here's a recent Times story on the perils of zinc. That story, an exploration of the mineral in its many forms, sheds some light on today's move by the company:

"Zinc raised other alarms last year, when researchers began to notice weakness, balance and memory issues and other neurological trouble in some patients. Sleuthing revealed the only common link: All of the patients used large amounts of denture cream enhanced with zinc.

"Denture cream is meant to be used in small amounts, says Jaya Trivedi, a neurologist at the University of Texas Southwest Medical Center in Dallas. But people with poorly fitting dentures may end up using much more of it to keep their dentures in place. Trivedi and colleagues published their analysis of four denture-wearing, zinc-overloaded patients in the journal Neurology in 2008.

"A tube of denture cream should last a month or more, Trivedi says. The patients in her study, however, had been using up to two tubes a week of Poligrip or Fixodent creams for many months or even years."

Here's the Neurology study's abstract.

And, as for the purpose for which zinc is most commonly used, there's this related story: But does zinc help colds? 

-- Tami Dennis

Photo: Zinc can be found in relatively high levels in various foods -- including the oysters and baked beans shown here -- and in some denture adhesives.

Credit: Bob Chamberlin / Los Angeles Times


Molars, incisors and canines -- oh, my!

November 20, 2009 |  3:25 pm

Teeth Concerned about the strength of teeth-whitening chemicals and by the growing number of non-dental venues through which they’re being sold, the American Dental Assn. today asked the U.S. Food and Drug Administration to evaluate the compounds for safety and classify them.

Currently, teeth whiteners, which commonly use hydrogen peroxide or carbamide peroxide as the active ingredient, are neither drug nor cosmetic device nor medical device, according to the dental association.

The ADA wants the FDA to put the chemicals in a category and evaluate them for safety.

Depending on the outcome of that evaluation, the whitening compounds could be available on an unrestricted, over-the-counter basis or, if determined to be at the upper end of risky, could be restricted to prescription-only availability.

“Without appropriate regulation, the application of chemically-based tooth whitening/bleaching agents may result in harm to both hard and soft tissues in the mouth,” the ADA said in a letter to FDA Commissioner Dr. Margaret Hamburg.

Dr. Ron Zentz, senior director of the ADA’s Council on Scientific Affairs, said the FDA was supposed to have classified whiteners years ago but never finished the task.

Zentz said there was no particular tipping point for the ADA’s request, but the letter to Hamburg notes that a lot of business is being transacted outside of dentists’ offices, with potential harm to consumers – not to mention to dentists’ bottom lines. 
  
“The tremendous expansion of products available directly to consumers and application of products in venues such as shopping malls, cruise ships, and salons is troubling since consumers have little or no assurance regarding the safety of product ingredients, doses or the professional qualifications of individuals employed in these non-dental settings,” the letter states.

-- Andrew Zajac

Photo illustration credit: Los Angeles Times


A snapshot of dental-care costs (in the 10 states with the most people)

October 29, 2009 |  6:25 pm

Dental Folks in Georgia and Ohio (and their insurers) get off fairly easily, not so those in New Jersey and New York.

In 2006, the national average a person spent on dental care was $607. In Georgia, the average expenditure among people who actually had one was $466. In Ohio, $474. The average in New Jersey on the other hand was $773, and in New York, $731. In California: $682.

The Agency for Healthcare Research and Quality, an excellent source of reliable statistics in a world filled with considerably less reliable "statistics," recently offered up an analysis of dental expenditures in the nation's most heavily populated states, comparing them with the national average.

And no, the research didn't assume that everyone in a state gets care. It looks only at the costs involved for those who did so. The access issue is more problematic.

The numbers are analyzed in other ways too -- percentage of residents with dental expenses, out-of-pocket expenses and amount paid by insurers.

Dental expenses made up 7.4% of all medical expenses in 2006.

Here's a recent collection of Times stories on finding affordable dental care:

The wallet need not open wide

The ins and outs of affordable dental care

Keep your kids smiling with these dental services

-- Tami Dennis

Photo: Dental cleanings and fillings don't come cheaply. But waiting can add to the pain and expense.

Credit: Matthew Staver / Bloomberg


In East Timor, teeth are a military mission for Camp Pendleton forces

October 16, 2009 |  8:28 am

Timor

Sometimes the best way to win hearts and minds is to take care of the teeth.

And so while Marines from Camp Pendleton are training with the military forces of East Timor, Navy medical and dental specialists are looking after the needs of civilians -- all part of a visit by the 11th Marine Expeditionary Unit.

East Timor, part of the Malay archipelago, is 400 miles from Australia. U.S. military engineers are also  refurbishing a school with a new roof, strengthened walls and a paint job.

Marine Col. Gregg Olson, commander of the 11th MEU, says that along with the combat training, the visit is an opportunity to get to know the East Timorese government and school officials before continuing on a six-month training deployment.

The 11th MEU flagship, the amphibious assault craft Bonhomme Richard, left from San Diego three weeks ago.

-- Tony Perry in San Diego

 Photo: Navy corpsman Ronald Shaw of Houston with a patient in East Timor. Credit: Sgt. Scott Biscuiti.


Athletic mouth guards protect teeth, but may pose other problems

August 27, 2009 | 12:39 pm

Mouth guards are an essential piece of protective gear for athletes who play contact sports. While they may protect teeth, the devices could be causing other problems.

J9b62oncA new study found that athletic mouth guards may cause a marked increase in the number and severity of oral lesions during the course of an athletic season.

Researchers recruited 62 Division I football team players who were told they could choose the type of mouth guard they wanted to wear, either a custom device, or a "boil and bite" style that's heated until softened, then bitten into to conform to the mouth. Each was also given a thorough oral exam at the beginning of the season, during which 85 oral lesions were found among 47 participants. There were 17 gingival lesions on the soft tissue that lines the mouth and surrounds the teeth; 60 buccal mucosal lesions in the mucous membrane on the inside of the cheek; eight lesions on the palate and none on the tongue.

Fourteen of the players were examined mid-season to see if the lesions were getting worse. They were, with 28 lesions counted, or two per person. At the end of the season, 53 players had a total of 198 lesions, or 3.7 per person. Broken down, there were 96 gingival lesions, 79 buccal mucosal lesions, five lesions on the palate, and 18 on the tongue. Some of the lesions also became worse over time. Although the increased number of lesions could have come from other issues such as poor oral hygiene or tobacco, they would have been noted at the preliminary exam.

The players' lesion pattern is different from what was seen in the general population during another study of 17,235 adults (including smokers). Most lesions in this group were found in the hard palate, followed by the gingiva, tongue and buccal mucosa.

Since mouth guards are important for tooth safety, researchers recommend that they should be worn, but thrown out at the first sign of distortion or when sharp, jagged edges appear, or when lesions occur. They should also be replaced regularly, and sanitized daily using an antimicrobial denture-cleaning solution to reduce the risk of harboring bacteria.

The study appears in the September/October issue of the journal Sports Health: A Multidisciplinary Approach.

-- Jeannine Stein

Photo credit: Dale Zanine / US Presswire


FDA says dental amalgam is safe, but recommends warning on product label

July 28, 2009 | 12:57 pm

Teeth The Food and Drug Administration has just released regulations on dental amalgam, a material is used to fill cavities in teeth and which, because it contains mercury, some fear may be dangerous to patients' health.

"While elemental mercury has been associated with adverse health effects at high exposures, the levels released by dental amalgam fillings are not high enough to cause harm in patients," the agency said in a statement.

The agency recommended that the product label contain a warning that dental professionals use adequate ventilation and that the amalgam not be used on people with mercury allergies. It also recommended the packaging carry "a statement discussing the scientific evidence on the benefits and risks of dental amalgam, including the risks of inhaled mercury vapor."

And, it further says, a scientific review has found that "The amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects. Even in adults and children ages 6 and above who have fifteen or more amalgam surfaces, mercury exposure due to dental amalgam fillings has been found to be far below the lowest levels associated with harm. Clinical studies in adults and children ages 6 and above have also found no link between dental amalgam fillings and health problems."

The agency said that there was less data to examine when it comes to risks to fetuses, breast-feeding infants and children under 6, but that the levels for kids under 6 are also likely to be safe and that the levels in breast milk are likely lower than those deemed risky by the Environmental Protection Agency. It added that pregnant and breast-feeding women should talk with their doctors about alternatives if they have concerns.

Dentists have been using dental amalgam for years. So why the rule now? Amalgam was already in use in 1976 when the agency acquired power to regulate medical devices. The agency was required by law to class pre-existing devices into classes I, II or III based on risk. They'd done mercury already, and they'd done powdered alloy (the other component of amalgam) but not the combined amalgam itself. The agency decided to do so in 2002, and this final ruling follows public comment and scientific reviews of several hundred studies.

Dental amalgam is rated Class II (moderate risk). Mercury, which used to be Class I (low risk), is now Class II.

Read more from the FDA on dental amalgam here.

-- Rosie Mestel

Photo: Al Seib / Los Angeles Times







Medications often the cause of dry mouth

July 10, 2009 | 10:19 am

Teeth Dry mouth is a common condition that can be hard to treat. A new survey from the Academy of General Dentistry found 91% of dentists believe that taking multiple medications causes most cases of dry mouth.

The survey, presented this week at the academy's annual meeting, involved 500 dentists. The dentists also suggested that aging, dehydration and salivary gland disease were causes of the disorder. Dry mouth is also known as xerostomia. It's caused by a decrease in salivary gland function and affects about 1 in 4 Americans. If left untreated, dry mouth can contribute to tooth decay.

"The number of xerostomia cases has increased greatly over time because people are taking more and more medications," said Cindy Kleiman, a dentist and expert on dry mouth, in a news release.

About 400 prescription medications are linked to dry mouth, including many antidepressants, painkillers, diuretics, antihistamines, tranquilizers and anti-hypertensives. Dry mouth can also be a symptom of a variety of diseases and medical disorders. People with dry mouth should discuss their symptoms with a dentist, according to experts.

The Academy of General Dentistry recommends these suggestions to alleviate dry mouth:

  • Brush and floss twice a day
  • Chew sugarless gum or suck on non-citrus flavored or sour sugarless candy
  • Drink plenty of water
  • Brush with a fluoride toothpaste to protect your teeth
  • Use over-the-counter saliva substitutes
  • Avoid alcohol and caffeine
  • Avoid smoking
  • Avoid overly salty foods
  • Avoid citrus juices
  • Avoid dry foods
  • Breathe through your nose instead of your mouth as often as possible
  • Use moisturizer regularly on your lips
  • Sleep with a humidifier in your room to add moisture to the air
  • Visit your dentist regularly

-- Shari Roan

Photo credit: 3D4medical.com



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