Molars, incisors and canines -- oh, my!

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)

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

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

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.

A 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

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

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

Hearts, minds and teeth in Afghanistan

The U.S. military is hoping to win hearts and minds among villagers in Afghanistan by pulling their rotten teeth.

A task force in the Shindand district of the Herat province reports pulling more than 180 teeth. Toothpaste and toothbrushes were handed out -- a rarity in Afghanistan.

The Army reports one of the first patients to volunteer was Arbov Zacharia, a village elder. A U.S. dentist said that afterward Zacharia kept pointing to the extraction site and giving the thumbs-up sign.

"It's nice to know your work is appreciated," the dentist told the American Forces Press Service.

-- Tony Perry

Photo: An Afghan village elder getting decayed tooth pulled.  Credit: U.S. Army