Friday Dental Download October 31, 2014

This week we discover a decrease in the rate of early childhood caries, discuss the link between hair keratin and tooth enamel, and learn that South Carolina will provide adult dental benefits under Medicaid starting December 1. Don’t forget to check out our healthy Halloween tips and our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.

1.     South Carolina to provide adult dental benefits under Medicaid: Starting December 1, 2014, South Carolina will provide preventive dental benefits to adult Medicaid clients in the state. Previously, South Carolina was one of 16 states that offered only emergency dental benefits through Medicaid. We are seeing this as a growing trend across the country and applaud South Carolina for its dedication to improving the oral health of all. You can read about what other states are doing related to Medicaid adult dental benefits here.

2.  A new study shows a link between hair keratin and enamel strength: A new National Institute of Health study found that keratins, the proteins that play a large role in maintaining the strength of hair, are also an essential organic component of tooth enamel. As part of tooth enamel’s protein composition, keratin can influence tooth enamel structure and strength. The study found that people who have had keratin mutations associated with hair disorder also had abnormal enamel structure that resulted in tooth weakness, which increases their risk of dental caries.

3.     CDC data shows early childhood caries trending down: CDC data presented at the University of Maryland Early Childhood Caries Conference, which DentaQuest attended, shows a downward trend in early childhood caries in the United States. The National Institute of Dental and Craniofacial Research defines ECC as the presence of at least one carious lesion on a primary tooth in a child under the age of 6 years. According to Dr. Bruce Dye, dental epidemiology officer at the Centers for Disease Control and Prevention National Center for Health Statistics, the greater proportion of caries experience in the U.S. among 2-5 year olds has clearly shifted towards more restored dental surfaces for all 20 primary teeth. The DentaQuest Institute’s Early Childhood Caries Collaborative has been engaging dentists, pediatricians, oral surgeons, educators and community health workers in developing and testing best practices for managing chronic caries infections in at-risk infants and pre-school children.

4.     Genetic test for periodontal disease honored at ADA meeting: The link between genetics and periodontal disease was a focus of this year's annual meeting of the American Dental Association, which took place from Oct. 9 to 14. Interleukin Genetics CEO Dr. Kenneth S. Kornman presented on the topic of genetic testing. The study provides insight into the prevention of periodontal disease and the importance of a personalized approach to preventive care that includes genetics.

How College Kids Are Spreading Cavities

By: Dr. Brian Novy, DentaQuest Institute

As a dentist, I’ve noticed an interesting phenomenon – kids who go to college without ever getting a cavity often return home to find out they now have dental caries. 

No one has looked at this phenomenon with rigorous clinical trials, but many of my colleagues see this happen to their patients. Why is this?

Most of us naturally have the bacteria that cause tooth decay already living in our mouths. As Everyday Health explains, tooth decay results when that bacteria feed on food debris (starchy, sticky foods are a primary culprit) and produce acid as a byproduct. This mixture of food, acid, saliva, and germs clings to your teeth as a filmy substance called plaque, which over time can erode the enamel and cause cavities to form.

When the mouth’s environment is repeatedly altered by a change in diet – such as constant snacking, which often occurs when college students study – it gradually begins to encourage the growth of the decay causing bacteria. Additionally, kissing, sharing food and utensils can cause germ to spread, making cavities “contagious.”

If college students don’t want to experience their first cavities during winter or summer break, they can follow these helpful tips:

• Brush teeth with fluoridated toothpaste for two minutes at least twice a day – preferably after breakfast and before bed
• Floss twice a day
• Rinse your mouth with anticavity fluoride rinse after brushing your teeth
• Leave a little toothpaste foam in your mouth when you go to bed
• Rinse your mouth with water after drinking sugary and acidic drinks like sports drinks or alcohol and eating candy or sticky foods. Be sure to brush later.

For more oral health tips visit our adult oral health library. 

Don’t End Up With Jack O’Lantern Teeth This Halloween

Each October, children look forward to dressing up and going from house to house collecting candy for Halloween. But in October, we celebrate more than just Halloween – it is also National Dental Hygiene Month so it’s the perfect time of the year to teach our children good oral health. 

Here are five of our favorite tips for making it through Halloween with healthy teeth and good oral hygiene:

Certain candy is better for teeth than others

As dentists, we do not recommend eating a lot of candy; however, there are some that can be more damaging than others. Candies that are sticky and chewy tend to get stuck in the crevices of your teeth and cause cavities. Candies that stay in your mouth longer, such as lollipops and Jolly Ranchers, also have the potential to be harmful because your teeth are exposed to the sugar for a longer period of time. We recommend sorting out these types of candies from your child’s Halloween candy and only keeping the candy that is quicker to eat and lower in sugars, such as chocolates and powdery candy.

Make the candy a treat

Children often tend to consume more candy around Halloween because it is lying around the house. That encourages snacking all day which is bad for your teeth. Instead of leaving the candy out, stash it away -- and make it a treat. This will prevent kids from consuming the candy whenever they want. Reward your child with a piece of candy for completing chores, getting a good grade, having a good attitude, etc.

Practice good dental hygiene after eating candy

Brushing twice a day is always important to maintaining good oral health; however, when your sugar intake increases, it is especially important to increase your oral health hygiene as well. Brushing your teeth and rinsing your mouth after consuming candy can reduce your chances of tooth decay. Also, make sure your little ones drink a lot of water (even better if it contains fluoride); this will help wash the candy particles away.

Donate extra Halloween candy

Donating your child’s Halloween candy is great way to limit the amount of candy your child consumes. We recommend sitting down with your child to help them pick a few of their favorites and then packing up the rest. There are many charities, dentist offices and organizations that take candy donations. Some dental offices will even reward patients for bringing in candy.

There are alternatives to candy

Consider purchasing healthy snacks or non-food treats for those who visit your home. Crackers, pretzels, stickers, pencils, yo-yos, coloring books, and of course toothbrushes, toothpaste and floss are all great things to handout and are still fun for kids.

Halloween doesn’t have to be scary for parents and dentists if you follow these tips. DentaQuest wishes everyone a happy and safe Halloween!

Why This Matters to Me Part 2: Reducing ER for Non-Emergency Dental Care

By Steve Pollock, Chief Operating Officer, DentaQuest

We have long known that patients showing up in the emergency room (ER) for non-emergency purposes is a significant cost driver. A recent article in Covering Health reported that between 2008 and 2010, more than 4 million patients turned to hospital ERs for help with dental conditions at a cost of $2.7 billion.

What many don’t realize is that patients often rely on ERs for dental problems that can be treated in a far less costly dentist office environment - or avoided completely through consistent, preventive dental care. Often ER care is focused on controlling infections and pain management. Neither treat the root cause of the dental problem, leading to new flare-ups and return visits to the ER for more medication for pain and infection.

As the Affordable Care Act (ACA) continues to encourage more informed use of healthcare resources and forces us to look at ways to reduce costs, reducing ER utilization for non-emergency services should be a top priority. Dental is a logical place to start.

The healthcare system is beginning to see the significant correlation between medical and dental health. ER care is an important place to make those connections, thus avoiding costly and unnecessary emergency treatment. For example, ICD-10 includes numerous dental codes; come October 1, 2015, doctors will be able to allocate time during appointments for a patient’s dental concerns.  However, from a patient, clinical and cost perspective, much more needs to be done to keep children and adults out of the ER, and prevent the painful, life threatening and costly diseases that can result from poor dental care. We believe the first step is effective education. As an enterprise, we’ve begun to tackle this issue from multiple angles, focusing on case management and education in an effort to mitigate the number of adults and children visiting the ER for non-traumatic incidents as a result of neglected oral health:  

• Emergency Room Diversion Program. Using medical claims from ER visits identified as non-traumatic dental, we develop a list of patients to reach out to via phone on a biweekly or monthly basis for education on the importance of dental care. Our outreach is working. As a result of this approach, one of our health plan clients is experiencing a 31 percent average reduction in ER visits for non-traumatic dental.

• Early Childhood Caries (ECC) Collaborative. For more than five years, the DentaQuest Institute has been collaborating with dental care providers at hospitals, safety net programs and private practices on the best ways to keep children out of hospital operating rooms for surgeries that treat Early Childhood Caries, an aggressive form of dental disease in young children. Cavities are a chronic and transmissible infection and one of the most common and avoidable diseases in children. The ECC Collaborative is focused on identifying best practice models of care that would reduce pain experienced by the children, reduce operating room utilization to repair damage caused by the disease, and prevent recurrence of the disease. As a result of this work, operating room utilization for ECC in the participating organizations has declined by a third, and the number of children who developed new decay declined by 30 percent.

Research shows that many costly visits to the ER could have been easily avoided with education, diversion programs, and proper care. As margins continue to tighten and health insurers are looking for new ways to reduce costs and improve services, diverting dental patients from ER care through education and prevention should be a top priority. 

Friday Dental Download: October 24, 2014

This week we learn about Ebola guidance for dentists, discuss the urge for action and education about the benefit of fluoride and learn what your teeth tell you about your body.  Don’t forget to check out our new blog series here! Join the conversation on Twitter using #FridayDentalDL.

1. Health authorities offer Ebola guidance for dentists: The American Dental Association released information for dental professionals about the Ebola virus this week. Among other recommendations, it recommends the delay of dental care for patients who recently returned from the West African countries of Liberia, Sierra Leone and Guinea until 21 days after their trip. In general, providers of dental health care services should continue to follow standard infection control procedures in the clinical setting.

2.  Medicaid and CHIP Enrollment Grows by 8.7 Million Additional Americans: The health insurance marketplaces under the Affordable Care Act, state-based Medicaid programs, and the Children’s Health Insurance Program (CHIP) are critical in providing health insurance coverage for many Americans who couldn’t afford it otherwise. As of October 17, 2014, approximately 8.7 million additional Americans have now gained coverage through Medicaid and CHIP, many for the first time.  In all 50 states, CHIP includes preventative dental services, and many other states are working on improving and expanding adult dental benefits in their Medicaid program.

3. ADEA president urges action, education on fluoride benefits: Time and time again, credible scientific evidence demonstrates that optimally fluoridated water is safe to drink, does not cause systemic disease and provides the best protection against dental caries in both children and adults over the course of a lifetime. Setting the record straight is essential and requires an “energetic response” from people in the position to make scientific evidence easy to understand for the public.

4. Proper Dental Care Linked to Reduced Risk of Respiratory Infections in ICU Patients: New research shows vulnerable patients in the intensive care unit (ICU) who received enhanced oral care from a dentist were at significantly less risk for developing a lower respiratory tract infection (LRTI), like ventilator-associated pneumonia, during their stay. Having a dentist provide weekly care as part the ICU team may improve outcomes for vulnerable patients in this setting. Patients who were provided enhanced dental care were 56 percent less likely to develop a respiratory tract infection during their ICU stay compared to the control group.

5. For Some Children with Autism, Even a Toothbrush Is a Challenge: Since dental cleanings happen only twice per year, it’s incredibly important that parents help their children brush their teeth twice per day. But according to this article in the New York Times' Motherlode section, that can be a challenge for some autistic children. Here are some tips for parents with kids with autism to follow to ensure your child has a healthy mouth:

• Use an electric toothbrush
• Accustom your child to the brushing sensation on gums even before the first teeth appea
• Give your child a reward – but not candy
• Offer choices so your child feels in control
• Set up a routine
• Use a timer 

6. What your teeth are trying to tell you: Your teeth and gums tell you something very important about your health. Pennsylvania resident Jennifer Harvey didn't go to the dentist for two years. Her gums were bleeding all the time and when she visited her dentist, she discovered that she had diseased, decayed teeth. More than 800,000 visits a year to the ER are because of teeth troubles. If you have white, yellow or brown spots and grooves on the tooth surface these could be signs of celiac disease. Pain in your top teeth could be a sign of a sinus infection. Canker sores are a tell-tale sign of allergies you may not know you have. Check your risk for dental disease here.

Eliminating dental disease in children: U Maryland Early Childhood Caries Conference Highlights Innovations

This is a busy week for DentaQuest. On Monday through Wednesday, we have teams in California at the annual conference of the California Association of Health Plans, where participants are Charting a Path for a Healthier California. 

Also this Monday through Wednesday, our Foundation is hosting the annual gathering of grantees and partners. They are working through strategies to achieve the ambitious goal of Oral Health 2020: Improving oral health across the lifespan and eliminating dental disease in children.

On Thursday, DentaQuest teams are heading to the University of Maryland School of Dentistry Innovations in the Prevention and Treatment Conference where the focus is eliminating early childhood caries (ECC), a virulent form of cavities that impacts very young children. Rob Compton, DDS, President of the DentaQuest Institute, is joining many other ECC experts; he will be sharing the models of care being developed and tested by the DentaQuest Institute’s ECC Collaborative. Additionally, the DentaQuest Foundation is a supporting sponsor of the conference.

This conference is important because it brings together organizations that have been specifically focused on the challenges of arresting and reversing early childhood caries. We are eager to hear how our colleagues are approaching this challenge.

Early childhood caries, an aggressive form of dental disease in infants and pre-school children, is a significant public health problem, especially among economically disadvantaged children. Children who suffer from ECC are often from low-income families. However, as modern families are stretched in many directions, many middle class families are also facing the challenges of this chronic disease.

The prevalence and spread of dental caries can be prevented or slowed if the disease is caught in the earliest stages. Unfortunately, the disease is often not detected until it is well established. When there is no intervention, the disease progresses until the tooth is destroyed. ECC is painful.  Children have problems eating, delays in speech, and even diminished self-esteem.  If the damage is severe, the child can lose teeth or require extensive surgery which may include root canals and stainless steel crowns. Even after surgery, children often return within a year (23-57 percent return within six-to-24 months) with new disease, in need additional surgery. Surgery treats the symptoms, not the factors contributing to the disease.

In 2008, recognizing an opportunity to tackle ECC using a disease management approach, the DentaQuest Institute, in partnership with Boston Children’s Hospital and St. Joseph Health Services and Hospital, launched a pilot that has focused on educating families of at-risk children about dental health and self-management. That work led to the ECC Collaborative, now in Phase III, which has been engaging dentists, pediatricians, oral surgeons, educators and community health workers in developing and testing best practices for managing chronic caries infections in at-risk infants and pre-school children. The Collaborative is focused on reducing new cavitation, reducing pain, and reducing operating room utilization in children ages 0-5.

ECC is serious. DentaQuest is excited to be part of the extraordinary collaborative learning opportunity hosted by the University of Maryland School of Dentistry. This is a public health problem that will certainly benefit from innovation and creative solutions.

Charting the Path to a Healthier California

A DentaQuest team is headed west for the California Association of Health Plans’ Annual Conference (October 20–22).  A team from California Dental Network, Inc.*, a DentaQuest company, is joining us at Booth 202. This year’s conference theme, “Charting the Path to a Healthier California” embraces how California’s health insurance market is transitioning to a new landscape as a result of the Affordable Care Act. Within this new environment has come a new consumer focus on health insurance, new regulations, the creation of a state-run health insurance exchange, and the expansion of Medicaid benefits.

It is all good news. Despite a bumpy start, healthcare reform is spurring the customer growth that health plans want to see. Today, millions of Californians have insurance cards that grant them access to quality medical care.  And, there is opportunity for more growth, through dental and vision benefits. 

Analysts at Cigna surveyed 1,847 U.S. residents ages 25 to 64 with an annual household income of at least $25,000 and found 30 percent wished they had dental insurance.  The demand clearly exists.

Dental benefits are a highly effective way for insurance plans to grow market share and improve the overall health of their members while managing costs.

We are looking forward to speaking with health plans about the many ways ancillary benefits should be viewed as a strategy for growth. We have a full suite of products for just about every business portfolio – commercial or government, on or off the Marketplace. And, we are also known for our ability to increase existing dental membership, control costs and improve the quality of service for our clients and their members.

Thanks to efforts led by the legislature and supported by the California Dental Association and many other organizations, including some DentaQuest Foundation grantees, California has set itself apart as a national healthcare leader and supporter of oral health. Recently Governor Jerry Brown approved a budget that included preventive and restorative care and full dentures for adult Medicaid recipients, benefits that had been eliminated in 2009.

As several U.S. Surgeon Generals have said, you can’t have good health without good oral health. We are looking forward to opportunities to work together in 2015.

*California Dental Network is a wholly owned subsidiary of DentaQuest, LLC. 

DentaQuest Foundation Grantees & Partners Commit to Oral Health 2020

This week, the DentaQuest Foundation is welcoming over 160 grantees, partners and friends to our annual grantee gathering in Philadelphia. This year’s theme is “Strengthening the Core: From Network to Social Movement.”

Since 2011, the Foundation, through grants and programmatic direction, has been fostering the growth and development of a national network of individuals and organizations dedicated to improving oral health.  This week’s gathering is an opportunity for members of this growing network to make new connections, celebrate individual and collective successes,  get support in meeting challenges, and become inspired by creative thinking and unexpected viewpoints.

This is also an opportunity for all of us to consider how we will commit to the possibilities of Oral Health 2020 to improve oral health across the lifespan and eliminate dental disease in children.

How will each of us – grantee, partner and friend – contribute to the ambitious targets that we collectively aim to achieve by the end of the decade?

• 75% of all children reach age 5 without a cavity
• Oral health is incorporated into the 10 largest school districts in the US
• A comprehensive adult Medicaid dental benefit is available in 30 states and through Medicare
• A comprehensive state and national oral health measurement system is developed

A focus will also be on how to elevate oral health equity and health literacy in the expanding work of the network. Meeting the milestones of Oral Health 2020 will bring the greatest benefit to communities that today experience the greatest burden of poor oral health. How can the oral health network help them lift their voices to support changes that deliver new possibilities for oral health for all? 

We have an exciting week ahead. Participants will be sharing their thoughts via twitter, using the hashtag #DQFConnections. Follow along to read all about the accomplishments and goals of our grantees. Attending the conference? Use the hashtag to tell us about it.

Friday Dental Download: October 17, 2014

This week we learn about a new genetic risk test for periodontal disease, discuss the role of dentists in pain management and addiction and learn that most kids have poor dental hygiene habits. We also introduced our new blog series, don’t forget to check it out! Join the conversation on Twitter using #FridayDentalDL.

1.     Study: Most kids’ dental hygiene not good: According to a recent Ad Council study, three out of four parents say their kids forget to brush their teeth, but only 22 percent of parents seem to be concerned about it. This is a big problem with kids grazing on sweet and snacks and sugary and acidic drinks throughout the day. The residue sits in their mouths creating opportunities for tooth decay to set in. Juice boxes, energy and sports drinks, soda, and high carb snacks increase the risk of cavities. For tips for pediatric oral health care visit our oral health library.  

2.     ADA 2014: Pain management and addiction – the dentist’s role: Pain management, identification of patients at high risk for substance abuse, and utilizing interventions for drug abusers were the focus of a session at the American Dental Association 2014 annual meeting. According to Patrick Sammon, PhD, professor emeritus from the department of oral health science at the University of  Kentucky College of Dentistry, about one third of every dentist’s patients (37 percent) have a drug problem. Dentists now have an array of drugs to control pain. If a dentist suspects a patient is abusing drugs, he/she should use the SBIRT method: screen patients, use brief intervention, and refer to treatment. Click here for more helpful tips and information.

3.     Athletes’ Teeth May Suffer from high Carb Diets, Sports Drinks and Eating Disorders:  We know that sports drinks partnered with poor oral hygiene can often lead to gum disease; however, a recent study shows that high carb diets can also contribute to cavities. Scientists found that a high carb diet – a  diet heavily based on refined and processed carbohydrate foods – can lead to tooth decay and gingival inflammation. If you’re an athlete, check your risk for gum disease here.  

4.     Genetic risk test for periodontal diseases highlighted during ADA annual meeting: Interleukin Genetics, Inc., Chief Executive Officer Kenneth S. Kornman, DDS, PhD and his colleagues reported on their study which found important new insights into the prevention of periodontal disease and the significant opportunity to improve oral health through a personalized approach to preventive care. The genetic test is performed by dentists during routine exams or cleanings. It measures variations in genes for Interleukin-1 (IL-1), a key mediator of inflammation, and identifies individuals who are at increased risk for moderate to severe periodontal disease.

                                                                                                             

The Best Thing You Can Do for Your Teeth is to Brush and Floss Them – Every Day.

We recently tweeted about Sarah Klein’s article in the Huffington Post, Why Falling Asleep Without Brushing Your Teeth is Actually Pretty Darn Gross. That tweet got your attention.

Sarah wrote, “Brushing is important for reasons beyond fresh breath.” Here’s why: brushing disrupts the growth of bacterial plaque on your teeth. When you don’t brush your teeth plaque makes itself at home on your pearly whites. The longer that plaque sits on your teeth, the more likely it is to become harmful.

When the bacteria stays on your teeth, it releases acids that draw minerals out of the tooth’s enamel.  You can even see this happening - white spots on the teeth are a warning sign. If you start to see white spots on your teeth, we recommend you see your dentist as soon possible because the tooth can still be ‘healed’ with fluoride treatments. If you don’t do anything, the acids will continue to eat away at the enamel, and over time, it will collapse, causing a cavity. 

The best thing you can do for your teeth is to brush and floss them twice every day (make sure to brush for 2 minutes each time).  The effectiveness of this simple routine was demonstrated in a study of children in the town of Nexo, Denmark. The experiment was pretty simple: parents and children were told the correct way to brush their teeth (using fluoridated toothpaste) before breakfast and before bedtime. Fluoridated toothpaste was used because fluoride helps harden the enamel, protecting it from the acids. At the start of the experiment, the children in the Nexo study and other children across Denmark had similar rates of cavities (see chart below). Over time, the simple routine of properly brushing twice a day with fluoridated toothpaste made a big difference – a 60 percent improvement in the cavity rate in seven years.

October is National Dental Hygiene Month so now is a great time to adopt a daily plan to brush, floss, rinse, and chew sugar-free gum in order to improve and maintain your best dental health. For more information and best practices visit our Oral Health Library.

DentaQuest Launches a New Series About Ancillary Benefits: Why This matters to Me

By Steve Pollock, Chief Operating Officer, DentaQuest

As we approach open enrollment this fall, millions of American’s will purchase and use health insurance for the first time, and dental management will be a key component of cost reduction strategies.

Between 2008 and 2010, the American healthcare system spent $2.7 billion on the more than 4 million patients who relied on hospital emergency rooms for help with dental conditions, many of which did not require immediate attention and could have been treated in a less costly dentist’s office. This unnecessary expense could be reduce or eliminated with proper dental management.

I am excited to launch my new blog series, Why this Matters to Me, an informational series to highlight how ancillary benefits, like dental and vision, are necessary to improve patient experiences, reduce the cost of care, and help health plans meet the new demands set forth by healthcare reform and increased regulation.

These strategies are especially important as the introduction of healthcare exchanges and the expansion of Medicaid allows many Americans to buy and use insurance for the first time.  Here are just some of the numbers:

As many as 8 million adults will gain dental benefits through Medicaid expansion Health insurance enrollment through the federal and state marketplaces is expected to quadruple to 28 million consumers by 2023. In the first year of health reform, 21 percent of all consumers on the federal exchange purchased stand-alone dental plans.

Oral health affects medical care in countless ways, and there are valuable opportunities for the two areas of healthcare delivery to collaborate more closely for the benefit of providers, patients and healthcare organizations.

The shifting healthcare landscape presents us with a perfect opportunity to explore strategies that will improve the delivery of care in a more efficient way. Below are a few examples of the types of topics I’ll cover in this series:

• Emergency Room Diversion: Too often, people rely on emergency rooms for dental problems that could be prevented and treated through regular visits to the dentist. At DentaQuest, we understand that preventive dental services mitigate the frequency of emergency room visits and that fewer emergency room visits reduce the cost of healthcare for patients and institutions. I’ll explore the innovative ways we are reducing reliance on emergency rooms, such as the DentaQuest Institute’s Early Childhood Caries (ECC) Collaborative that seeks to reduce dental surgery through education.

• Medical Dental Integration: Periodontal disease, a type of dental disease, produces inflammation throughout a person’s body, which affects their ability to manage and combat chronic disease.  Aligning medical and dental professionals to provide coordinated care for patients can lead to better disease management and thus reduced costs.

• Using Ancillary Benefits as a Strategy for Growth: In this changing market, consumers are demanding greater value at reduced costs while regulations are creating even more strain on margins. I will explore the advantages of using dental as a strategy to grow market share and provide great value in your offerings. 

The ACA continues to significantly influence the ways in which today’s consumers purchase, view and seek healthcare services. As a result, we must adjust the way we think about providing and funding healthcare. In that vein, I look forward to engaging in a conversation about how integrating dental benefits can make the healthcare industry more efficient and effective for all of us.