Is Anyone Listening?

Sometimes, at the end of the day, I wish I believed that there was a single politician in Washington who wanted to understand dental insurance.

I am a dentist. And, for the past 20 years, I have been chief dental officer, first for a medical insurance carrier and now, for a dental insurance carrier. One of the reasons I was attracted to my current position is the singular mission of this organization to improve the oral health of the residents in the regions we serve through dental benefits, through research into better ways to deliver care, and through philanthropy that extends oral health services to underserved groups. When your one and only focus is dental benefits, you want your offering to be the best – in prevention services and in reimbursement for dental work when it is needed.

With half of all dental payments being made by insurance companies, many of the improvements in the care you receive at your dentist are made possible thanks to forward thinking dental carriers. Do you have children? Dental carriers led the way with coverage for sealants and fluoride treatments because they help prevent cavities. Have gum disease? Dental carriers paved the way for multiple cleanings and screenings each year. Other innovations? How about coverage for brush biopsies, localized antimicrobials that halt gingivitis in adults, risk-based care and benefits, disease management programs, oral health report cards, and prevention-focused care.

For medical carriers, dental is a plan enhancement, an add-on commodity that can be downsized, restructured, or even eliminated when the carrier needs to meet bottom line demands. Medical plans don’t innovate in the area of dental services, and only sometimes do they watch dental carriers closely and copy new benefits that are popular and financially advantageous. Medical carriers often use the same customer service staff to respond to medical and dental calls, which may leave the caller wondering if the customer service representative understood their questions about tooth decay and gum disease.

So I am concerned that one of the current health reform bills under consideration advocates bundling essential dental services for children into medical plans offered under the Exchanges. And I am concerned that none of the bills include dental benefits for adults. It’s a bad idea to separate children’s coverage from their parents. If parents don’t see a dentist because they don’t have dental insurance, then chances of their children seeing a dentist drop significantly. Keeping standalone dental carriers among the options on the Exchanges makes sure cost effective and prevention-focused innovations in dental benefits will continue. That is the kind of innovation that makes care more efficient and keeps health care costs under control. Without proper support for oral health, current health reform proposals may actually undermine the progress we are making as a nation toward improved oral health and add new barriers to care for the individuals and families that this reform legislation is intended to help. Good oral health is critical for the entire family—parents and children alike.

Healthy Smiles in Miami Dade Schools

We know from the successes of several of the DentaQuest Foundation’s grantees in Massachusetts that portable, school-based dental programs are a proven, effective public health approach to bring oral health services to children. Properly designed school-based programs can overcome many barriers that make it difficult for children to get care -- barriers such as parents getting time off from work to accompany the child, finding transportation to the dentist, and providing regular preventive oral health services for children participating in the Medicaid program.

This fall, the DentaQuest Foundation and the Miami-Dade office of Doral Dental, partnering with the Health Foundation of South Florida, The Children’s Trust, and two Miami community health centers, saw the start of the Healthy Smiles in Our Schools program in 17 public schools in Miami-Dade County.

The goal of Healthy Smiles is to increase the number of children receiving dental exams and treatment and to deliver these services in a practical and cost-effective way – at school where the children spend most of their day. Healthy Smiles is working in partnership with Health Connect in Our Schools, the healthcare program operated by The Children’s Trust in Miami Dade public schools.

The Healthy Smiles program is an example of how public education, philanthropy and public health in Miami Dade are working together to create a lasting solution for the oral health needs of South Florida’s children. Regular prevention measures like dental exams and putting dental sealants on the molars of adolescents can prevent dental disease that interferes with a child’s learning, speech, and eating, and which often leads to poor nutrition and problems in school.

Two community health centers, Borinquen Health Care Center and Community Health of South Florida, are the anchors for the project, providing the dental exams and treatment. The school-based program is an opportunity to provide necessary preventive care to children in Miami-Dade County and to connect their families with the clinics for ongoing comprehensive health care.

We are very proud to be part of this creative and practical partnership of healthcare, education and philanthropy.

Guest Blogging by Ralph Fuccillo, President, DentaQuest Foundation

Health Reform: Put Teeth in the Debate

While oral health is often overlooked in health policy discussions, it remains an essential element for good overall health. Dental health coverage from private insurers like DentaQuest embodies the best elements of a good health care system: it is relatively inexpensive and it promotes preventive care and early intervention.

It is good to see the provisions in the House of Representative’s bill, Affordable Health Care for America Act (H.R. 3962) that include children’s dental care in the essential benefits package. The procedures to be included in the essential benefits have not been discussed yet, but we are hopeful that organized dentistry will have an opportunity to outline the set of essential benefits. Adult dental coverage is not included in the reform bill, so while children might be insured through the “Exchange”, their parents would have to seek coverage in a different plan.

That would have the unintended consequence of dividing children’s coverage from their parents. Good oral health is critical for the entire family—parents and children alike. If parents don’t see a dentist because they don’t have dental insurance, then chances of their children seeing a dentist drop significantly. And that may mean that many childhood diseases, like early childhood caries – an entirely preventable bacterial disease—are less likely to be caught and treated early.

Americans understand how important dental coverage is to them and their families. In a recent poll by Oral Health America, nearly two out of three U.S. adults (63 percent) agree that dental coverage should be part of an overall health reform package. Forty percent believe this is very important.

Despite these facts, the recent discussion of health care reform has ignored oral health, rather than including it as a critical element of comprehensive health care.

The Senate Finance committee proposal has a solution that works for families. It allows family dental coverage to be offered through a dental insurance company and still makes sure that children’s dental needs are covered. Since over 97% of Americans currently receive their dental benefits this way today, please join me in letting your Senators know that you want family coverage to continue.

Whitening vs. Bleaching: What to Know Before you Undergo

White teeth look healthy and a pretty smile usually brings a return smile from those we meet. So if you have been thinking about whitening your teeth, but just don’t know much about it, let me remove the mysteries for you.

Whitening is defined as removing stains so the teeth are clean and as white as they can be. Bleaching is defined as altering the natural color of the teeth, and making them whiter by the use of bleaching agents.

This information alone can help you understand the advertisements for whitening toothpaste, mouthwash and chewing gum. These are merely stating that they have been shown to remove stains from the surface of a tooth.

Bleaching is analogous to frosting a piece of clear glass. Bleach and peroxide penetrate the enamel of a tooth and give it a frosty white appearance. This appearance can remain indefinitely if bleaching agents are used regularly. However, if bleaching is a one-time experience, then the teeth will lose the frosty white appearance over time (usually around 6 months) and the natural tooth color will return.

Be careful though, as teeth are bleached they become more porous and this can cause sensitivity to cold air and water. Many dentists recommend toothpastes that reduce sensitivity for their bleaching patients. Other than the sensitivity, there are usually no other side effects when used as directed. The temptation to exceed the recommendations for bleaching however, can lead to chemical burns on the gums and oral tissues.

The difference between the bleaching kits available at the drug store and those used in the dental office is the concentration of the bleaching agent. The higher the concentration of bleach, the quicker the result, and the higher the incidence of sensitivity. In the long run, over the counter bleaching reaches the same results as the professional bleaching, but it may take several months to achieve the same whiteness as the one hour bleaching in the dental office.

Take Some Candy, Leave the Cavities

Plastic vampire teeth, as popular as they may be on October 31, are no replacement for your child’s own teeth.

While any candy should be consumed in moderation at all times of the year – sugar free if possible – there are other factors to be aware of so that the Halloween holiday doesn’t have lingering effects.

Sugar is a known, major cause of tooth decay and cavities. Even after the candy bars are devoured and your child’s themed bucket or bag has been emptied, sugar and plaque lurk in the crevices of your child’s teeth and cause cavities. If not removed by brushing, bacteria in the mouth will feed on the sugars and turn them into acid. This acid then attacks tooth enamel and causes tooth decay, i.e. cavities.

Halloween is a time for children to enjoy, but you don’t want them to be paying for it in dental pain down the road.

Here are a few guidelines to safeguard your children’s teeth as they savor their sweets:

1. Look for Halloween treats that can be eaten quickly, like miniature candy bars.
2. Sugar free gums that use Xylitol, the all natural sweetener, are a great candy alternative. Chewing gum with Xylitol helps prevent cavities and also neutralizes the effects of sugar from the candy.
3. When you get home from trick-or-treating, discard hard or sticky candies like sugared fruit snacks, caramels, popcorn balls or lollipops. It is hard for saliva to wash away these sticky sugars and they stay in the crevices of the teeth for long periods of time.
4. It is not a good idea for children to graze on candy from after school until dinner time as this will increase the amount of time sugar comes in contact with teeth. Instead, encourage your child to eat a small amount in one sitting followed by a glass of water and thorough tooth brushing.
5. Make sure that your children use an age-appropriate fluoridated mouthwash every evening to strengthen their teeth and rebuild the enamel which helps prevent cavities.

Watching the amount of sugar we consume is good advice at Halloween and year-round for young and old alike. According to the American Heart Association, women shouldn’t eat more than six teaspoons of sugar a day, about the amount of sugar in a candy bar, and men shouldn’t consume more than nine teaspoons a day. On average, Americans consume 22.2 teaspoons of sugar each day.

Regularly practice and encourage good oral health habits with your children, including brushing at least twice a day, flossing and visiting your dentist every six months to ensure the sugary villains don’t stick around on your children’s, or your teeth long after Halloween is over.

Dear Readers

I have some great news to share with you. The National Association of Dental Plans (NADP) has reelected me to their Board of Directors to serve a second three year term (2010-2012) with the group.

NADP is the largest non-profit, national trade association focused exclusively on the entire dental benefits industry, i.e. dental HMOs, dental PPOs, discount dental plans and dental indemnity products. They are the recognized leader of the dental benefits industry, which includes over 173 million covered Americans.

Service with professional organizations like the NADP compliments my work with DentaQuest as well as other dental and community organizations. I share this with you not to pat myself on the back, but to highlight the importance of collaboration within the industry as NADP’s mission –which mirrors our own - is to promote and advance the dental benefits industry to improve consumer access to affordable, quality dental care.

To find out more about what the NADP is up to, please visit http://www.nadp.org/.

Preventing Flu Starting with Your Toothbrush

With cold and flu season upon us, and all the concern about H1N1, almost daily we are reminded about washing our hands to prevent the spread of germs and bacteria. But it is just as important to pay attention to your toothbrush, where germs collect and can be spread.

With this in mind, I want to share a couple of helpful oral health tips that could prevent you from catching a cold this season or worse yet, the flu.

1. Replace your toothbrush often. Most people replace a toothbrush after four months of use, but it really should be changed every two to three months. In any case, get a new brush at the start of an illness and always replace your brush after a cold or flu – which most people don’t think to do.

2. Sterilize your toothbrush and you should do this once or twice a week – especially if someone in your home is sick. The microwave is one option. Put the toothbrush in a microwave-safe cup with 2-3 inches of water and bring the water to boil in the microwave for 3 to 4 minutes. If you are cleaning the brush for your electric toothbrush, submerge the entire brush in water, then bring the water to a boil for 3 to 4 minutes. (This is important to prevent sparks if your brush has a metal connector on it.) The kitchen dishwasher is another great way to sterilize a toothbrush. Just put the brush in the silverware basket when you run a load of dishes. Dishwashers are the nearest thing we have in our homes to the steam autoclave used in the dentist’s office. Cleaning your toothbrush is a good habit to adopt year-round, as there are plenty of germs and bacteria floating around the bathroom eager to cling to your toothbrush.

3. Store your toothbrush away from others in the house, use a toothbrush cover if possible, and always store it upright. Airborne bacteria can move easily from toothbrush to toothbrush, so any way you can limit contact with other toothbrushes is beneficial. Plain soap and water can be used to clean a toothbrush as well as our hands. Also, remember that the tube of toothpaste contacts the bristles so germs can spread from one person to another this way. When you’re sick, it is a good idea to use travel toothpaste or squirt the toothpaste onto your clean finger and then apply to your toothbrush.

4. Wash hands before and after brushing. Bacteria from your hands and food particles from your mouth are unavoidable, but washing your hands – before AND after – can help prevent oral inflammatory disease caused by these kinds of bacteria.

Good dental habits are very important to a healthy body. So take care this cold and flu season and please contact me if you have any questions about these or other oral health tips.