Sonrie!

Oral care in the United States is undergoing many significant changes. One of these is the exciting growth in the number of Hispanic dental practitioners and patients.

I just returned from the Hispanic Dental Association’s Annual (HDA) Roundtable in Plano, TX where I had the privilege of representing DentaQuest. HDA is a rapidly growing organization and the growth is expected to continue well into the 21st century. That’s a good thing because some experts are projecting a U.S. population that will soon be 40% Hispanic. Being able to talk to patients in a way that respects their culture and background is so important in providing the right care, at the right time, so we make a real impact.

The Hispanic Dental Association is playing a major role in building leadership for Hispanic oral health professionals during this time of change and it, like DentaQuest, is focused on prevention, treatment and education. DentaQuest and the DentaQuest Foundation are proud to support their work in improving oral health in the Hispanic population.

It was good to hear about the plans, concerns, needs and passion for dentistry among the member dentists. Several chapter presidents are DentaQuest providers. For me, this was an opportunity to explain the many facets of the DentaQuest enterprise’s commitment to improving oral health – our benefit programs, philanthropy, and clinical care improvement projects. I talked about the work we are doing to support dentists and their patients, to make participating in our networks easier, and to make sure oral health providers can deliver the best care outcomes. The dentists at the Roundtable were very interested in DentaQuest’s dental home project, our broken appointment project, and the many ways our website makes their work easier.

The dentists I met are enthusiastic champions for good oral health. They are hopeful that we will continue to support their meetings with our presence and are anxious to work with the DentaQuest Institute to improve cultural competency at the practice level. I believe that we have a very effective partnership developing. But for any effort like this to truly be successful we will need the partnership to extend to patients as well. Patients can and should play an important role. I’d like to hear from you on your thoughts.

Sip Safely

Spring and summer are a time of sports and hot, humid weather which leads to very thirsty kids. That often translates into an increase in the consumption of sugary and acidic sports drinks. These seemingly harmless liquids can actually wreak havoc on children’s teeth.

The combination of acidic components, sugars, and additives in sports drinks combine to erode the tooth’s surface, weakening the enamel that protects teeth from bacteria. The enamel erosion ultimately makes teeth more susceptible to bacteria and leads to hypersensitivity, staining, and tooth decay.

Frequent consumption of sports drinks lowers the pH in the mouth promoting the demineralization of tooth enamel. (The lower the pH, the more acidic the item.) Demineralization is caused primarily by stable acids found in acidic foods and drinks or which form as by product from bacteria feeding on starches and sugars in the mouth, especially refined sugars.

Demineralization begins at a pH level of 5.5 although under certain conditions, may even start at a higher pH. Popular sports drinks can have a pH of 2.4 and contain 5.5 tsp of sugar in a 12 oz can. So, not only does the drink have a pH that promotes demineralization, it also contains 5.5 tsp of sugar, which can independently contribute to demineralization and tooth decay.

To put the sports drink pH of 2.4 in perspective, compare it to battery acid, which has a pH of 0 and water, which has a pH of 5-7 (neutral). Shocking that a sports drink is closer on the pH scale to battery acid, than water.

Given all this, water is always the best option for everyone but the highest performing athletes who need to replenish minerals from intensive workouts.

If these facts haven’t convinced you to avoid the casual consumption of sports drinks, here are a few tips to keep in mind:

Don’t sip the drink throughout the day. - Drinking them for short periods of time means less time for the sugars and acids to erode enamel. Rinse your mouth with water when you’re done to clear away remaining acids and sugars.

Don’t swish the drink around your mouth. - That only increases the risk of erosion. Instead, use a straw so teeth aren’t immersed in or in direct contact with the sugars and acids in the beverage.

Resist the urge to brush your teeth immediately after finishing a sports drink. - Tooth enamel softens after consumption of acidic drinks, making teeth susceptible to more wear from the abrasives in toothpaste. Wait 45 minutes to an hour before brushing to give your saliva time to re-mineralize the tooth structure and neutralize the damage.

Seek regular dental care. - Tooth decay is the most common chronic childhood disease, five times more common than asthma. It’s also preventable with proper care. Your dentist can identify early signs of erosion, pinpoint the causes, and advise you on how to prevent further damage and more serious problems from occurring.

State of Oral Health in America is Not So Good

In April, the Institute of Medicine (IOM) released a report on the state of oral health in America, concluding a two year evaluation of the current oral health care system. The U.S. Department of Health and Human Services (HHS) requested and funded this report to inform its work in addressing oral health challenges across America. HHS asked the IOM to assess the current oral health system and make strategic recommendations for its future programming. HHS is the federal agency which directs many of the government’s dental delivery, research, training and other programs.

Here are highlights:

• Tooth decay continues to be a common chronic disease in the United States


• The prevalence of oral diseases pose a significant burden on the health and well-being of the American people


• Evidence shows that decay and other oral health complications may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, and diabetes


• Tooth decay is a highly preventable disease


• The general public and many healthcare professionals remain unaware of oral disease risk factors and preventive approaches and they do not fully appreciate how oral health affects overall health and well-being.

The IOM recommended that HHS design an oral health initiative that addresses areas in greatest need of attention, using approaches that have the most potential for creating improvement s, and to support this effort with strong leadership, sustained interest, and the involvement of multiple stakeholders.

“The Committee on an Oral Health Initiative reaffirms that oral health is an integral part of overall health and points to many opportunities to improve the nation’s oral health,” IOM President Harvey V. Fineberg, M.D., PhD., said in the foreword to the report. “We issue this report in the hope that it will prove useful to responsible government agencies, informative to the health professions, and public, and helpful in attaining higher levels of dental health.”

The IOM report and brief are posted online at www.iom.edu/Reports/2011/Advancing-Oral-Health-in-America.aspx

Making Coverage Matter: Pew’s 50 State Report on Children’s Oral Health

On May 24th, The Pew Center on the States, with support from the DentaQuest Foundation and W.K. Kellogg Foundation, issued its second annual report, Making Coverage Matter: Pew’s 50 State Report on Children’s Oral Health.

The report reflects a concerted effort and notable improvement among many of the states during the past year, proving that system changes can yield positive results for states continuing to struggle to provide adequate oral health care for children.

This year, seven states earned ‘A’s including Alaska, Connecticut, Maine, Maryland, Massachusetts, Minnesota, and South Carolina. Of these, Maryland was the top performing state, meeting seven of eight benchmarks. In addition, 22 states improved their grades, six of which raised their grade by at least two letters.

But even ‘A’ states have work to do. In five of these seven states, most Medicaid-enrolled children went a full year without seeing a dentist. And the total underserved population of all 7 ‘A’ states is 2,854,594 people.

While this report highlights the hard work that has gone on across the country to educate the general public and policy makers about programs that reduce disease and increase access to oral health care, lack of access to dental care is still an unacceptably persistent problem. Every year, 16 million children go without dental care, placing them at great risk of getting cavities. Cavities are almost 100% preventable when children have access to prevention, education and treatment services.

Five states including Florida, Hawaii, New Jersey, Indiana, Montana, received ‘F’s from this year’s report. By adopting relatively inexpensive and cost-effective strategies, ‘F’ states could improve children’s dental health. For Florida, Hawaii and New Jersey, this is the second straight year receiving failing grades. Indiana and Montana fell from a ‘D’ to an ‘F’.

This report gets people talking about oral health—and that’s important because it serves as a continuing national call to action for all 50 states to do more to improve children's oral health.

So let’s keep talking. What do you think this report has accomplished? Have you seen any signs of change in your state? Please share your thoughts by commenting on my blog.

A copy of the report can be found on the DentaQuest Foundation’s website, www.dentaquestfoundation.org.

Maryland Dental Action Coalition Launches 5-Year Oral Health Plan

On May 17, the Maryland Dental Acton Coalition proudly presented a 5-year (2011-2015) state plan to promote the oral health of all Marylanders. The plan addresses Maryland’s most critical oral health needs and capitalizes on available resources and data.

Speaking at the celebratory launch event is The Honorable Elijah Cummings, U.S. Congress, a long time supporter of oral health access for children in Maryland and across the United States. Also speaking are Delegate Keith Haynes, Maryland General Assembly, Renee Cohen on behalf of the Honorable Ben Cardin, U.S. Congress, Josh Sharfstein, Secretary, Department of Health and Mental Hygiene, Joseph and Madeline Misero, Katrina Holt, Chair, MDAC Maryland Oral Health Plan Committee, and Beth Lowe, Chair, MDAC. Also speaking is Ralph Fuccillo, President of the DentaQuest Foundation, which provided start up grant funds to MDAC.

Maryland has become a national model in improving the oral health of its citizens over the last decade. The roots of this process go back to 2007, following the untimely death of a 12-year old Maryland child from an untreated dental infection. A statewide Dental Action Committee (DAC) was convened by John M. Colmers, Secretary of the Maryland Department of Health and Mental Hygiene (DHMH), with a specific charge to make recommendations to improve access to oral health care for vulnerable (disadvantaged and/or underinsured) children.

In 2010, the DAC transitioned to the Maryland Dental Action Coalition (MDAC), an independent, broad-based partnership of individuals working to make sure progress continued on the DAC’s recommendations for improving access to oral health care for all Marylanders. Last year, MDAC hosted an Oral Health Heroes Celebration to recognize the work of these oral health pioneers.

The Maryland Dental Action Coalition and its members initiated the development of a 5-year state oral health plan and offered guidance as it was developed. The process involved many individuals in state and local government, academic institutions, professional dental organizations, private practice dentists, community-based programs, the insurance industry, advocacy groups, and others. The goals, objectives and activities in the plan will be the basis for work of the Maryland Dental Action Coalition in the years ahead specifically for:
• Access to oral health care
• Oral disease and injury prevention
• Oral health literacy and education.

With the launch of the plan comes a new phase of collaborative action to improve oral health for Marylanders. MDAC is taking inspiration from Helen Keller, who once said, “Alone we can do so little; together we can do so much!”

A copy of the Maryland Oral Health Plan will be posted to the DentaQuest Foundation website in Reports: www.dentaquestfoundation.org/resources/reports.php

Eliminating Disparities; Promoting Health Equity

Pictured:
Dr. Chester W. Douglass, Harvard University School of Dental Medicine and Harvard School of Public Health and Dr. Philip Woods, Periodontist and Reede Scholar.


Guest blog post by Ralph Fuccillo, President, DentaQuest Foundation

The DentaQuest Foundation was honored to sponsor the Reede Scholars 2nd Annual Health Equity Symposium held at Harvard Medical School on May 12, 2011. An audience of more than 75 leaders among the health professions, including community programming, health delivery systems, health plans and purchasers, large employers, government leaders, and health policy experts attended.

Reede Scholars are health care professionals (physicians, psychiatrists, psychologists and dentists) who are working from the grassroots level to the national level, in business, academia and government. This makes for a powerful network of individuals with numerous and varied talents, experiences and interests -- all focused on improving the health and well-being of underserved populations and racial/ethnic minorities.

The program is named to honor its creator and mentor, Dr. Joan Y. Reede, a pioneer in efforts to improve the representation of ethnic minorities in health services careers and founder of the Minority Health Policy Fellowship. Dr. Reede is an inspiration for thousands who seek to make a difference in the health of their communities. Reede Scholars are advancing public health goals that aim to remedy the root causes of poor health, chronic illnesses, morbidity and death and encouraging greater civic participation and support for improved health, community empowerment, and health equity.

The 2011 Health Equity Symposium explored Health Information Technology (HIT) as an approach to achieving health equity. Dr. David Blumenthal, the National Coordinator for Health Information Technology under President Barack Obama, spoke about the potential of health information technologies as a tool providers can use to better understand the socio-demographics of their patients and monitoring for disparities. Properly used, HIT has the potential to provide a rich and consistent profile of the patient to all his/her providers (medical, behavioral, oral health) not just for diagnosis but also as a point of engagement for patient education and lifestyle improvements.

Often, problems with access to dental care can be linked to the insufficient number of dental and medical provider groups with the experience and training to offer culturally competent care to the population as it is now. Investing in educational programs to diversify the student pool and provide consistent quality experiences outside of traditional clinics is nothing less than investing in the future. Sponsorship of the Reede Health Equity Symposium is one example of DentaQuest’s investments in public health dentistry, health equity and eliminating disparities.

DentaQuest shares the commitment that the return on these investments continue to add new professionals who enter public and private practice with the cultural sensitivity and training to meet the needs of the population as it is now and as it will change.

Penny Wise, Pound Foolish?

This week, two news stories caught my eye. One, in the Washington Post, was about a vote taken in the U.S. House of Representatives to repeal mandatory funding for school-based health center construction. The other, in the Worcester, MA Telegram & Gazette, recalled the days when children in Worcester received their dental care within the public school system. That ended in the late 1970s when most school dental clinics were closed. And since then, the rate of dental disease in the city’s children has been on the rise. It also doesn’t help that the city of Worcester does not fluoridate its water supply.

Across the United States, school-based health centers are becoming an important vehicle for health care delivery for all children, but especially for poor, uninsured or underinsured children. Providing health services where children spend the greatest part of their day makes sense. It eliminates the biggest impediments to getting care – such as the parent/caregiver getting time off from work, finding a provider who accepts the family’s insurance plan, and securing appropriate transportation. School-based health centers help families too, especially when the providers introduce children, siblings and the extended family to community health resources that all can use.

School-based clinics are a first line of disease prevention and eradication. When children and their caregivers know what to do to take care of teeth, and when they are able to see a dentist when something is wrong, cavities are nearly completely preventable. And when neither of the above takes place, children can end up with serious decay and infections that require emergency room care and extreme interventions. (Read about Early Childhood Caries in this blog here and here.)

Today Worcester, MA is working to establish a pathway for young at-risk children and their families to a lifetime of good oral health. Through a pilot program, 730 Head Start children and their families are learning about oral health as part of classroom activities and parent meetings. They are introduced to the dentist as a friendly, supportive adult. Parents/caregivers get a colorful “Baby Tooth Timeline” -- a growth chart which tracks age, height and weight and provides useful dental health information for the child’s first five years. The chart explains when to expect first teeth, what to do to prevent decay, and when to schedule dentist visits.

The next step is to be sure the children have connections in the community to get care when they need it. Statistically, low-income children suffer from dental disease at much greater rates than the general population. Many Head Start children are covered by Medicaid; but not all dentists accept Medicaid patients.

And, not all school-based health centers provide dental services. We think they should. As the Worcester example shows, prevention works. It would be nice if the U.S .House of Representatives would reconsider their recent vote, and instead, approve the wise investment in school-based health centers.

Dr. Mark Doherty is Executive Director of the DentaQuest institute, a not-for-profit organization focused on improving efficiency, effectiveness and quality in dental care.