Washington’s Unseen Oral Health Debate

President Obama’s state of the union address the other night sent a clear message that the health care reform debate will continue in some form. Whatever happens, lawmakers should not overlook what happens above the neck—the importance that oral health plays in an individual’s overall health.

The good news is that today, more than 174 million Americans have dental coverage, and 97 percent of that is provided by stand-alone and dedicated dental insurance companies. Dental insurance companies have a singular focus that has resulted in affordable coverage—the average individual plan is around $30 a month—with an emphasis on preventive services like sealants and fluoride treatments.

The old adage—“if it ain’t broke, don’t fix it”—should apply here. The system works. Yet there are proposals in Congress that would force up to 50 million children to switch dental coverage from a stand-alone plan to one administered by a medical insurer (like HMOs). This overlooks the benefit of stand-alone plans and would put Americans’ oral health needs at risk.

Congress should move forward to overhaul our health care system, but we shouldn’t attempt to ‘fix’ what already works in providing Americans high quality oral health care.

Guest Blog Post by Fay Donohue, President and CEO of DentaQuest

Predictions Can Come True in Dentistry

I see lots of predictions at this time of year and it is interesting to see how close they are to reality.

In dentistry, new predictive tools that indicate whether a person will get cavities are very close. New technology is helping dentists move from treating disease, that is waiting for a cavity to form and repairing the tooth, to emphasizing prevention and wellness -- by determining which individuals are at greater risk for cavities and showing them simple interventions that may save them from getting dental disease.

Researchers have perfected a technique called ATP-bioluminescence that measures the energy source for the cavity-causing bacteria in an individual’s mouth. And interestingly, the results are as accurate --and possibly even more accurate -- than sending mouth swabs to a lab for analysis. The energy source is called ATP.

A hand-held test is now available for use in the dentist’s office that measures the amount of ATP in the cavity-causing bacteria of a patient’s mouth with an instrument about the size of a television remote control. As part of a routine exam, the dental hygienist simply takes a swab sample from the patient’s teeth and in fifteen seconds, the device analyzes the energy in the bad bacteria. Counts below 1,500 are seen as “good” and those reaching 10,000 are “bad”.

Bad does not mean that you are doomed to a mouthful of cavities. But it will alert your dentist that intervention is needed. The first step may be to reduce the acidity in your mouth, and therefore reduce the energy available to feed the cavity-causing bacteria. Your dentist may suggest brushing with baking soda toothpastes or using specially formulated mouth rinses which reduce acid levels and help reduce or eliminate cavities for you.

Dentists also strongly recommend the use of prescription fluoride gels and rinses which help small cavities heal themselves. Another good idea is to use products (like chewing gum) sweetened with xylitol instead of sugar because xylitol has been shown to reduce the risk of forming new cavities.

ATP-bioluminescence looks promising. It will be interesting to hear what dental offices think about this new technology as way to help patients prevent dental disease.

I am always on the look out for details about new technological advancements in dentistry, especially those which promise to help patients and their dentists prevent disease. There is currently some very innovative research underway that may lead to surprising health outcomes. I’ll be bringing them to your attention as I learn more about them.

For now, you can see how the ATP bioluminescence meter works at: http://www.carifree.com/media/CariFree_Demo.html.

A Resolution to Smile About

The many family and social gatherings between Thanksgiving and New Year’s Day are trying times for your waistline … and for your teeth.

Americans consume roughly 675 million pounds of turkey on Thanksgiving Day. Billions of candy canes are eaten each holiday season and each person puts away an estimated 12 pounds of premium chocolates. Almost all of our favorite holiday treats are filled sugar that could all take a serious toll on your teeth.

And it’s not just the food. Americans drank enough last year for every person to have had 7 bottles of liquor, 12 bottles of wine, and 230 cans of beer. If you don't make good decisions about what you are eating and drinking, or properly clean your teeth afterward, you could end up with tooth decay, gum disease and possible tooth loss.

With this in mind, I want to share some oral health tips that will help keep your smile intact this holiday season and into the next:

If you drink wine, choose red over white. White wine is more acidic than red wine and it contains more sugar, making it more harmful for your teeth in the long run. Researchers say contact with white wine erodes the tooth’s protective enamel - making teeth more sensitive to cold, hot and sweet food.

Regardless of the color of the wine, rinse your mouth with water before brushing your teeth. Brushing immediately after consuming wine, a very acidic beverage, may damage the tooth's structure. Give your mouth’s saliva time to re-mineralize the tooth structure and neutralize possible damage. So wait, and then rinse with water before brushing.

If you choose to drink spirits or liquor, the opposite is true. Opt for lighter or clear liquids to avoid higher sugar content. Also, be aware of the sugar content of your favorite mixers. And as with the wine, rinse your mouth with water after you drink and before you brush your teeth.

Eat some cheese. The mouth naturally becomes more acidic after eating to aid digestion. Cheese keeps the mouth less acidic and therefore healthier for teeth. Cheese also coats the teeth with calcium and prevents demineralization. (And consider this -- chewing sugarless gum increases saliva, which helps clear food from tooth crevices and replaces essential minerals on teeth. We recommend gum with the sweetener Xylitol which is a natural cavity fighter.)

Consume candy in moderation – sugar free if possible. If you are choosing between a candy cane and a piece of chocolate, go with the chocolate. Sticky candies are less likely to wash out from between your teeth with saliva and therefore get more time in contact with your teeth. (This is also true for fruit cake.) Also, avoid biting directly down on hard candies to avoid fracturing a tooth.

Resolve to floss at least once a day this next year. If you are already a flosser, good for you. If you aren’t, or are only flossing sparingly, make a resolution to add this to your family’s daily routine. To get you started, most dentists give you a free trial size to ease you into this great lifelong habit.

No matter how exhausted you may be from hosting your family or attending your fifth party in a row, remember to brush your teeth before you go to bed. If all the acid from the food you ate gets 8 hours to fester in your mouth, it can do a lot of damage that you could have been prevented with 2 minutes and a toothbrush. Do the same in the morning --keep in mind plaque builds up even if you haven't eaten anything for 8 hours.

Good dental habits throughout the holidays – and year round – will help make for a happier New Year. As you make plans for 2010, I hope you all will resolve to be better to your teeth because that’s something we can all smile about.

Guest Blog Post by Dr. Linda Vidone, Associate Dental Director for DentaQuest

Dental Care as an Essential Benefit

When times are tough and people tighten their belts and family budgets, visits to doctors and dentists often get cut. Even relatively small co-pays can be justification to skip a check-up, renew a prescription, get an annual dental cleaning, or even get a small cavity filled. Unfortunately, ignoring routine care can have serious consequences.

Many States are facing budget challenges as well. As legislatures work to close shortfalls in state budgets, dental benefits provided through Medicaid are being cut or eliminated. This year, California, Hawaii, Massachusetts, Michigan, North Carolina, and Washington have considered funding cuts to, or elimination of, dental benefits. The numbers are significant –California stands to save about $614 million per year. Massachusetts hoped to save $60 million a year, but a recent upturn in revenue has put proposed cuts on hold. That is positive news for Massachusetts because the impact of the proposed cuts would have been staggering. The Massachusetts Medicaid program provides dental services to more than 1 million of the state's low-income seniors, chronically ill, and people with disabilities. That is almost one in ten of the state's neediest residents.

There's a great misconception that dental care is not one of the essential types of health care that people need. Not true. Dental care is critical to everyone’s good health and wellbeing. According to the U.S. Department of Health and Human Services and the American Dietetic Association, a variety of medical conditions – such as diabetes, heart disease, HIV, and complications of pregnancy—have been associated with poor oral health.

When states are forced to make cuts in Medicaid-sponsored dental programs, there are consequences. One is an increase in the numbers of patients with illnesses that could have easily been prevented. Fixing a chipped tooth right away, or filling a cavity when it is small is simpler, less painful, and less costly than waiting for the issue to escalate to a larger, more complicated dental infection. A second consequence is an increase in emergency room and other triage costs -- which taxpayers ultimately pay for -- as patients desperate to relieve mouth pain are left with no other options for care. When an individual visits the emergency room because of mouth pain, the pain may be addressed, but the cause of the problem is often not treated. This leaves the patient vulnerable to more severe problems, which ultimately become more costly to treat.

These are facts. Dental disease is nearly 100% preventable. Dental benefits help people get the care they need in good times and in tough times. Making sure dental care is an essential benefit in state Medicaid programs makes good sense.

Guest Blog Post by Steve Pollock, President of DentaQuest Government Business

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.