FYI

Dentist blog from Delta Dental

Category: Oral health

Stay on top of the latest news and research in the world of oral health, and find educational resources to promote wellness to your patients.

Kids’ unmet oral health needs highlighted by the pandemic

Do you know how many of your patients plan to become pregnant or adopt a child in the next year? Unlike physicians, you probably see most of your patients every six months. In the space between cleanings, a woman could be almost 2/3 of the way through a pregnancy or an average adoption could be nearly finalized.

Since visits can be far apart, communication is key. When your patients tell you about plans to have a child, tell them how important it is to consider dental health and visits to the dentist as an important part of a child’s overall health. Less than half of parents receive professional advice on when to start taking their child to the dentist, which can lead to early oral health problems and dental disease.

The pandemic’s effect on pediatric oral health

Even before the COVID-19 pandemic, dental disease among children was rampant:

The pandemic made these problems worse by stressing the financial systems that deliver dental care with job loss that led to lack of coverage and loss in income. As a result of the pandemic, households were three times more likely to indicate that dental care was an unmet health need of theirs rather than medical care, according to a JADA study. The authors found a significant association between the probability of unmet child dental care and pandemic-related household income or job loss.

About 40% of families reported the loss of a job or decrease in income due to the pandemic. Before the pandemic, children from families with lower incomes or on Medicaid were twice as likely to have cavities than children from higher-income households. Whether due to lost or decreased income, fear of contracting COVID-19 or mixed communication from health organizations, dental care visits dropped in 2020.

Luckily, households were unlikely to completely lose health insurance during the pandemic. Robust signups for Medicare and Medicaid kept many people insured. But cost remains the major barrier to receiving dental care. Although access to pediatric dental care has grown for families with public insurance since the early 2000s, inequitable access continues to be linked to socioeconomic status. Additional barriers include difficulty finding a dentist, transportation and geographic proximity to available dentists.

What you can do to address unmet needs

As a dentist or a hygienist, you’ve got a lot to do in a day. You can still find ways to address children’s health that fit into your office’s workflow. Here are some examples you can use to start the conversation with your co-workers and with patients:

  • Talk about timelines. Be sure to inform any new parents, guardians or caretakers about recommended timelines for pediatric care to guarantee they get the information they need from a trusted source.
  • Get innovative. Did you know that 75% of pediatric dentists offer virtual services, compared to only a third of general dentists? If you haven’t explored teledentistry services, consider adding them to your repertoire.
  • Share materials. Explore Delta Dental’s wellness resources and share a selection of helpful articles and flyers in your office or on your website. You can even highlight assets that are made for kids, like MySmileKids and Grin! for Kids.
  • Collaborate instead of criticizing. Making a patient feel guilty, ashamed or afraid for their health rarely works to inspire improvement. Focus on behaviors that they can change and empower them with knowledge.
  • Gather information. Your patients may feel uncomfortable if you ask them directly about their plans to conceive or adopt in the next year. If your practice already does pre-screenings, consider adding a question to capture that information and add it to the patient’s file.

How Delta Dental invests in communities

The best way to treat the pediatric oral health dilemma is large investment in public dental health, something dentists can’t really do on their own. The COVID-19 pandemic stressed the financial system that supports the delivery of dental care services, revealing that changes are required to support access to dental care during times of changing financial situations.

To help dentists make investments in their communities, the Delta Dental Community Care Foundation awards several million dollars in grants each year to increase access to care. These awards enable underserved individuals, including children, to get preventive and restorative treatments in accessible locations. More than 250 organizations received funding from the Delta Dental Community Care Foundation during the COVID-19 pandemic, totaling $11 million to provide relief. Many of these clinics support and serve children.

These Access to Care grants fund activities designed to remove barriers to seeking care such as distance, cost and even fear. The grants can be used to set up mobile or pop-up clinics in a local community, provide dental care in underserved clinical settings, fund outreach programs or offset costs for clinics that routinely provide care to underserved populations.

What comes next

The U.S. economy seems to be recovering. The national unemployment rate is projected to fall to 5.3% by the end of the year. But the problems highlighted by the pandemic shouldn’t be ignored.

As a dentist or dental hygienist, you can’t be expected to fix all of the problems in the American economy or health care industry. Still, by making active efforts to be accessible and communicative with your patients, you can make a difference in their lives and the lives of their children.

Why your patients’ blood pressure matters

In addition to your exam findings, do you evaluate your patient’s blood pressure readings? May is National High Blood Pressure Education Month, when you can renew focus on the importance of heart health in oral health and total wellness care.

The time you take for a blood pressure reading gives you vital information for your patient’s gum treatment, which may reduce hypertension risk.

The causal link between gum disease and hypertension

A March 2021 research study showed that patients with periodontitis and no other health issues are twice as likely to have elevated blood pressure as those with healthy gums. This may suggest that periodontal bacteria can trigger an inflammatory response that affects blood vessel function and lead to the development of hypertension.

When does blood pressure signal health risks?

A normal blood pressure reading is less than 120 mm Hg systolic and less than 80 mm Hg diastolic, according to Centers for Disease Control and Prevention (CDC) guidelines. You should be concerned if the systolic/diastolic reading falls into one of these categories:

  • Elevated: 120-129 mm Hg and less than 80 mm Hg
  • Stage 1 Hypertension: 130-139 mm Hg or 80-89 mm Hg
  • Stage 2 Hypertension: >140 mm Hg or > 90 mm Hg

Hypertension puts your patients at risk for heart disease and stroke, the leading causes of death in the U.S. Nearly half (45%) the adults in the U.S. have hypertension or are taking medication to control it, according to the CDC, and only 24% of them have it under control.

The dangers of gum disease

Gum disease triggers inflammation that thickens the lining of blood vessels. The thickening plaques decrease blood flow, which increases the risk of heart disease and stroke.

Patients with healthier gums had lower blood pressure and responded better to medications, compared to those with periodontitis, according to an analysis, published in Hypertension, based on review of medical and dental exam records of more than 3,600 people with high blood pressure. 

What’s more, periodontal therapy can make a difference. Intensive periodontal treatment lowered blood pressure levels (12.67 mm Hg/9.65 mm Hg) in patients over six months, after a four-week intervention, according to a clinical study published in 2017 in the Journal of Periodontology.

How you can educate your patients about high blood pressure

With this in mind, use your blood pressure check as an opportunity to educate your patients. If you notice an elevated reading, discuss the importance of getting blood pressure under control.

And you can explain how keeping gums healthy can contribute to better circulation and heart function through lowering blood pressure.

Your periodontal treatment and advice on daily flossing and brushing regimens take on added value for your patient, in reducing risks from hypertension.

Exploring the connection between COVID-19 and oral health

Illustration of a woman surrounded by a list of the oral symptoms of COVID-19. The symptoms are loss of taste and smell, dry mouth, excessive saliva, rashes in the mouth, oral ulcers, angular cheilitis and bad breath.

Chest pain, difficulty breathing and fever are three signs of COVID-19 that are frequently discussed, but there is evidence that COVID-19 could have oral symptoms as well.

Oral symptoms of COVID-19

  • Dry mouth and loss of taste and smell. Dry mouth and loss of taste and smell are two symptoms reported by many COVID-19 patients, according to research published in the American Journal of Otolaryngology (September 2020). These can be some of the first and only symptoms exhibited in some cases.
  • Excessive salivation and angular cheilitis. Conversely, hypersalivation is also a potential symptom, according to a case-series and literature review in Oral Diseases (October 2020). Hypersalivation can contribute to issues like angular cheilitis (inflammation of the corners of the mouth), since the salivary enzymes in excess saliva can irritate the skin.
  • Bad breath. The SARS-CoV-2 virus can cause changes to the surface of the tongue and the chemicals in saliva. These changes may lead to the development of halitosis (bad breath), according to a letter in Special Care in Dentistry (November 2020). However, more research needs to be done, since there are a variety of factors that can contribute to more noticeable bad breath. For example, wearing a mask may make a patient more aware of the smell of his or her breath or encourage mouth breathing, which can contribute to bad breath. Bad breath is also a common side effect of several over-the-counter medicines used to treat COVID-19 at home.
  • Oral ulcers and mouth rashes. Several patients who have tested positive for COVID-19 were also diagnosed with oral ulcers, according to research published in Oral Diseases in May 2020.Another potential symptom is the presence of a rash on the upper palate of the mouth. Various types of internal rash were found in six of 21 patients with confirmed diagnoses of COVID-19, according to a study in JAMA Dermatology (July 2020). Certain rash patterns are more commonly associated with viral infections, and the rashes found in COVID-19 patients are consistent with those patterns. 

Gum disease and the severity of COVID-19

Periodontal pockets could be a favorable reservoir for the virus that causes COVID-19, according to research published in Medical Hypotheses (October 2020).

There is also some evidence that inflammation caused by periodontal disease could contribute to the severity of a patient’s COVID-19 symptoms. This is because inflammation prompts the release of interleukin-6 (IL-6), which can damage tissue in the lungs and blood vessels. Damage to these body parts can lessen the amount of oxygen a person gets and contribute to COVID-19 progressing faster.

COVID-19 joins a number of other diseases worsened by the presence of periodontitis, including diseases of the brain, heart and lungs.

Problems with diagnosis

Oral complications because of a COVID-19 infection have been poorly described and potentially underreported, likely due to the fact that most oral symptoms are unlikely to be fatal or dangerous. This has left gaps in the early diagnosis of the onset and characterization of such symptoms, as well as their associations with COVID-19 outcomes.

One of the problems with treating COVID-19 is that two people rarely have the exact same symptoms. Some people infected with the disease may only experience loss of smell, while others experience many other symptoms. Further research will provide a greater understanding of how the coronavirus interacts with the body. As dentists become aware of the variety of oral symptoms associated with COVID-19, they may even be able to use that information to detect otherwise asymptomatic cases in their patients.

Teeth filing a dangerous trend for teens

A troubling trend has emerged on social media during the coronavirus outbreak: DIY teeth filing with household items such as nail files.

In June 2020, a 19-year-old TikTok user named Mia Dio posted a video of herself filing her teeth with a nail file. The video went viral. After being watched nearly a half million times, numerous TikTok videos have been posted showing young people filing their teeth.

Wait, what? Why would anyone do this?

In the video, Dio explains that she wants to remove imperfections in her teeth, but doesn’t want to spend the money for a professional procedure, such as an enameloplasty.

“We’re ballin’ on a budget!” she said.

Later in a Washington Post interview, Dio also said that she was reluctant to visit a dental during the current coronavirus pandemic. The TikTok videos also imply some confusion about the nature of tooth enamel which, unlike nails and hair, doesn’t regenerate.

Yikes! So what can I do about this?

Many dental professionals have taken proactive steps to ensure their patients and their families don’t try this. Some have decided to fight fire with fire by posting their own TikTok videos warning people about the danger of the practice. Other steps to consider include the following:

  • Send an email to your patients that explains this trend and warns them about the dangers. This may be especially effective for the parents of teens, who may not be aware of what their children watch on social media.
  • Post information on your practice’s website, Facebook page or social media feed about the danger of this fad and safe alternatives.
  • Ask patients who visit whether they’re aware of this practice, then explain the dangers and suggest safe alternatives for imperfect smiles, such as cleanings, orthodontics, cosmetic procedures and professional teeth whitening.
  • Make it a point to talk to any teen patients about the serious risks associated with this practice. Point out low-cost options such as cleanings that might be particularly attractive to teens.
  • Explain to patients that they can safely visit the dentist during the pandemic for any procedure they might need.

However you choose to spread the word, ensure that your patients understand that filing their own teeth is a terrible idea. And that the resulting damage can take a real bite out of their wallet.

As Dio said later in the Post interview, after she saw warning videos posted by dental professionals and understood the risks, “I probably would have thought twice about it.”

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