FYI

Dentist blog from Delta Dental

Tag: dental health

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.

Stress taking a bite of patients’ dental health

For many, 2020 ushered in feelings of isolation and fear, as well as new concerns about financial stability, safety, family and how to juggle all of it from home. For some dentists, the stress of the situation has become apparent in their patients’ oral health. As of March, over 70% of dentists surveyed by the American Dental Association (ADA) Healthy Policy Institute reported an increase in patients experiencing teeth grinding and clenching since before the pandemic. That number is up nearly 10% from fall of 2020. In fact, more than 80% of Americans have reported emotions associated with prolonged stress, according to a January study by the American Psychological Association (APA).

“Generally, manifestations of stress go away when the stressing event goes away. That’s where the pandemic comes in,” said Dr. Daniel Croley, DMD, chief dental officer for Delta Dental. “One of the ways that some people manifest stress is by clenching and grinding their teeth.”

Dental conditions related to stress go beyond teeth grinding, of course.

Stress-related conditions

Multiple studies have shown that emotions can play a significant role in periodontal disease. Thanks to an increase in inflammation from stress-induced conditions, the gums can become a hotbed for bacteria, leading to gingivitis. According to the ADA, dentists reported recent upticks in all of the following conditions:

  • Bruxism
  • Chipped teeth
  • Cracked teeth
  • Temporomandibular joint disorder (TMJ) symptoms
  • Caries
  • Periodontal disease
  • Xerostomia
  • Halitosis
  • Oral mucosal lesions

Delta Dental’s claim data also suggests a rise in stress-related conditions. Bite guards, commonly associated with treatment for bruxism and TMJ were prescribed 14.3% more by Delta Dental dentists in the second half of 2020 than during the same period in 2019.

Sleep and ergonomics

During the mad rush to convert homes to offices in the early days of the pandemic, couches and stools took the place of lumbar-supported work chairs. Ergonomic workspaces became less of a priority than merely having a functioning workspace and the resulting poor posture may also be to blame for some TMJ issues. If your patients have been working from home, suggest they read up on proper ergonomics for their workstation.

Likewise, stress and disrupted routines likely hurt the chances at restorative sleep, increasing nighttime teeth grinding. Insomnia and restlessness can result in bruxism and TMJ.

Mask mouth

On top of these stress-induced issues is yet another pandemic problem: mask mouth. The facemask has been a staple of pandemic life and has greatly contributed to the slowing of the virus but can come with unfortunate byproducts: bad breath, dry mouth and even gingivitis and tooth decay.

Dental professionals attribute mask mouth to dehydration and mouth breathing when wearing a face covering. Though the ADA found no substantial rise in these specific indicators, the symptoms are preventable through thorough brushings and more regular hydration. On the upside, masks can sometimes help wearers identify their own halitosis, which may stem from more serious problems.

Other reasons for the spike

It is important to note that not all of these conditions are caused solely by anxiety and tension. For instance, a broken tooth could come as the result of anxiety-induced teeth-grinding, but it could also be caused by an accident or prolonged dental problems. Unfortunately, most claim data does not include the cause behind the diagnosis. Without that, it is impossible to say with absolute certainty that stress is the sole reason for a spike in numbers.

“It’s logical to conclude that current stress is leading to those broken and chipped teeth,” Dr. Croley said. “We will monitor and see. As we see broader distribution of the COVID vaccine and our daily lives feel more typical of what we experienced pre-pandemic, we will see our stress subside and as a result the need for bite guards to treat grinding and clenching subside — but our bodies can take some time to re-acclimate. Going back to the typical is still a change from what has been our weird ‘normal’ over the past year, and any change can generate stress.”

Many patients may not realize the correlation between stress and oral health. Educating your patients about how mental health can affect their mouth when signs of stress are detected is an important first step toward solving the issue. The ADA has created a compilation of resources for recognizing and managing stress. These may be especially helpful if you are are working with anxious patients or experiencing stress yourself.

Grin! offers patients a free, fun and informative wellness resource

Looking for a way to connect with your patients this winter? Encourage them to brighten their smiles — and their days — with Delta Dental’s fun, informative and free e-magazine: Grin!

Available in both English and Spanish, this quarterly publication is full of content that’s both useful and entertaining, such as:

  • The latest news on dental care – including what to do during the coronavirus pandemic
  • Advice from experts
  • First looks at innovative technology and procedures
  • Fun features like activities and trivia
  • Healthy recipes
  • Informative articles on the connections between dental health and overall health
  • And more!

If Grin! sounds like something you want to share with your patients, you can put up this free poster in your office to let them know all about it. The latest issue of Grin! is available online, and it’s easy for your patients to subscribe to Grin! and have email notifications sent straight to their inboxes.

Don’t wait! Share the educational and entertaining Grin! with your patients today and give them something to smile about.

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