Dentist blog from Delta Dental

Tag: wellness

Too few kids are getting fluoride treatments: What you can do

Dental fluoride treatments are among the most effective and efficient techniques for hindering tooth decay in children. But despite their proven effectiveness, and despite the fact that such treatments are often covered by insurance, too few children are getting them.

Very few privately insured young children receive recommended dental fluoride treatments at health wellness visits, according to a study published in the Journal of the American Medical Association (JAMA) Network Open. The study’s analysis of more than 328,000 well-child visits for privately insured 2- to 5-year-olds found that fluoride treatment was done in fewer than 5% of visits between 2016 and 2018.

Parental refusal and clinical intervention strategies

One common reason that children aren’t getting fluoride treatments is parental refusal. In a survey, nearly 80% of dentists said they believed fluoride refusal was a problem. In one study, refusal of fluoride was found to be correlated with refusal of vaccines, and as many as 51.5% of parents refused topical fluoride treatments.

“Tooth decay is the number one disease of early childhood, and fluoride plays a critical role in strengthening the enamel and preventing cavities,” said Dr. Jessica Buehler, Director of Dental Affairs at Delta Dental. “Unfortunately, in today’s world of information overload and patients getting their news through social media, there are many families that oppose or do not understand the value and importance of fluoride.” 

Reasons for parental refusal

Parental attitudes and beliefs about health are important determinants of fluoride refusal. Most common is the belief that fluoride is unsafe. Such concerns are often spread and amplified through social networks, the media and the internet. Other factors may include religious beliefs, a desire for autonomy and concerns about the true intent of fluoride treatments.

Clinical interventions

The following clinical strategies can help you improve communication with parents about topical fluoride treatments:

  • Assess parents’ knowledge, beliefs and attitudes early. Screen for possible fluoride hesitancy at the start of preventive visits by asking open-ended, non-judgmental questions, such as “Do you have any questions for me about fluoride?” This can help you assess beliefs and start a conversation.
  • Ensure your team is prepared. Make sure your staff of dental assistants and hygienists understands how fluoride works and why it’s important, as they will likely be the ones applying fluoride treatments. Acknowledge that parental refusal can be a problem and assure your staff that you are there to support them. “Auxiliary staff should not engage in an argument when a parent refuses fluoride,” suggested Dr. Buehler. “They should inform the dentist so that she or he can answer any questions the family may have.”
  • Obtain information about why parents are refusing fluoride. Avoid a pro-fluoride “sales pitch.” Instead, ask questions about what’s motivating a parent’s decision to opt out. Listening is key and can help build trust. Reassure the parent that you respect their health care decisions. Some parents may reconsider their decision after several discussions over time. Document conversations with parents so that future discussions can be framed appropriately.
  • Incorporate specific caries risk factors into discussions. Provide parents with an explanation of why fluoride is important based on the unique risk factors associated with each child. For instance, white spot lesions on the child’s teeth should be pointed out to the parent, with a description on how fluoride helps to prevent white spots from turning into cavities that require fillings.
  • Discuss alternative fluoride sources and behavioral strategies. Parents who refuse fluoride during dental and medical visits may be open to use of at-home fluoride products. Discuss alternative sources of fluoride that could be used at home, like fluoridated toothpastes and fluoride mouthwashes. Remind parents about the benefits and safety of fluoride in water. For parents who refuse all fluoride-containing products and water, emphasize that reducing dietary sugars and acids becomes even more critical in managing caries risk.

Fluoride treatments, your pediatric patients and you

Fluoride varnish is recommended by the U.S. Preventive Task Force and the American Academy of Pediatrics for all infants and children starting at tooth eruption through age five years. All children in this age category should receive fluoride varnish application at least once every six months, according to the recommendation. Most private insurers cover the procedure, and coverage with no cost-share for families is mandatory under the Affordable Care Act.

Most Delta Dental PPO™ and DeltaCare® USA plans cover fluoride treatments for children up to age 12, and many cover such treatments up to age 18, and for adults, as well. The specific codes for fluoride treatments are:

  • D1206 Topical application of fluoride varnish
  • D1208 Topical application of fluoride excluding varnish

Preventive dental care is important at any age, and we encourage you to give regular fluoride treatments to your pediatric patients. Developing a clinical workflow that includes fluoride application can greatly improve the oral health of children within your practice.

The dental office and mental health: what you need to know

Dentistry can be a stressful and challenging profession. Teams like yours can often face depression, anxiety and other mental health issues. For Mental Health Awareness Month this May, take some time to get a closer look at why many dentists and their staff face mental health problems and what you can do to improve overall well-being in your office.

Dentistry and mental health

The percent of dentists diagnosed with anxiety more than tripled in 2021 compared to 2003, according to the 2021 Dentist Health and Well-Being Survey Report from the American Dental Association (ADA). The ADA also found 13% of the dentists reported that they suffered from depression, while it’s estimated that only 3.8% of the general population is affected.

The challenging, demanding work of a dentist’s office can affect the well-being not just of dentists but of office staff, as well. Dentistry can be an especially stressful profession because dentists and their staff often:

  • Work in isolation in confined, small, sometimes windowless spaces
  • Deal with time constraints, economic challenges and other business-related pressures, many of which have only worsened with the advent of COVID-19
  • Perform stressful procedures on a sensitive part of the body with no room for error
  • Deal with long working hours and a heavy workload
  • Face an unfavorable public perception of dentists and dentistry
  • Work with patients who may loathe or resent visiting the office
  • Provide care for others on a day-to-day basis and may not be as accustomed to caring for themselves
  • Are often high achievers who may view reaching out for help as a sign of weakness or failure

Know the signs

As a dentist, you’re trained to identify oral pathology by clinical evidence, diagnostic testing and a patient’s own account. But identifying mental health problems can be very different. Signs related to mental health issues are most often manifested as behavioral changes or they’re experienced internally by the affected individual in the way he or she thinks and feels.

Common signs and symptoms of someone dealing with depression, anxiety or other common mental health issues include:

  • Behavior that is uncharacteristically sad, irritable, critical, indecisive or disorganized
  • Reduced productivity or frequent absence from work
  • Loss of interest in hobbies and other pleasurable activities
  • Withdrawal from friends, family and other social activities
  • Expressions of negativity or feeling “helpless,” “burned out,” “lost” or “hopeless”
  • Frequent complaints of tiredness, headaches, stomach problems, back pain or other aches and pains
  • Changes in sleep, such as insomnia or oversleeping
  • Changes in weight or diet, such as eating more or less than usual
  • Abuse of alcohol or drugs, including prescription medications

These symptoms may increase in severity and frequency over time. In advanced cases, affected individuals may lose their ability to support the team and function in the office.

What you can do

Raise awareness and reduce the stigma

Make sure you and your staff can talk openly about problems and reach out for help without negative judgment. As an office leader, you can model this behavior by talking openly and honestly about stress and problems you may be experiencing. Remember that your colleagues and staff could be experiencing similar issues, so openly sharing can be comforting and encouraging. If you don’t suffer from mental health problems, work to be empathic and supportive of those who do.

Resources and assistance should be available and accessible, and using them should never threaten someone’s job or reputation. Consider adding an employee assistance program (EAP) to the offered benefits at your practice if you haven’t already.

Take care of your emotional health

Here are some tips for self-care during stressful times:

  • Take care of your body. Try to exercise regularly, eat well-balanced meals and get enough sleep. Limit your alcohol intake and avoid tobacco and other drugs.
  • Connect with others. Share your concerns about how you’re feeling with a friend or family member. It’s important to maintain a strong social support system and to build healthy relationships during difficult times.
  • Take breaks and vacations. Allow yourself time to unwind and engage in activities you enjoy.
  • Seek help. If stress is impacting your life and work, don’t be afraid to seek out help from others when you need it.

Know where to turn for help

The following free resources can help promote mental health in the dental office:

Other mental health resources include:

  • The National Suicide Prevention Lifeline (800-273-8255). Provides 24/7 free, confidential support for people in distress as well as best practices for professionals and resources to aid in prevention and crisis situations.
  • NAMI. The National Alliance on Mental Illness provides advocacy, education, support and public awareness to individuals and families affected by mental illness.  
  • SAMHSA. The Substance Abuse and Mental Health Services Administration is an agency within the U.S. Department of Health and Human Services that leads public health efforts to reduce the impact of substance abuse and mental illness on America’s communities. Their resources include a helpline at 800-985-5990.

The mind, just like the mouth, requires constant care. Optimal mental health is a crucial part of your practice success and your overall well-being. Don’t neglect mental well-being in your office or feel shame or stigma about needing to reach out for help.

5 things patients don’t know about nutrition and oral health

As a dentist, you know that diet plays a significant role in oral health. By discussing healthy nutrition with your patients, you can build stronger relationships, show your investment in their well-being and help prevent disease and stop progression. Education is a powerful prevention tool.

But patients who otherwise maintain healthy habits may still be making a number of dietary mistakes that can add up to tooth decay. Here are five things that even your most nutrition-savvy patients may not know about how their diet is affecting their oral health.

1. Even “healthy” foods can be full of hidden sugars

As human beings, we crave and enjoy sugar, and no one knows that better than the manufacturers and purveyors of the foods we eat. Nutrition-savvy patients know that they should avoid foods and beverages with a lot of added sugar, but what they may not realize is that their diet may still contain an unhealthy amount of hidden sugar.

Manufacturers pack sugar into seemingly harmless products like pasta sauces, salad dressings, breakfast cereals and ketchup. Patients may even believe they’re reaching for mouth-healthy choices when they choose items like fruit smoothies, yogurt, granola, protein shakes, organic cookies, bottled tea, vegan candies and so on, but these can still be loaded with sugar. Furthermore, health-conscious eaters may not recognize that the cane sugar, honey, maple syrup and fruit concentrates used to sweeten natural food products can still cause tooth decay.

Remind your patients to check labels so they’ll be aware of the amount of sugar — obvious or hidden, processed or natural — in the foods they eat. 

2. Refined carbohydrates can harm teeth just like sugar does

Even some health-conscious patients may not realize that refined carbohydrates can contribute to tooth decay. When starches remain in the mouth for a long time, they break down into simple sugars. Bacteria in the mouth then feed on these sugars and produce acids, just as they do when they encounter dietary sugar itself. Many patients may not realize that the refined carbohydrates in foods like white bread, crackers, pretzels and pasta can be just as harmful for their teeth as the more familiar and obvious culprits containing refined sugar.

Remind patients to reach for complex carbohydrates like whole grains, corn and wild rice rather than refined carbohydrates and starchy foods.

3. Sequencing of food consumption can play a role

Many patients don’t know that it’s not just about what they eat, but when.

For instance, cheese eaten after a meal or after sweets can help prevent the production of acids in the mouth. Drinking water with or after a meal helps rinse sugars from tooth surfaces. Patients are likely already aware that nibbling on pretzels or candy throughout the afternoon isn’t great for their health, but they may not realize that they’re actually giving bacteria more opportunities to cause cavities throughout the day.

Encourage patients to think about the timing of what they eat and remind them to drink water and to brush after meals or snacks. Reducing the length of time that food sugars or carbohydrates remain on the teeth can help prevent cavities.

4. Hydration is an important part of a healthy diet

Water is crucial for oral health. Water helps wash away food particles that may cling to teeth, and it also helps form saliva, which helps the mouth defend against decay. And drinking fluoridated water helps keep teeth strong and reduces cavities.

Hydration is especially important if your patients frequently have dry mouth or take medications which cause the condition. Remember to explain to your patients that saliva production helps inhibit the formation of plaque and neutralizes acids in the mouth.

The U.S. National Academies of Sciences, Engineering and Medicine have determined that an adequate total daily fluid intake from water, other beverages and food is about 15.5 cups a day for men and about 11.5 cups a day for women. That likely requires more water than most people are accustomed to drinking. Encourage patients to be aware of how much water they’re drinking and to take in more if they’re not getting an adequate amount. Staying adequately hydrated is an important component of oral health and overall wellness.

5. Alcohol can harm your oral health

Drinks high in alcohol, like spirits, can cause dry mouth, which boosts the chance of cavities. Many popular mixed drinks like daiquiris can add fuel to the fire by being loaded with sugar, and others contain citrus juices, which can be highly acidic and eat away at tooth enamel. Drinks high in tannin like red wine or dark liquors can also stain the teeth.

Patients who otherwise look after their oral health may not consider alcohol consumption as part of the picture. While mild alcohol consumption can easily fit into a healthy diet and lifestyle, patients should nonetheless be aware that moderate to heavy drinking can end up having a detrimental effect on their oral health.

Your patients and nutrition

Diet and nutrition play an important role in maintaining oral health. Although your patients may know the basics of eating well, there are many less familiar ways that diet can play a role in oral health. Education is key. Be sure to share tips like these with your patients along with Delta Dental’s wellness resources, including healthy recipes and articles about diet and nutrition.

Information is at your patients’ fingertips with Delta Dental’s wellness library

Here’s a great new way to help your patients stay informed about oral health and wellness. Delta Dental’s refreshed wellness library features updated articles, colorful images, informative videos and loads of information about oral health.

When will my baby’s teeth fall out? How can I get my teenager to take care of his braces? Why do my teeth hurt when it’s cold outside?

Your patients can now find answers to their most frequently asked questions in Delta Dental’s wellness library. The site is mobile-responsive and accessible, with articles that are straightforward, easy to understand and backed by the latest research. 

Find sections on:

Your patients will learn about the crucial link between oral health and overall well-being, with articles exploring the relationship between oral health and various medical conditions and explaining the best habits for lifelong wellness.

Readers can even expand their cooking repertoire with a host of dentist-approved recipes for the whole family in our recipe section. Find ideas for tasty and healthy dishes like a warming pumpkin soup, homemade banana nut muffins or garlic mashed sweet potatoes.

Those on special diets can explore recipes tailored to their needs with special sections listing recipes that are dairy-free, diabetic-friendly, gluten-free, vegan or vegetarian.

Your patients now have instant access to an abundance of oral health information through Delta Dental’s wellness library. Please feel free to share articles from the wellness library on social media to help us get the word out, and send any feedback or ideas for articles you’d especially like to see to Delta Dental at

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