Making the Grade with West Maple

Spring truly is the season for growth, change, and health! While Omaha may have found itself with a rather chilly start to the season, spring will always come, however late! And with it, opportunities to start fresh, relearn, and grow together!

As the school year comes to a close, you and your child may be very preoccupied with the thought of finals, year end grades, and how this year’s report card will reflect on their future goals. While we don’t give out report cards, your child’s oral health will be tested in more ways than one!

From having a confident smile to avoiding expensive repairs, how much your child learns about taking care of their mouth will affect their health and confidence for the rest of their lives.

Today’s lesson is a short study in your child’s teeth! How they grow, how to keep them healthy, and why it matters!

Grow, Baby, Grow!

Did you know that children statistically grow measurably more in the spring than any other time of the year? Researchers have spent years narrowing down the causes for this accelerated growth, and it comes down to several factors

  • Increased sun exposure means higher levels of vitamin D, which create stronger, healthier bones
  • Warmer weather means more playing outdoors, and more high-impact activity, which can strengthen bones and increase muscles mass
  • Improved circulation from activities leads to higher energy levels, healthier skin, and improved focus
  • Increased activity leads to a more restful sleep, giving the body time to heal, grow, and regenerate

It’s important to anticipate these growth spurts for many reasons. If your child becomes particularly restless at night, it could very likely be caused by growing pains in the limbs. Soaking in a warm bath, gentle massage of the affected area, and increasing potassium intake (which can be as easy as eating a banana daily) can help ease the discomfort.

Getting Crowded in Here!

Another benefit to anticipating growth is the ability to use preventive orthodontics to help guide your child’s teeth properly into place. As the jaw and facial bones grow, they can alter your child’s bite, facial structure, and spacing. This can cause overcrowding, resulting in crooked teeth. If addressed early, it may be possible to avoid the need for more expensive and extensive corrections later!

While it seems that our mouth wouldn’t contain more or larger teeth than our mouths can safely accommodate, many problems like tongue thrusting, headaches, mouth and jaw pain, and unnecessary crowding can be caused by a lack of space in the mouth. Using jaw expanders is a gradual and safe way to create more room in your child’s mouth, helping avoid these painful issues!

Catching overcrowding before the loss of the final baby teeth is a great way to use interceptive orthodontics. Spacers and other temporary hardware can guide your child’s teeth into place, helping to avoid bite problems, and spacing issues.

Overcrowded teeth are far more difficult to keep properly clean and are more susceptible to decay and damage. If your child ultimately does need braces, we will refer you to a very trusted orthodontist, who cares as much about your child’s smile as we do!

Breaking Up

Interceptive Orthodontics may also be used if a sports injury, clumsiness, or decay have cost your little one a tooth before it was ready to go. Losing baby teeth doesn’t seem like a very big deal, but if it’s lost before the adult set is ready to take its place, the surrounding teeth will move into the space created, leaving little or no room for the new tooth to come through!

This can lead to odd spaces, crooked and crowded teeth, and painful orthodontic treatments later in life if not addressed early. A simple metal spacer can hold the place of the missing tooth until the new one takes its place!

We will teach you and your child to care for temporary hardware, how to clean it, and how to protect new teeth as them come through.

Summer Vacation Doesn’t Mean Taking a Break

As vacation time approaches, it may be a great time to revisit proper oral care! Leaving the house in the morning during the school year often feels like a fire drill, and by bedtime, your child may be too tired to do an effective job. Now in the no-stress summer, take the time to go over the basics again, reminding your child that there is always time to properly care for their mouth!
When your child is on summer break, you want to let them just enjoy their time off! Bedtimes often slip out from underneath you, and with them, the bedtime routine. As the late nights wear on, be sure to remind your child to take a break from their evening activities to spare 5 minutes for their teeth! While they may be on vacation, bacteria are still happy to work 24 hours a day!

Even if you’ve abandoned an official bedtime for the summer, try scheduling a time to limit snacking. At 9pm (Or your pre-determined cut off) put the snacks away and take a break from movies or games to brush and floss. It’s still important that your child gets plenty of rest, and keeping a firm window on snacking can encourage them to bed on their own a little earlier.

Higher Education

If you have an older child who is home from college this summer, try to get them in for a checkup! Between studies, work, tests, and trying to maintain a social life, making an appointment with the dentist has very likely fallen off of their radar!

Remind them that while their growth spurts have come to an end, nobody outgrows the need for proper dental care.
West Maple is proud to be on your team from teething, to growth spurts, to grown and gone. We are grateful that you’ve chosen to be part of our family, and to let us look after yours!

Our Oral Ecosystem

Last time we talked, we discussed Earth Day and cleaning up our habits. This month, we wanted to take a few minutes to talk about the nature of oral health!

Our mouths have their own delicate ecosystem, much like Mother Nature! And like Mother Nature, they are resilient, and have put in place systems to protect and heal themselves. But when outside factors come into play, we have to take extra steps to protect ourselves. For Nature, that means cleaning up litter, recycling, composting, reducing waste, and cutting our carbon footprint.

But what does that mean for our mouths?

Enemy of the State (of Our Mouths)

Our mouths are constantly cleaning themselves, creating healthy bacteria, and working to create tissue. Have you ever noticed that when you bite your cheek, tongue, or lip, it heals faster than most parts of your body? That’s because your mouth has created a perfect environment for regeneration.

So why do so many Americans suffer from poor oral health? There are a lot of factors, but the main threat to our mouth’s natural health system is one sweet word: Sugar.
Sugar inhibits our body’s natural responses to a lot of things, from insulin reactions, energy levels, and fat loss, to how our mouths are able to cope and heal. You may notice that just the thought of your favorite delectable sweet treat, your mouth begins to water. You think that excess saliva is your cue that you truly desire that food, but it’s actually your body initiating a defense against sugar.

Your mouth will instantly create more saliva in an attempt to wash away the sugar you’re only thinking about eating. That’s how much of a danger your own body sees sugar as.

Mouth Pollution

What we put into our mouths has an effect that lasts far longer than the flavor. Whether it’s energizing our body or feeding unhealthy bacteria and heart issues, it’s working long after we have satisfied the craving.

The culprits aren’t always the obvious bad-guys we suspect. Starchy foods are converted to sugars in our mouths and bodies. Our teeth recognize french fries and sandwiches almost the same as they recognize a candy bar! You knew a loaf of bread weighed heavy on the hips, but who knew the toll it took on the lips?

Even healthy foods can become the villain in our toothy tales. Cherries and blueberries are highly acidic and can stain and wear through enamel quickly. Strawberries are packed with sugar, and the seeds can easily lodge themselves, and the sugar they are coated in, between unsuspecting teeth and beneath the gum line.

Clean Up Your Act!

We would never suggest cutting healthy fruits out of your diet just because they contain sugar, and we wouldn’t even suggest taking candy out of special occasions! What’s life without a sweet indulgence now and then?

It is important to restore your mouth to a balanced state as soon as possible after acidic, sweet, or starchy treats. A thorough swish with water, making sure to dislodge any stuck food, can save your teeth hours of exposure!

Put That Brush Down!

It’s actually not recommended that you brush immediately after eating citrus. This might seem counterintuitive, as you want to remove acids from your teeth before they cause corrosion, but your teeth are in a weakened state after eating acidic foods.

When an artist is etching a design into glass, they first paint the surface with an acid, then scratch the design into the surface. The acid temporarily weakens the hard surface of the glass, allowing a gentle scratch to leave a permanent mark.

Acids have a similar effect on your teeth. They temporarily weaken the enamel and leave them vulnerable to damage.

The standard PH of your mouth is a level 7. A soft drink’s PH is about 2.5, nearly the same as vinegar, and will lower your mouth’s PH, leaving teeth weak. Brushing them in this state can damage the enamel of your teeth. Instead, rinse with water or chew sugar free gum after acidic foods or drinks, and then wait about 30-60 minutes before brushing. This gives your saliva time to return your mouth’s PH to safe levels!

What Counts as Acidic?

There is no need to fear or restrict these foods from your diet, but it is important to remain aware and take care after consuming them! The following is a brief list of foods and drinks that contain acids and can create a harmful environment for your mouth.

  • Fruit Juices
  • Citrus Fruits (Pineapples, Grapefruit, Lemons, Limes, Kiwi, Oranges, etc)
  • Salad Dressings, Especially Vinegar Based
  • Soda, Including Diet or Zero Calorie/Zero Sugar Soft Drinks
  • Coffee and Tea
  • Wine
  • Tomatoes and Tomato Ketchup
  • Mustard
  • Honey
  • Energy Drinks (Even Sugar Free)
  • Sports Drinks, Including Low Calorie and Artificially Sweetened Versions

If you have noticed increased sensitivity, receding gums, or thinning enamel, a high-acid diet could be to blame! Always do your best to neutralize the acids as soon as possible, and always give your mouth a chance to do its job!

Oral Environmental Friendliness

You mouth says a lot about you, even when you aren’t speaking. Make sure it’s sending a healthy message. Fresh breath, a clean tongue, and strong teeth send signals with every smile.

A well maintained mouth works hard for you, day and night to stay healthy! Drinking plenty of water, brushing and flossing, and keeping your routine checkups on the calendar are all ways you can keep your mouth a healthy, happy place!

Spring Clean Your Routine!

West Maple Knows Your Smile Makes the World a Better Place, Now it Can Make it a Little Greener Place, Too!
There are a million reasons to look after our precious planet, and your smile is just one of them! Environmental issues affect every part of your life, and your oral health is no exception.

Today, let’s look at some ways our daily routine is affecting our environment, and what we might be able to do to be a little greener!
The Issue: Air and Water Pollution

Toxic air is nothing to smile about, and pollution is anything but great for your grin. Just the thought of chemicals, environmental toxins, and air pollution are enough to take the smile right off of your face, but they can have a more indirect impact on your oral health.

Contaminated water can quickly become a health concern, from drinking, to bathing, to brushing your teeth. Run off from factories can contaminate waterways and growing fields, and the energy used to clean the water causes issues of its own.
Do Your Part!

Ending waste is a fast way to cut back on both how much trash we’re adding to the environment, and how much energy, water, and environmental impact it takes to clean up and replace what we consume! Make shopping lists and only buy the food on the list. This easy step will cut back on food waste, which accounts for about 17% of the garbage in Omaha landfills.
Chop veggies and store them on low shelves in the fridge in glass jars for easy access to a healthy snack! Your kids are more likely to grab carrot sticks if they’re already cleaned and washed. Making a salad is fast and easy when the ingredients are washed and close at hand, and you’re less likely to forget them in your crisper if you’ve already taken the time to prepare them!

Compost what you can, feeding your home garden for richer, more nutrient-dense soil. Avoid buying individually wrapped foods, as they are a huge source of packing waste, and recycle whenever possible!

The Issue: Water Waste

Mother Nature does an impeccable job of cleaning the water we use naturally, but at the rate humans are currently consuming the supply, she simply can’t keep up! Water treatment plants are needed to provide access to safe water sources, but more chemicals and more energy are needed for this process.

We are incredibly lucky to live in a country with such an abundant water supply. Even in other well-developed nations, water shortages are becoming a very real threat. This year, the South African Port of Cape Town faces a true water crisis. It is anticipated that they will have run out of water before you have read these words. As far away as this sounds, this is only one extreme example. As close as Flint, Michigan, residents are faced with contaminated water supplies that have crippled much of the area. But it isn’t until the crisis occurs that we think to begin preservation efforts.

Do Your Part!

An ounce of preservation is worth a pound of water treatment! If you leave the water running while you brush your teeth, the average American faucet wastes two gallons per minute that the water is running! You use less than a quarter of a gallon if you only turn the water on while rinsing the brush.

Put a bucket in the shower to collect the water that runs while you wait for the water to warm up. Use this bucket to water house plants, flush the toilet, or scrub your floors! If you wait five minutes every morning before stepping in the shower, you are wasting 3,650 gallons of water per year, just waiting for the water to warm up! That’s every member of your household. Saving a few gallons of water every day may seem like a drop in the bucket, but with 7billion people on the planet, Earth could use every drop!

 

This Issue: Plastic Pollutants

Plastics seem to make life easier every day, from grocery bags to straws. It is estimated that each Americans throws away more than 185 pounds of plastic each year.
But as cheap and convenient as plastic is to make and use, the environmental cost is astronomical. Plastic doesn’t decompose, and even as the particles do break down, they contaminate soil and ground water.

 

Do Your Part!

 

When you’re done with your toothbrush, reuse it. Scrub that tricky spot behind the faucet, clean the hinges of your toilet, scrub the grout in your tile work. Teach kids to make splatter paintings and detail clean their trophies. When you have used every bit of life, give it a good clean and recycle it. Rather than spending eternity in a landfill, that toothbrush that saved your smile can live a hundred lives before it’s done! Most mouthwash bottles are also recyclable, so check your local regulations and keep it in the bin!
Buying your family reusable straws can keep thousands of plastic single use straws from contaminating ground soil, while keeping your teeth free from acids and stains! Bring plastic bags back to the grocery store, which will have a recycling receptacle in the entryway. Try to remember to bring a canvas bag, use glass jars for buying in bulk, and ask for paper if you’ve forgotten your reusable bags. Every little bit helps!
And with your new spring cleaned routine, you can smile a little brighter! Every day, you’re making the world a little healthier place, and a little happier one, too!

Celebrate National Children’s Oral Health Month

At West Maple Pediatric Dentistry, we think every day is a great day to celebrate oral health! It’s our passion and our pleasure providing happy, healthy smiles to Omaha families for life!

February is National Children’s Oral Health Month, and we wanted to take the opportunity to first thank you for trusting us with your child’s care. Nothing means more to us than protecting the health of Omaha’s little smiles!

Second, we wanted to spend some time addressing common questions and concerns about the care your children are or ought to be receiving. Parenthood didn’t come with a handbook, and there is never an end to the second guessing, guilt, and worry we put ourselves through for our little ones. Thankfully, pediatric dentistry did come with a handbook! Several, actually. We spent years studying them, testing on them, and chasing new research so that one day we would have the opportunity to show off for you!

Every concern you have about your child’s health, oral or otherwise, is completely valid. You have a right to ask questions, to worry, and to be informed. We welcome your questions and are ready to discuss options any time you have a concern. We know that your children mean the world to you, and the fact that you trust us with their care means the world to us!

Here are some of the most common concerns our clients had about their children’s oral health:

Baby’s First Check-Up. How Soon is Too Soon?

The impact of early treatment for babies is vital. Your child should have their first visit between the eruption of their first tooth, which usually occurs around 6 months old, and their first birthday. Your child’s tooth could wait to erupt until 10 or 11 months, or they could already have one at birth! These are all variations of normal, and nothing to worry about. There are many reasons parents choose to skip this crucial initial visit.

  • With no visible decay, parents often feel this early visit isn’t importantDeveloping a good relationship with the dentist helps avoid the anxiety many people experience when they have a dental appointment approaching. Early encounters help your child understand that the dentist is there to protect and help them, which makes it easier to cope when they do have a procedure done. Also, lip and tongue tie issues can be addressed early before they cause problems with speech and spacing.And while pooling milk in cheeks and along the gum line can cause decay and gum disease, your child could very easily be picking it up from a shared spoon, or even from kisses by family members who are suffering from gingivitis, unaware that it is a communicable disease. Early treatment can keep your child’s mouth healthy, even before the eruption of the first molar!
  • Baby teeth fall out anyway, does it really matter if they’re healthy?

    YES! Not only are you developing a lifetime of oral health habits, but you’re preventing gum disease, pain, and possible bone loss. When children’s teeth decay, it affects more than what you see. This can cause disease to spread into their permanent teeth, and even their jaw bone. Unhealthy bacteria in the gums can lead to abscesses, and these bacteria can spread to the blood stream, causing serious health complications. If a tooth is lost early to injury or decay, a spacer is needed to allow room for the adult tooth to eventually grow in.
  • It’s too expensive to go every six months from infancy through collegeA study done for The Journal of Pediatrics indicated that children who visit the dentist by age 1 had 40% lower dental costs by the age of 5. Early prevention of decay and gum disease cuts the cost of care nearly in half. Avoiding those early cavities and identifying spacing and development issues early can save you a small fortune in surgery and repair.

Flouride Facts and Fictions

The internet is a beautiful place filled with all of the information humans were able to pour into it. Parenting message boards and Facebook groups are full of worried parents trying to support one another. Sometimes this connection can get you through those really hard parenting days. Sometimes, it leaves you more confused and afraid than when you started scrolling through.

The fear that fluoride causes everything from stained teeth to autism runs rampant in a lot of homeopathic and natural parenting groups. We understand how this myth was started, but let us assure you, fluoride treatments only protect your child’s teeth. It is important that your child be old enough to spit their fluoride toothpastes out before you allow them to brush unsupervised, because of course you don’t want them simply eating it, but fluoride treatments are completely safe and effective. We do encourage you to do your own research if you don’t feel comfortable, and we always respect our client’s wishes for their children’s treatment plans.

Our Teeth Are Sealed

As your child grows, their smooth molars will develop what dentists refer to as “pits and fissures”. These are the porous parts of the molar where sugars, bacteria, and plaque can accumulate, causing decay. This part of the tooth only accounts for about 15% of the total real-estate of your teeth, but it is where approximately 80% of cavities are diagnosed.

While it’s widely recommended that teeth be sealed with a resin to prevent decay, 60% of children between the ages of 6 and 11 haven’t had the treatment, and suffer 3 times as many cavities as children who have had at least one sealant treatment.

Permanent molars, which erupt around age 6, are the most commonly sealed teeth. Your dentist can tell you if your child’s teeth are good candidates for sealant, and can help you determine when the best time to place the resin.

How Hard is Healthy?


From sugary diets to forgetting to floss, sometimes it feels like there are a million ways to go wrong with your healthy smile. Thankfully, with just five of the right steps, you can protect your child’s smile for life!

 

  1. Start Early – Schedule your child’s first visit before their first birthday and protect those tiny milk teeth!
  2. A Healthy Routine – A fun bedtime song, dance, or routine to keep brushing and flossing fun could become a treasured memory while protecting precious teeth.
  3. A Healthy Diet – Filling your child’s plate with vegetables, healthy proteins, and bright fruits can fill their bellies and prevent cravings for unhealthy treats. Drinking plenty of water, especially immediately after eating starches or proteins, can make or break a healthy smile!
  4. Preventative Treatments – Fluoride and sealants stop decay before it starts, helping your child avoid more stressful (and expensive) treatments down the line.
  5. A Great Relationship – Finding a smile team you can trust and communicate with creates a stress-free environment for your child, and sets them up for a lifetime of keeping their dental appointments…

We only get one chance at perfect teeth, but you have a new chance every day to instill healthy habits to help your child protect theirs! Thank you for choosing West Maple Pediatric, and Dr. Lourdes Secola to be your smile team!

How to choose the best toothpaste for your child

include antibacterial agents, fluoride, and mild abrasives. There are tons of choices when it comes to children’s toothpastes. In fact, there are so many choices that it
can make buying toothpaste a very difficult process. However, choosing the right toothpaste promotes good oral hygiene habits, and helps your child maintain a healthy smile.

There are thousands of different bacterias in your mouth. They group together and create the film on teeth that we refer to as “plaque.” When this plaque is not removed, it can accumulate and cause things like tooth decay, gum disease, and bad breath. Brushing teeth twice a day with fluoridated toothpaste significantly decreases the risk of developing these problems, helps create a lasting healthy smile, and promotes overall health and well being in general.

To help you choose the best toothpaste for your child and their teeth, consider the following guidelines:

  1. Choose a toothpaste with the ADA seal—It is important to choose a toothpaste that has been approved as safe and effective product in maintaining optimum dental health. To ensure you are buying a product that is recommended by the American Dental Association, look for their seal of approval, which can be located on the toothpaste box and tube.  The ADA seal ensures the toothpaste has been objectively tested and approved as safe by the ADA Council on Scientific Affairs. The most reliable informant for dental product recommendations is your child’s pediatric dentist. As a specialist, your pediatric dentist can provide guidance and direction in choosing the best toothpaste for your child.
  2. Dodge harsh abrasives—Choosing an age befitting toothpaste for your child is actually quite critical, because some toothpastes consist of harsh ingredients that may erode and wear away young tooth enamel, the protective outer coating of the teeth. Abrasives are key in polishing and removing plaque from the teeth, but large amounts of phosphates and alumina found in some toothpastes, for example, can be too strong for young enamel and may actually cause young teeth to become too sensitive. To choose a toothpaste that is gentle enough for you’re your child’s teeth, ask your pediatric dentist which toothpastes are age appropriate and most beneficial for your particular child.
  3. Look for fluoride—According to the American Dental Association (ADA), children of all ages should use toothpaste that contains fluoride, which helps protect teeth against cavities and plaque build up. Ingesting too much fluoride is not healthy, especially for young children, so the amount of fluoridated toothpaste used must be controlled. The advised amount for children under three years of age is a ‘smear,’ while a pea-sized amount is recommended for older kids. Children under two years of age generally are unable to spit out their toothpaste, so take caution, as kids this young may swallow small amounts of fluoride when a parent or caregiver is brushing their teeth. Ask your pediatric dentist about fluoridated toothpaste for children under three years of age.
  4. Take flavor into consideration—Though flavor may not be considered technically relevant to dental health, choosing a toothpaste that tastes good to a child helps get him or her more excited about the routine of brushing their teeth. Some kids dislike the taste of minty toothpastes, because they feel too ‘spicy’ on the tongue or make the mouth tingle. While most adults prefer these flavors, kids tend to become more willing to brush more consistently and often when ‘fun’ toothpaste flavors, such as strawberry or bubble gum are offered. Finding a flavor your child is excited about encourages them to practice good dental hygiene habits that will hopefully last a lifetime. In fact, letting kids pick their own flavors may even have them asking to brush their teeth more often!

Utah Kids Score Poorly on Oral Healthcare

Significant numbers of Utah elementary schoolchildren have experience with cavities or have untreated dental decay requiring immediate care, according to the results of a new study. Many children are also lacking dental insurance or have not received required dental care because their parents could not afford it.
These are the results of the latest survey of children between the ages of 6 and 9 conducted by the Utah Department of Health. Conducted every five years, the survey includes a parent questionnaire and a dental screening exam of each child, with the results intended to guide the state’s Oral Health Program to determine future activities, monitor trends, and improve the oral health of Utah children.

 

Untreated decay still a problem

The 2015-2016 Oral Health Survey was conducted between September 2015 and January 2016. The survey was given to parents of more than 5,100 children ages 6 to 9 in first through fourth grades in 47 randomly selected public schools in Utah.

The parents were asked to complete questionnaires focusing on the following:

  • Dental insurance coverage
  • Toothache and time since the child had seen a dentist
  • Unmet dental needs and problems accessing dental care
  • Source of drinking water
  • History of fluoride supplementation
  • Participation/eligibility for the free or reduced-price lunch program
  • Demographic information on the child

The dental screenings were performed by dental hygienists using dental LED headlights in place of dimmer, portable dental overhead lights that were used in the 2005 and 2010 surveys. The overhead lights made it harder to identify tooth-colored restorations and tooth-colored or clear sealants, according to the authors.

The following were noted during the screening:

  • Presence of cavitated untreated caries
  • Presence of treated cavities
  • Number of surfaces decayed, missed, or filled (primary and permanent)
  • Presence of sealants on permanent molars
  • Dental treatment needs

Of the parent questionnaires and consent forms handed out, 45% were filled out and returned. Of those, almost 90% of parents gave consent for their child to undergo screening. After excluding children who did not meet the study’s age criteria, more than 1,900 underwent a screening. The researchers adjusted the data to be representative of the state.

They found that 66% of children ages 6 to 9 have experienced cavities, compared with the national Healthy People 2020 target of 49%. This year’s results represent a significant increase from 52% of children having experienced cavities in the 2010 Utah survey.

Untreated tooth decay was found in 19% of children, up from 17% in 2010, yet better than the national target of 26%. Urgent care admission caused by oral pain and infection was needed by 2% of respondents.

The presence of dental sealants improved from 26% in 2010 to 45% in the current survey, well ahead of Healthy People 2020 goal of 28%. The lack of dental insurance improved to 18% from 22% in 2010. Also, 17% had not visited a dentist in the past year, and 2% had never been. Unmet dental needs were found in 4% of children, which was improved from the previous survey, with 46% of those saying that they could not afford it, and 30% that they lacked dental insurance.

The researchers found disparities in care and insurance coverage among children of Hispanic origin compared with other children, as well as in children of racial minorities. Children who qualified for the free and reduced-price lunch program also had substantially higher rates of cavities and untreated decay.

Access to care by race and ethnicity

Greater access to care needed

The authors reported some limitations of the study’s results:

  • The questionnaire for parents was based on self-reporting, subject to recall bias, and could reflect underreporting or overreporting.
  • The overall survey response rate was below 50%.
  • Dental screening results could not be reported for each racial minority group because of small numbers.

They recommended several strategies to improve the oral health of children in Utah:

  • Increasing access to dental insurance and care
  • Enhancing the public’s understanding of the importance of oral health and its benefits to overall health and quality of life
  • Improving coverage by educating families about Children’s Health Insurance Program (CHIP), Medicaid, and other dental insurance
  • Expanding access to community water fluoridation
  • Expanding school-based caries prevention activities, such as fluoride varnish and sealant programs in elementary schools
  • Providing better incentives and reimbursements to dental practitioners who see low-income people
  • Focus on closing the dental care access gap by increasing awareness of existing community resources

 

Pediatric Dentists and Childhood Obesity

When it comes to tackling the growing epidemic of childhood obesity, dentists are in a unique position to start a conversation with parents.

downloadThey already talk about the dangers of sugar-sweetened beverages, the importance of not letting babies go to bed with bottles— so why not take it a step further and talk about obesity?

This was just one of the solutions proposed at Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention. The Nov. 3-4 conference brought together 125 dentists, hygienists, physicians, nurses, educators, researchers and dietitians to discuss ways the professions can work collaboratively on prevention.

According to the Centers for Disease Control and Prevention, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. And because obese youth are more likely to be obese as adults, this can put them on a path to heart disease, type 2 diabetes and many other serious medical conditions as adults.

It’s a problem no one profession can solve singlehandedly, which is why words like interprofessional and collaboration were stressed repeatedly during the two-day event.

During the conference, presenters shared studies, evidence-based recommendations and advocacy efforts already in motion. They also discussed new ways to engage parents, educators, communities and insurers on the importance of the issue.

This need for health professionals to work together was timely: On Nov. 1, the U.S. Preventive Services Task Force issued draft guidance recommending clinicians screen for obesity in children and adolescents age 6 years and older.

While proposed solutions such as oral health curriculum in schools, increased chair-side screenings and dentists providing nutrition guidance were favorable received, so were the existing barriers. For every potential game-changer exists the sobering reality that everyone—be it a solo practice, dental school or hospital — needs more time, money and training. The issues of reimbursement — would insurance cover this? — and mostly incompatible relationship between medical and dental electronic health records were also discussed.

In addition to talking solutions, presenters and participants alike talked evidence, and the need for more of it.

Healthy Futures was organized by the ADA, National Maternal and Child Oral Health Resource Center, American Academy of Pediatric Dentistry, American Dental Hygienists’ Association and Santa Fe Group. It was supported by the Robert Wood Johnson Foundation and its commitment to eliminating young children’s consumption of sugar-sweetened beverages and ensuring children enter kindergarten at a healthy weight. A reception was provided by the DentalQuest Foundation.

Disparities in Access to Dental Care Narrow Among U.S. Kids

cartoon-1099727_1280The number of U.S. children receiving dental care significantly increased from 2000 to 2014, according to a new study in Pediatrics. Even more positively, the researchers found a steep narrowing of coverage disparities in race/ethnicity and income. However, they are concerned about the future of treatment coverage under the new U.S. administration.

The authors knew from previous studies that insurance coverage had improved as pediatric enrollment in public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP) increased. However, they didn’t know whether that translated to increased utilization and what the difference was among children of different races and ethnicities, as well as between poor and better off children.

“The expansion of Medicaid and CHIP financing for children from lower socioeconomic groups has made it easier for them to access these services,” said study co-author Andrew Racine, MD, PhD, in an interview with DrBicuspid.com.

Dr. Racine is the system senior vice president and chief medical officer at Montefiore Medical Center and a professor of clinical pediatrics at Albert Einstein College of Medicine in New York.

Measuring changes in access

The health insurance coverage gains for U.S. children seen in recent years are expected to have improved access to healthcare services, particularly for vulnerable populations. Nonetheless, few studies have analyzed children’s healthcare access trends, including by race/ethnicity and income, and whether the magnitude of disparities has diminished.

“The expansion of Medicaid and CHIP financing for children from lower socioeconomic groups has made it easier for them to access these services.”

— Andrew Racine, MD, PhD

For future healthcare policy decisions, it is important to assess insurance coverage rates and also access to healthcare and disparities in access, the authors wrote (Pediatrics, November 15, 2016). Millions of children may become ineligible for public or subsidized coverage by 2019 if funding for separate state CHIP programs expires or states are allowed to roll back Medicaid and CHIP eligibility thresholds to statutory minimums.

Therefore, the researchers examined data from 173,038 children up to age 17 from the 2000 to 2014 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of U.S. households. Within each household, a sample child was chosen. An in-person interview was conducted with a parent or adult knowledgeable about the child’s health and healthcare.

They were asked about whether the child had health insurance and the type. They were also asked whether the child had visits with any type of dental professional (including dentists, oral surgeons, orthodontists, or hygienists), well-child visits, and doctor’s office visits and also about usual sources of care and unmet health needs, which included dental care, within the previous year. The dental care question was asked only for children ages 1 to 17, with the sample size therefore smaller for that question.

Children were classified into three income categories:

  • Poor (less than 100% of the federal poverty level)
  • Near poor (between 100% and 199%)
  • Not poor (200% and above)

The lack of a dental visit within the previous year dropped by half from 2000 to 2014 in Hispanic children and by 37% in black children, nearly eliminating disparities with white children, as shown in the table below.

  No dental visit within the previous year,
2000-2014
2000 2014
Hispanic children 43.2% 21.8%
Black children 32.8% 20.7%
White children 25.1% 19.5%

For unmet healthcare needs, the higher rates seen in children in poor (12.8% in 2000 to 8.5% in 2014) and near-poor families (13.0% to 7.2%) narrowed compared with those from all other families (4.8% to 4.2%).

The rate of uninsured children dropped significantly from 12.1% in 2000 to 5.3% in 2014, representing an additional 4.9 million children receiving coverage. At the same time, public coverage among the children in the study increased from 18.9% to 38.9%, and private coverage decreased from 69.0% to 55.8%. Increases in public coverage and decreases in private coverage were found across all racial/ethnic and income groups.

The uninsured rate narrowed for Hispanic children compared with white children and was eliminated for black children compared with white children, as shown in the table below.

  Uninsured rates in children, 2000-2014
2000 2014
Hispanic children 26.1% 9.3%
Black children 11.7% 3.3%
White children 8.2% 4.0%

Steeper declines in uninsured rates were seen for children in poor (22.2% to 5.9%) and near-poor (21.2% to 8.8%) families compared with others (6.0% to 3.5%).

“We have managed to satisfy a pent-up demand,” Dr. Racine said regarding the increases seen in accessing dental care, in conjunction with increased rates of insurance. “We may not have reached the limits of what health insurance expansion can produce. Even if we did nothing and kept things the way they are, we might expect to see continued improvement.”

Future public insurance coverage unknown

Gains in health insurance coverage appeared to explain some but not all of the increases in access to care, the authors wrote. Some states have quality monitoring programs with performance improvement programs targeting goals, including increasing dental visit rates, while some have worked to improve dental provider availability by increasing dental service reimbursement rates. And states are now required to provide dental services to all children enrolled in Medicaid and CHIP.

The Patient Protection and Affordable Care Act (ACA) had the effect of bringing more children who had previously been eligible for public insurance coverage into the system, Dr. Racine said.

In a separate commentary in the same Pediatrics issue, Stephen Berman, MD, a professor of pediatrics at the University of Colorado School of Medicine and School of Public Health, wrote that the study’s findings have important implications for future child healthcare policy decisions.

“First, all children should have coverage, and strong efforts must be made to reach the 5.3% who remain uninsured,” he wrote. “These efforts should target the near-poor and Hispanic families because the gap is greatest for these populations. Second, the reauthorization and continued funding of the Children’s Health Insurance Plan, due to terminate in 2019, is essential and should be addressed sooner rather than later.”

He also recommended that ACA exchange plans become more affordable to near-poor and middle-class families.

The study’s strengths were its use of nationally representative NHIS data with consistent measurement over time and the ability to link health insurance and healthcare access data, according to the study authors. A limitation, though, was its reliance on parents reporting the use of health services not validated against medical records.

Dr. Racine noted that the availability of public health insurance, the willingness of dental practitioners to provide care to those with this coverage, and the willingness of our society to ensure that rates paid to practitioners are in line with the cost of providing them will determine if the rates of children receiving dental care increase in the coming years.

“Depending upon the policy responses of the new administration to these programs, we could see a complete reversal of these funds,” Dr. Racine said regarding the incoming Trump administration’s position on funding for children’s health insurance through Medicaid and CHIP.

 

Pacifiers and Dental Health

baby-552610_1920We get asked all the time about children who use pacifiers. An important fact to note is that sucking a pacifier or finger is natural. Babies suck even when they are not hungry to comfort themselves. Some babies even begin to suck on their fingers or thumbs before being born!

However, when babies repeatedly suck on a pacifier or thumb and finger over a long period of time, you run the risk that their upper front teeth will begin to tip outward and not grow in properly.

In addition, crooked teeth and bite problems can occur with prolonged sucking, which may result in children needing significant orthodontic treatments later in life to correct the damage.

The American Academy of Pediatric Dentistry (AAPD) does recommend a pacifier over a finger or thumb, as the habit is easier to break should babies not willingly give it up.

The organization also recommends considering safety when selecting that pacifier.

The shield on the pacifier should be wider than the child’s mouth, and the pacifier should be monitored for wear and tear.

A bottle nipple should never be used as a substitute and discontinue use if the child can fit the entire pacifier in their mouth.

Don’t dip the pacifier in anything sweet, and never leave a baby with a pacifier unattended.

It is an instinct and most children will come to the point where they will give up the thumb or pacifier on their own.

If it continues past the age of 3, it is time for the parents to intervene to help break the habit. The earlier the habit is stopped, the better for their teeth in the long run.

Early visits to a pediatric dentist will help parents to help their children stop sucking their thumbs and pacifiers and hopefully prevent damage before it is too late to turn back.

The AAPD recommends taking your child to a pediatric dentist before age 1 or when the first tooth appears.

Study Finds 99% of Obese Kids Have Inflamed Gums

702px-obesidadinfantilyadolescenteThe vast majority of overweight and obese children show signs of gingivitis, according to a study in Diabetes Care. While the study was relatively small, the authors highlight the need for a multidisciplinary approach to care for children with excess body fat.

Researchers from Argentina and California wanted to see if excess body fat in children was tied to a number of inflammatory conditions. They hypothesized that overweight and obese kids may also have periodontal disease because of the inflammatory processes of other diseases associated with obesity, such as insulin resistance.

Obesity is considered a global epidemic by World Health Organization. It is a serious health problem among children and adults.

Pediatric obesity linked to gingivitis

Scientists have already established a link between periodontal disease and obesity in adults, but no such link has been explored for children. The researchers felt it was important to investigate a potential link between periodontal disease and pediatric obesity, because untreated gingivitis may progress to more severe forms of gum disease later in life.

The researchers began by evaluating rates of gingival inflammation in 90 overweight and obese but otherwise healthy Argentinean children and adolescents. The children were referred to an outpatient clinic for obesity treatment, and gingivitis incidence was evaluated using the gingival inflammatory index.

Almost 99% of obese children and 85% of overweight children had at least some gingival inflammation. The researchers also found a statistically significant correlation between children with gingivitis and insulin resistance, a condition in which cells don’t respond properly to glucose.

The evidence showed an association between insulin resistance and the development of periodontal disease. These results reinforced the importance of addressing insulin resistance and of gingivitis awareness for children with excess body fat.

A comprehensive multidisciplinary approach

The study had a number of shortcomings, including having a relatively small sample size. The sample was also homogeneous, consisting of white Argentinean children, and did not include a control to compare rates of gingival inflammation to kids with a healthy body weight.

Furthermore, because it was a short two-page study, the authors did not include details about the severity of gingival inflammation or who conducted the measurements.

Nevertheless, the study highlights the need for similar studies to evaluate the link between pediatric obesity and gingivitis. The authors believe the study findings also serve as a reminder that dentists and hygienists should be a part of the multidisciplinary team that cares for overweight and obese children.