The NobleDentist Blog

This article by Emily Dunn appeared recently in the Sydney Morning Herald.

The high costs of dentistry and a shortage of practitioners are putting the bite on Australians.

It starts as a tiny fissure that slowly grows to a black cavity. It attacks soft tissue and bone, causing painful swelling and bleeding. Left untreated it can develop into full-blown cellulitis and you can end up in hospital, with a hefty medical bill to boot.

It is the most common medical condition in Australia and it isn’t diabetes or heart disease. It’s tooth decay, followed closely by its related condition, gum disease.

Dental diseases are also among the most preventable health conditions.

Australians are visiting dentists more often – two-thirds of us now see a dentist regularly, up from 50 per cent a decade ago – yet, according to the Australian Council of Social Service, the oral health of middle-aged Australians is among the worst in the developed world, with tooth decay on the rise.

Australian children enjoy one of the best standards of oral care in the world. However, a report released last week by the Australian Research Centre for Population Oral Health at the University of Adelaide shows the number of children requiring general anaesthetic for dental surgery, most commonly tooth extractions, tripled in the past decade.

Each year more than 30,000 people in Australia are hospitalised because of a dental condition, usually a tooth or gum infection that has been left to fester. So why the neglect for our teeth and gums?

Dentists say a lack of funding and a lack of dentists are just two of the reasons. “Governments treat dentistry as if it is not part of health, as if the human body stops at the mouth,” says Hans Zoellner, chairman of the Association for the Promotion of Oral Health. “The mouth is a communication organ, a sexual organ and it is cosmetic – it is not just for eating.”

A report published last week in the Medical Journal of Australia predicted that by 2010 Australia will be short 1500 dental care providers. Zoellner says almost a third of the vacant positions will be in NSW.

For those in poor socio-economic or regional areas, the issue of access to dental care is more critical. There are about 9000 practising dentists in Australia, about 43 per 100,000 of population, but in rural areas this ratio drops to 28.

The second and perhaps most prohibitive factor for patients is the cost of a visit to the dentist.

There is no Medicare rebate for dental care. In 1997 the Liberal Government axed the Commonwealth Dental Health Program, designed to lower waiting lists in the public system.

Publicly funded dental care is now provided through the state hospital system but it is restricted to children aged up to 18 years and concession card holders (about 34 per cent of the adult population).

In NSW there are only about 240 dentists working in the public system, compared with more than 3000 private practitioners, and the teeth they see are often in an advanced state of decay.

Population Oral Health research shows public patients are twice as likely as private patients to have teeth extracted.

Last year, an investigation by the Herald found patients in the public system were waiting up to eight years for treatment. That led to an NSW parliamentary inquiry, which found NSW spent less than any other state on dental health.

In response, the NSW Government announced that an extra $40 million would be spent on dental health in the next four years. The funding will be used to reduce waiting lists in the public system and target groups at risk of dental problems, including young children and senior citizens.

Zoellner says the additional funding is not enough to improve waiting list times and staffing levels in NSW. “[The funding] will barely meet the inflation rate.”

With about 250,000 public patients in NSW on waiting lists for dental treatment, patients are seeking help from general practitioners and, in some cases, requiring hospitalisation for dental infections.

“GPs are seeing an endless stream of patients coming in for repeated scripts of antibiotics and painkillers for teeth problems,” Zoellner says. “This is at a substantial cost to the public purse.”

But while those in the public system deal with long waiting lists, patients in the private system have the burden of high costs.

About 85 per cent of dentistry is performed in the private sector. The Australian Dental Association does not recommend a fee schedule for its members but, according to the MJA report, practitioners charge an average rate of $350 an hour, of which overheads account for about 70 per cent.

The president of the ADA, Chris Wilson, says fees vary along with the rebate from health funds, with some funds only paying for treatment from preferred providers. “The decision whether or not to have a treatment comes back to the patient,” Wilson says. “The dentist informs them of the risks and the cost.”

For those without private health care, the cost can be too much.

The report in the MJA estimated 25 per cent of dental patients delay treatment because of the cost. The likes of root canal surgery can cost upwards of $500 at a private practice; surgical procedures can add thousands of dollars.

Delayed treatment means that problems get worse and the eventual treatment becomes more expensive.

Delaying the inevitable through the use of antibiotics is also a problem. “This creates a public health issue – the over-use of antibiotics creates strains of resistant bacteria,” Zoellner says.

“From a public health perspective, it is lunacy that there is not guaranteed treatment for acute infection, that people are waiting.”

The majority of dental problems are largely preventable. However, the problems dentists are treating are increasingly complex. This is due in part to delayed treatment but also, ironically, to an improvement in oral health since the introduction of fluoride in the 1950s.

Fluoridated water supplies, along with fluoridated toothpaste and mouthwash, has meant people are keeping their teeth longer.

Tony Dawson, a Canberra prosthodontist specialising in reconstructive and replacement dentistry, says that while edentulism (people who are completely toothless) is decreasing, the number of people who have some teeth missing is increasing.

“We have gone from the ‘when in doubt, pull it out’ phase of dentistry to a much more conservative view,” Dawson says.

The more dental work people have, the more maintenance they may need, such as replacement fillings. “Everything we do has a certain life expectancy – these days we try and do the smallest possible fillings we can,” Dawson says.

Dental work such as fillings are often necessary to prevent further tooth decay, but it takes a toll on teeth. Each time a filling is replaced it takes a part of the tooth with it and, eventually the tooth may need to be replaced.

The trend towards people keeping their teeth for longer also means dentists are treating older patients with associated health complications.

‘When you are younger, the problem is likely to be tooth decay,” says Mark Schifter, a senior specialist in oral health at the University of Sydney. “But when you are older it is gum disease.”

Gum disease is linked to conditions such as diabetes, heart disease and low-birthweight babies. Gum disease that is left untreated has also been shown to worsen a patient’s diabetes.

“Evidence also suggests there is a similar causal relationship between oral health and cardiovascular disease,” Schifter says.

“The worse the gum disease becomes, the worse the medical condition, and vice versa.”

For some, gum disease is unavoidable. Some are genetically predisposed to tooth decay and gum disease – they just have the wrong saliva. “Some salivas have better anti-bacterial properties than others and some [people] have more aggressive bacteria,” Schifter says.

“We need to identify these patients that need help before the problems get out of control.”

Pregnant women are at higher risk of gum disease and, if the condition develops, they risk delivering lower birth-weight babies because of the toxins produced by the bacteria entering the blood stream.

Mothers also risk passing on the bacteria to their babies. When babies are born, their mouths are sterile. It is only when they begin sharing food and utensils, usually with their mother, that bacteria starts to build up in their mouths.

“If you are planning to have a baby you should visit your doctor and your dentist,” Schifter says.

Advances in fluoridation, now present in 90 per cent of the NSW water supply, are also being offset by diets that are high in sugar.

As a result, the rate of caries, or holes, in children’s teeth is increasing.

“People seem to see fluoride as a panacea, but it isn’t,” Schifter says.

During Dental Health Week, from August 1 to 7, the ADA will be campaigning for better awareness of how the consumption of bottled water – which does not contain the same amount of fluoride as tap water – along with sugary soft and sports drinks, is contributing to a decline in dental health.

In addition to government funding, Schifter believes, there should be more public education campaigns encouraging oral health, and they should be given the same status as the campaigns that encourage people to use sunscreen or quit smoking.

“The mouth should be given the same status as the rest of the body,” he says.

Grin and bare them, Hollywood-style
You may never have Julia Roberts’s legs – but you can have her teeth.

While some patients struggle to afford basic care, others spend the price of a small car on cosmetic improvements.

The celebrity smile is a sought-after cosmetic enhancement. In New York, clients are said to browse dentists’ books of “red-carpet smiles” in search of Oscar-winning choppers.

In Sydney, an online directory search finds more than 300 “cosmetic dentists”. But cosmetic dentistry can cause more harm than good.

Canberra prosthodontist Tony Dawson specialises in restoring lost or damaged teeth and says cosmetic dentistry can have unwanted side-effects. “You can achieve virtually anything if your pockets are deep enough and you are willing to accept the risks,” he says.

Dental implants and porcelain veneers are often necessary to replace lost or damaged teeth.

An implant can cost about $8000 a tooth and consists of a titanium screw, capped in either metal or porcelain.

Starting at about $1000 a tooth, porcelain veneers last about 10 years. But they can damage both your teeth as well as your bank account if not applied properly, Dawson says.

In an effort to change the shape of teeth, some dentists are cutting deeper into the tooth, below the enamel surface to the dentine.

“Carving up perfectly good teeth because people want to look like Julia Roberts or Jessica Simpson has problems,” he says.

“The harder you cut back teeth to change their shape the more likely you are to have problems such as nerves dying and having to crown or replace the teeth.”

Dawson advises patients to choose treatments for function rather than aesthetics.

“Go and see your family dentist first, if they can’t answer your questions they can arrange an appropriate referral.”

Publicly funded dental care is now provided through the state hospital system but it is restricted to children aged up to 18 years and concession card holders (about 34 per cent of the adult population).

In NSW there are only about 240 dentists working in the public system, compared with more than 3000 private practitioners, and the teeth they see are often in an advanced state of decay.

Population Oral Health research shows public patients are twice as likely as private patients to have teeth extracted.

Last year, an investigation by the Herald found patients in the public system were waiting up to eight years for treatment. That led to an NSW parliamentary inquiry, which found NSW spent less than any other state on dental health.

In response, the NSW Government announced that an extra $40 million would be spent on dental health in the next four years. The funding will be used to reduce waiting lists in the public system and target groups at risk of dental problems, including young children and senior citizens.

Zoellner says the additional funding is not enough to improve waiting list times and staffing levels in NSW. “[The funding] will barely meet the inflation rate.”

With about 250,000 public patients in NSW on waiting lists for dental treatment, patients are seeking help from general practitioners and, in some cases, requiring hospitalisation for dental infections.

“GPs are seeing an endless stream of patients coming in for repeated scripts of antibiotics and painkillers for teeth problems,” Zoellner says. “This is at a substantial cost to the public purse.”

But while those in the public system deal with long waiting lists, patients in the private system have the burden of high costs.

About 85 per cent of dentistry is performed in the private sector. The Australian Dental Association does not recommend a fee schedule for its members but, according to the MJA report, practitioners charge an average rate of $350 an hour, of which overheads account for about 70 per cent.

The president of the ADA, Chris Wilson, says fees vary along with the rebate from health funds, with some funds only paying for treatment from preferred providers. “The decision whether or not to have a treatment comes back to the patient,” Wilson says. “The dentist informs them of the risks and the cost.”

For those without private health care, the cost can be too much.

The report in the MJA estimated 25 per cent of dental patients delay treatment because of the cost. The likes of root canal surgery can cost upwards of $500 at a private practice; surgical procedures can add thousands of dollars.

Delayed treatment means that problems get worse and the eventual treatment becomes more expensive.

Delaying the inevitable through the use of antibiotics is also a problem. “This creates a public health issue – the over-use of antibiotics creates strains of resistant bacteria,” Zoellner says.

“From a public health perspective, it is lunacy that there is not guaranteed treatment for acute infection, that people are waiting.”

The majority of dental problems are largely preventable. However, the problems dentists are treating are increasingly complex. This is due in part to delayed treatment but also, ironically, to an improvement in oral health since the introduction of fluoride in the 1950s.

Fluoridated water supplies, along with fluoridated toothpaste and mouthwash, has meant people are keeping their teeth longer.

Tony Dawson, a Canberra prosthodontist specialising in reconstructive and replacement dentistry, says that while edentulism (people who are completely toothless) is decreasing, the number of people who have some teeth missing is increasing.

“We have gone from the ‘when in doubt, pull it out’ phase of dentistry to a much more conservative view,” Dawson says.

The more dental work people have, the more maintenance they may need, such as replacement fillings. “Everything we do has a certain life expectancy – these days we try and do the smallest possible fillings we can,” Dawson says.

Dental work such as fillings are often necessary to prevent further tooth decay, but it takes a toll on teeth. Each time a filling is replaced it takes a part of the tooth with it and, eventually the tooth may need to be replaced.

The trend towards people keeping their teeth for longer also means dentists are treating older patients with associated health complications.

‘When you are younger, the problem is likely to be tooth decay,” says Mark Schifter, a senior specialist in oral health at the University of Sydney. “But when you are older it is gum disease.”

Gum disease is linked to conditions such as diabetes, heart disease and low-birthweight babies. Gum disease that is left untreated has also been shown to worsen a patient’s diabetes.

“Evidence also suggests there is a similar causal relationship between oral health and cardiovascular disease,” Schifter says.

“The worse the gum disease becomes, the worse the medical condition, and vice versa.”

For some, gum disease is unavoidable. Some are genetically predisposed to tooth decay and gum disease – they just have the wrong saliva. “Some salivas have better anti-bacterial properties than others and some [people] have more aggressive bacteria,” Schifter says.

“We need to identify these patients that need help before the problems get out of control.”

Pregnant women are at higher risk of gum disease and, if the condition develops, they risk delivering lower birth-weight babies because of the toxins produced by the bacteria entering the blood stream.

Mothers also risk passing on the bacteria to their babies. When babies are born, their mouths are sterile. It is only when they begin sharing food and utensils, usually with their mother, that bacteria starts to build up in their mouths.

“If you are planning to have a baby you should visit your doctor and your dentist,” Schifter says.

Advances in fluoridation, now present in 90 per cent of the NSW water supply, are also being offset by diets that are high in sugar.

As a result, the rate of caries, or holes, in children’s teeth is increasing.

“People seem to see fluoride as a panacea, but it isn’t,” Schifter says.

During Dental Health Week, from August 1 to 7, the ADA will be campaigning for better awareness of how the consumption of bottled water – which does not contain the same amount of fluoride as tap water – along with sugary soft and sports drinks, is contributing to a decline in dental health.

In addition to government funding, Schifter believes, there should be more public education campaigns encouraging oral health, and they should be given the same status as the campaigns that encourage people to use sunscreen or quit smoking.

“The mouth should be given the same status as the rest of the body,” he says.

Grin and bare them, Hollywood-style

You may never have Julia Roberts’s legs – but you can have her teeth.

While some patients struggle to afford basic care, others spend the price of a small car on cosmetic improvements.

The celebrity smile is a sought-after cosmetic enhancement. In New York, clients are said to browse dentists’ books of “red-carpet smiles” in search of Oscar-winning choppers.

In Sydney, an online directory search finds more than 300 “cosmetic dentists”. But cosmetic dentistry can cause more harm than good.

Canberra prosthodontist Tony Dawson specialises in restoring lost or damaged teeth and says cosmetic dentistry can have unwanted side-effects. “You can achieve virtually anything if your pockets are deep enough and you are willing to accept the risks,” he says.

Dental implants and porcelain veneers are often necessary to replace lost or damaged teeth.

An implant can cost about $8000 a tooth and consists of a titanium screw, capped in either metal or porcelain.

Starting at about $1000 a tooth, porcelain veneers last about 10 years. But they can damage both your teeth as well as your bank account if not applied properly, Dawson says.

In an effort to change the shape of teeth, some dentists are cutting deeper into the tooth, below the enamel surface to the dentine.

“Carving up perfectly good teeth because people want to look like Julia Roberts or Jessica Simpson has problems,” he says.

“The harder you cut back teeth to change their shape the more likely you are to have problems such as nerves dying and having to crown or replace the teeth.”

Dawson advises patients to choose treatments for function rather than aesthetics.

“Go and see your family dentist first, if they can’t answer your questions they can arrange an appropriate referral.”

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

Dr Frank Huang of Master Dental has recently become a participating dentist.

Master Dental is located at Suite 104, 30 Fisher Road, Dee Why, New South Wales.

Dr Frank Huang and the team look forward to assisting members of NobleDentist.

Members wanting to make an appointment can simply click on Sydney Dentists for contact details.

Surrounding suburbs include Warriewood, Narrabeen, Elanora Heights, Collaroy Plateau, Oxford Falls, Beacon Hill, Frenchs Forest, Brookvale, North Curl Curl, Manly, Harbord, Curl Curl, North Manly, Queenscliff, Allambie Heights, Manly Vale, Belrose, Seaforth, Balgowlah, Clontarf, Fairlight, Mona Vale, Davidson, and Forestville.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by Dr Peter Lavelle titled ‘Holes in Dental Health’ recently appeared in ABC News.

Got a toothache? Well it better be during business hours in a big city, and you better be wealthy enough to afford to see a dentist.

That’s the message from the Medical Journal of Australia (MJA) this week which suggests low-income Australians better learn how not to smile.

There are only about 9000 practising dentists in Australia – about one per 2000 people, it says.

Most of these are in the central business districts or middle-class residential suburbs of major population centres. Of these, 86 per cent work in the private sector.

And they’re expensive. A standard consultation costs around $100 (compared to about $25 to $40 for a standard GP consultation), while the bill for more complicated procedures like root canal work can be as high as $500. And specialist treatment can amount to thousands of dollars.

People who have private health insurance get a partial rebate for these costs. But the rest have to pay the full amount.

Those with a Commonwealth Seniors Card, a Health Care Card, or a Health Benefits Card can get subsidised dental treatment from a dental hospital or community centre.

But there are so few dentists working in the public sector that waiting lists are between eight months and five years. About 600 000 Australian adults are on waiting lists.

Then there are a further unknown number of ‘working poor’ who aren’t eligible for subsidised dental care; they don’t have a card, but they can’t afford to see a dentist either.

Even a few months waiting to see a dentist is too long. The longer the wait, the greater the complications. They include:

• malnutrition. About a third of people using public dental services avoiding eating some foods because of bad teeth or gums;


• embarrassment and social isolation;


• illness such as mouth infections which can spread to the lungs, the blood and the arteries, and increase the risk of heart disease.

Increasing number of patients are turning up in doctors surgeries with complications like tooth abscesses and blood infections, says the MJA.

While doctors’ costs have been covered by a comprehensive national insurance scheme since the 1970s – Medicare – dental health is different. For most people, there’s no direct government assistance for dental bills apart from the overstretched public dental treatment services and the private health cover rebate.

Two years ago, the Federal Government announced that Medicare would cover dental procedures for the first time. Patients with chronic health problems like diabetes and heart disease that are made worse by bad oral health could be referred by a GP and Medicare would cover part of the dentist’s fees. The new scheme was supposed to benefit 23 000 people over four years.

Well, how is this system going? Abysmally, says the MJA this week. In 2005, there were only 2055 GP referrals for dental assessment and 2500 dental treatments worth a total of just over $500 000 (or $250 per 100 000 population). In other words, there’s been negligible use of the scheme. The cost and time involved doesn’t make it financially worthwhile for patients, doctors or dentists, it says. The patient can’t be refered until the original medical condition is treated – which leads to a long delay in dental treatment. And the rebate only covers a small part of the cost of the dental treatment, leaving patients out of pocket, and acting as a deterrant to those thinking about using the scheme.

States vs Federal

Low-income Australians with bad teeth are the victims of a tussle between the state and federal governments as to who should pay for public dental health programs, argues Robert Boyd-Boland, CEO of the Australian Dental Association.

The Commonwealth Government says it’s a state issue, while the states say it’s the responsibility of the Commonwealth to pay for dental services.

Last week’s meeting of the Council of Australian Governments (COAG) and last May’s Federal Budget both contained announcements of funding increases for more medical and nursing places in universities, but in effect nothing for dental training, he says.

There needs to be another 120 new dental training places created annually just to keep the dental workforce at current levels, given that a third of the dental workforce is over 50 and likely to retire in the next ten years, he says.

The Australian Dental Association would like to see financial incentives for dentists to treat public patients – similar to the Commonwealth Dental Health Program, in which dentists were paid to treat public patients – a scheme abolished in 1996 by the Commonwealth Government.

He says the additional investment would be more than recouped by the savings from fewer costs involved in treating advanced dental disease, and the better productivity of a nation with good teeth.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by Clare Masters appeared recently on news.com.au (Australia).

Children as young as three are being fitted for dentures while six-month-old babies grow up with rotten teeth as experts warn the obesity epidemic has sparked a dental crisis.

The numbers of children with dangerous dental decay is rising across Australia with the incidence of youngsters having serious dental work tripling in the last decade.

Australian Research Centre for Population Oral Health spokeswoman Lisa Jamieson said the rate of children aged under nine who had dental general anaesthetic – usually for extractions – rose from 216 per 100,000 in 1993-94 to 713 in 2003-04.

The University of Adelaide researcher said she had seen a three-year-old boy fitted for dentures after his baby teeth rotted away on a diet of junk food and soft drinks.

Even babies were turning up with crumbling teeth, she added.

“Children from about six months to three years are given a bottle filled with cordial or Coke,” she said.

“In one child every single tooth was rotten to the core because the mother gave the baby a bottle of Coke every night and added four spoons of sugar. She thought it was the right thing to do – we need public health campaigns.”

George Comino, grandfather of Kareela brothers Christopher, 6, and Benjamin, 7, said a ritual of oral hygiene was important.

“These boys are lucky they go to the dentist regularly and know the importance of a balanced diet and religious tooth brushing,” he said.

With the increased consumption of sugary drinks, dentists are calling for cigarette-style warnings on bottles and junk food advertising ban.

Australian Dental Association chief executive Robert Boyd-Boland said unfluoridated bottled water also contributed to the decay.

“The advertising of these foods is making them more attractive to the consumer, which is increasing their consumption and having an adverse effect on oral health,” he said.

Children’s Hospital Westmead dentistry head Richard Widmer said the public health system’s waiting list made the situation worse.

“A lot of the time we have an enormous number of children waiting,” he said.

A recent parliamentary inquiry was told more than 650 children were waiting on a general anaesthetic for dental treatment at Westmead Hospital – and the rate is increasing 15 per cent every year.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by Wendy Smith appeared recently in The Chronicle (Montreal, Canada).

A report revealing that twice as many Dorval children have developed cavities since the city stopped fluoridating its water has infuriated dentists and worried local parents, but some scientists are cautioning that re-fluoridating the water could cause more problems than it would solve.

The fluoride in the drinking water is not pharmaceutical grade fluoride, noted Sierra Club scientific advisor Daniel Green, but chemical grade fluoride or fluorosilicic acid, which has never been approved by the American FDA or by Health Canada as a drug or a food additive. “Because of the quantities needed to fluoridate entire communities, it would be too expensive for companies to use pharmaceutical grade fluoride,” Green said.

Fluorosilicic acid is a byproduct of the aluminum smelting and phosphate fertilizer industries and contains amounts of other chemicals from those industries, including lead, mercury, cadmium, and arsenic. “There is enough lead in fluoridated water to increase blood lead levels in children that leads to increased tooth decay,” said Gilles Parent, N.D., who co-authored the book La fluoration: autopsie d’une erreur scientifique with Pierre-Jean Morin, Ph.D and lawyer John Remingtom Graham.

The book contains over 700 scientific references to recent studies that link fluoride to dental and bone fluorosis, mongolism, Alzheimer’s disease, thyroid dysfunction, and a host of mutagenic, teratogenic and carcinogenic effects.

After studying 25,000 articles and reports, the authors found fluoridation was not effective in reducing tooth decay. Parent mentioned two studies, one from the government of Ontario and another from the University of York in England, which both conclude that fluoride has little, if any impact in reducing cavity rates.

Dr. Stéphane Schwartz, head of preventive dentistry at the Montreal Children’s hospital, disagrees. The member of the Montreal Coalition for Healthy Teeth told The Chronicle that fluoride lowers rates of tooth decay by 50 per cent. “All the dentists working together would not come to that result,” she said, adding that fluoridation was listed by the World Health Organization as one of the ten most important public health initiatives.

Schwartz says she’s “not terribly surprised” by the results of the Dorval study, which surveyed 385 children between 2003 and 2005. In 2003, while the city was still adding fluoride to its water supply, two dental hygienists from the CLSC Dorval-Lachine examined 122 kindergarten children in the area’s public schools. Twelve of these children were afflicted with caries – decay of the tooth enamel that can lead to cavities if left unchecked. In 2005, over a year after the city stopped fluoridating its water, 27 children out of 127 had caries. A survey conducted in Lachine during the same time period revealed fairly constant numbers of cavity-ridden children.

Green, who has a 14-year-old son and is also a member of the Societé pour Vaincre La Pollution, admitted he is literally “in the dentist’s chair” when it comes to the fluoride debate. He would rather see a more “hands-on interventionist” approach taken by clinics in schools to promote better nutrition and oral hygiene.

However, Schwartz says the schools have tried this approach before – and it hasn’t worked. She is adamant that kids need to be treated in their first few years of life in order to stop cavities from forming. “We ask them to come in for their first dental appointment at the age of one, so if decalcification starts, we can reverse it,” she said. “If you have a child who comes in full of cavities at the age of four or five, it’s too late. If you take fluoride supplements when you’re 15, it’s not going to make a heck of a difference.”

The benefits of drinking fluoridated water would only affect young children whose teeth are still forming, but the water could adversely effect others in the population, including the elderly, people with renal dysfunction, or osteoporosis sufferers, Green said.

Green is also concerned about the amount of fluoride that sewers would discharge into a river system already heavily contaminated with pharmaceuticals and additional fluoride from nearby aluminum smelting industries.

“I always used to say our fish must have the nicest teeth,” quipped Dorval Mayor Edgar Rouleau, who will meet with the Ministry of Health and Social Services at the end of August to discuss re-fluoridation of Dorval’s water. The city stopped adding fluoride in 2003, after the province refused to pay the $450,000 needed to upgrade its water treatment facilities unless the entire island of Montreal agreed to be fluoridated.

“The thinking is, if it’s good for the kids, we want it,” Rouleau said. “And we do want it; (the Ministry) can fight with Montreal.”

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by Denise Yearian titled ‘No Teeth to 32 Adult Teeth’ appeared recently in Delaware Online.

(Note: This is an American article – the spelling of some words will vary slightly.)

Step into a pediatric dental office and it may look more like an indoor playground. Waiting rooms adorned with Disney decorations, mini-movie theaters and climbing apparatuses are among the lures used to get kids to like going to the dentist.

“The goal is to get children in early on so they grow up with a healthy attitude about dentistry and continue in a lifelong routine of good oral health care,” said Dr. George Derenzo, a 25-year veteran pediatric dentist and orthodontist in Wilmington.

Derenzo didn’t always work with children. “I graduated from Temple University with a degree in general dentistry,” he said. “After interning in New York, I started my practice in Philadelphia. That’s when I realized I really liked working with children.”

So Derenzo returned to Temple for two years of training in pediatric dentistry, followed by another two years of orthodontic training at Fairleigh-Dickinson University in Hackensack, N.J. “I decided to combine these specialties so I could treat a full range of problems common to children,” he said.

Pediatric dentistry is a specialized field of dentistry that focuses on the oral health of infants, children, adolescents and those with special needs, with an emphasis on prevention, early detection and treatment of dental diseases.

“We see a variety of patients coming in at different ages and developmental levels—some with different issues—and we need to know how to make it a positive experience for each one,” said Dr. David Curtis, past president and spokesman for the American Academy of Pediatric Dentistry.

This is why specialized training is vital. Pediatric dentists must have a broad understanding in child psychology and behavior, growth and development, and medical issues that may affect children. They also need to be able to communicate with parents.

“There are more dynamics in working with children than with adults,” Derenzo said. “As a child grows, his mouth and dental structures are changing. You’re going from a mouth with no teeth to one with 32 adult teeth.”

That’s not all, Derenzo said. “You may have a 10-year-old child in your chair, but if he has developmental delay issues, you may actually be dealing with a 2-year old,” he said.

As with any pediatric specialty, pediatric dentists must enjoy children, and not only be able to communicate well with them but also motivate them. “A great deal of our time—both in training and on the job—has to do with establishing communication with children,” Curtis said.

Children aren’t naturally afraid of the dentist, Curtis said. Rather, those fears may emerge from not knowing what to expect. “If an open line of communication and a good relationship is established early on, most times you can allay the child’s fears,” he said.

When Derenzo sees an anxious child who’s old enough to understand, he tries an approach called “Tell. Show. Do.” He tells the child what he’s going to do, shows him how it’s done on his hand or finger, then actually does the work.

“Talking and giving reassurance is a lot of times what is needed,” Derenzo said.

Another facet of the job is the continual training needed to keep up with new procedures and equipment. In Delaware, 50 hours of continuing education is required every two years.

“Dentistry, generally speaking, has evolved to a great extent over the past couple of decades and there are constantly new materials being created, so it’s important that we keep up with leading technology,” Curtis said.

“That’s one of the biggest changes I’ve seen in this field—the type of materials we use,” Derenzo said. “Today we’re doing more white restorations instead of silver fillings. And the medications we use are more effective.”

Derenzo also has seen an increase in demand for pediatric dentists. “Parents are becoming more aware of this specialty and want someone who is an expert working with their children,” he said.

Since most pediatric dentists are self-employed, they have the freedom to make their own schedules and be their own bosses. But running a business does have its downsides. “You have to maintain the business end of it and deal with the issue of employees. And sometimes you have to deal with uncooperative parents,” Derenzo said.

Even so, pediatric dentistry provides a great deal of personal satisfaction.

“I love children and enjoy watching them grow into healthy, functioning adults,” Derenzo said. “Hopefully, as more information is given to parents about early prevention at a young age, the cavity rate will go down, and we’ll see children with better oral health

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

Pregnancy can trigger a number of physical changes in oral health including pregnancy gingivitis and pregnancy epulis.

Pregnancy gingivitis

Gingivitis, or inflammation of the gums, is very common in pregnancy. The hormonal changes that occur at this time lead to increased blood flow to the gum tissue and increased inflammation of this tissue in response to the presence of plaque.

If you have pregnancy gingivitis, your gums will appear swollen and bleed easily. The severity of the gingivitis can be minimised by greater attention to oral hygiene. Brushing your teeth thoroughly twice a day with fluoride toothpaste will help reduce plaque, as will flossing after each meal.

Pregnancy epulis

Occasionally, some pregnant women will develop a localised swelling on the gum known as a pregnancy epulis. Typically this will occur in the second or third trimester, sometimes even appearing for the first time in the final month of the pregnancy.

A pregnancy epulis will often bleed easily, and can appear very red and inflamed, however they are generally not painful. They are also not cancerous and do not have the potential to become cancerous.

Some women who have an epulis will have it removed during pregnancy, usually because of bleeding, for cosmetic reasons, or because the diagnosis is uncertain. However, if left alone, the epulis will usually regress after childbirth.

Special considerations

Special considerations regarding oral health during pregnancy include:

• Nutrition – You should eat a balanced diet including sufficient quantities of calcium, protein, phosphorus, and vitamins A, C, and D during pregnancy. This is important for your baby’s dental health as well as your own.
• Dental procedures – In general, any elective dental procedure should be postponed until after delivery, especially if it involves X-rays and anaesthesia. However, a toothache should be considered a dental emergency. It is particularly important for your dentist to treat infections that can cause toothache, because these infections can potentially spread throughout the body and affect your pregnancy. If you need to have a filling, it is important to note there is no evidence that silver fillings are linked to mercury toxicity. Nevertheless, if you are concerned about having silver fillings, there are viable alternatives.
• Antibiotics – Some antibiotics are not suitable during pregnancy, including tetracyclines, which can affect your child’s developing teeth.

Therefore it is important that your doctor or dentist is always aware if you are either pregnant or possibly pregnant. There are many antibiotic options available that have been proven to be safe in pregnancy.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

The Australian Dental Association is recommending that first aid include information and training relating to a dental injury. In particular they suggest that parents and teachers need to be aware of some techniques.

Dr Don Wilson of the Australian Dental Association makes the following points in relation to the matter.

• ‘Australians have a reputation for being cool in a crisis and when it comes to dealing with dental injury. This is essential’. For instance, if a tooth is ‘re-planted’ immediately after being knocked out, it has an excellent chance of recovery.
• Incidents of teeth being knocked out or broken are quite common but few people are aware of how to deal with this situation when it arises. The Australian Dental Association suggests that parents and teachers in particular need to be aware of some basic techniques.
• If ‘first aid’ is applied immediately after a dental injury, it significantly increases the chances of a faster recovery and a more satisfactory outcome. The ADA offers the following first aid advice for teeth.

Tooth injury

When a tooth is knocked out, it should be carefully inspected for debris — avoiding holding it by the root — and, if necessary, gently washed with water or saliva. The tooth should then be put back into the socket.

If the tooth cannot be re-planted, it should be placed in milk, or stored in Glad Wrap or in the patient’s mouth inside the cheek.

The patient and the tooth should then be taken to a dentist as soon as possible, preferably within 30 minutes. Time is critical for successful replanting the tooth.

If a tooth is broken, try to clean the debris from the injured area with warm water. If a blow to the jaw or mouth causes the injury, place a cold compress on the face next to the injured tooth to minimise swelling.

If you can, find all the bits that are missing and bring them to the dentist, keeping them moist. In many cases, broken bits can be bonded back onto the teeth almost invisibly.

Toothache

When it comes to toothache it is usually a sign that you need to see a dentist as soon as practicable.

In the meantime, relief can be obtained by rinsing the mouth with water and trying to clean out debris from any obvious cavities.

Use dental floss to remove any food that might be trapped within the cavity (especially between the teeth).

If swelling is present, apply a cold compress (NOT HEAT) to the outside of the cheek.

Take pain relief, if necessary, using pain medicines that you know you can take safely.

It is important to remember that pain relief tablets don’t work directly on the tooth. They must be swallowed as directed. If placed on the tooth, they can cause more trouble (especially aspirin).

If people are travelling overseas or into a remote area and they break a tooth, often they do not need to interrupt their trip to get it fixed, especially if there is no toothache. They can file down any sharp edges with an emery stick and get the tooth fixed when they get home.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by Dr Peter Lavelle has recently appeared on ABC Online (Health Matters).

Bad breath – also known as halitosis – is one of two conditions only other people have. (The other is BO, or body odour.)

The usual cause is the breakdown of food remains in the mouth. The smell is from substances called volatile sulphur compounds caused by the breakdown of protein in the mouth by bacteria. It’s essentially, food ‘going off’ in the mouth.

As they break down the proteins, the bacteria produce compounds with names like cadaverine, putrescine, hydrogen sulphide and methyl mercaptan. These compounds produce aromas characteristic of rotten eggs, cabbage, sulphur, gasoline, mothballs, faeces, corpses, urine, decaying flesh, sweat, rancid-cheese, and off-milk. (Don’t go looking for the bacteria in a Calvin Klein laboratory.)

The smell of sulphur in the morning

Bad breath can happen to anyone at any time, but it’s usually more common when a person wakes up in the morning.

That’s because when we are sleeping, the flow of saliva diminishes and there is less flushing of food by saliva. The result is the food stays in the mouth longer to be broken down by the bacteria.

When a person is dehydrated, their flow of saliva also diminishes. For example, someone who gets dehydrated after exercise may have bad breath.

People who get anxious often have a dry mouth and may get bad breath.

Some people can get a dry mouth as a side-effect of taking medications, particularly high blood pressure medications, antidepressants, anti-anxiety agents, and antipsychotic agents.

But probably the most common cause is poor oral hygiene that causes gum diseases such as gingivitis and periodontitis. When clumps of food and bacteria gather in damaged gums and teeth, they give bacteria plenty of time to work on them.

Less commonly, it can be caused by infections like bronchitis, post nasal drip, or sinus infection. Other causes include chronic conditions like diabetes, kidney or liver failure, or reflux oesophagitis (when the oesophagus becomes inflamed by acidic food entering it from the stomach).

Smokers often have bad breath. Not only does tobacco have its characteristic smell, but smoking dries out the mouth, and smokers are also more likely to have gum disease and hence bad breath.

Some foods, such as onions or garlic, can give the breath a certain aroma – but they don’t last long and don’t cause classic bad breath.

What should those other people do?

There is a device that can be used to test for bad breath. It’s called a haliometer – a box with a plastic tube coming out of it which takes a sample of air and measures the amount of volatile sulphur compounds in parts per billion. A normal reading is less than 200 parts per billion, and greater than 300 is considered a problem. For anyone you know who has consistent bad breath, a haliometer makes a terrific gift.

But in most cases a haliometer won’t be necessary. Someone will probably tell you – a friend for instance who doesn’t care about embarrassing you.

So if no-one says you have bad breath, you either have no volatile sulphur compounds, or no friends.

Just to stay on the safe side, the latest issue of the Mayo Clinic Health Letter has some useful tips:

• Brush your teeth or use mouthwash after you eat. Brushing is more effective, but if you use mouthwash, swish it around in your mouth for 30 seconds before you spit it out.


• Floss your teeth at least once a day in order to remove decaying food.


• When brushing your teeth, brush the back of your tongue too, or scrape it with a tongue scraper, available from pharmacies.


• Drink plenty of water to keep your mouth moist.


• You can also chew sugarless gum or suck sugarless sweets to help stimulate saliva production.


• If you have dentures, clean them daily to get rid of food particles and bacteria.

If these measures don’t seem to be working, see your doctor or dentist – the odds are that you may have a gum or tooth disease or some other problem that can be treated.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

Teeth grinding (bruxism) is involuntary clenching and gnashing of the teeth. It is thought that about half of the population bruxes from time to time, while around five per cent are habitual and forceful tooth grinders. It generally happens during sleep, but some people experience it when they are awake.

Bruxism is usually a physical expression of mental stress; for example, susceptible people tend to grind their teeth when they are angry, concentrating hard on a particular task or feeling anxious. Another cause may be incorrect tooth alignment.

Generally, the person doesn’t realise that they grind their teeth in their sleep. The spouse or partner who shares their bed (and hears the grinding noises at night) is often the first to notice the problem.

Symptoms

The symptoms of bruxism include:

• Audible grinding sounds while the person is asleep
• Headache and/or ear pain
• Aching teeth, particularly upon waking
• Aching jaws while chewing, particularly during breakfast
• Clenching the jaw when angry, anxious or concentrating
• Temperature-sensitive teeth
• Cracked tooth enamel
• Tooth indentations on the tongue
• Raised tissue on the cheek mucosa caused by cheek biting (linea alba)
• Inflammation of the tooth socket (peridontitis).

Complications of bruxism

Teeth grinding can cause a range of dental problems, which may include:

• Cracked tooth enamel
• Excessive wear and tear on the teeth
• Broken teeth
• Tooth loss
• Enlargement of the jaw muscles
• Strain on the joints and soft tissue of the jaw joint (temporo-mandibular joint)
• Damage to the disc that sits inside the temporo-mandibular joint
• Arthritis of the temporo-mandibular joint (this is suspected although not yet proven)
• Temporo-mandibular dysfunction syndrome.

A range of causes

Some of the many factors believed to trigger bruxism in susceptible people include:

• Emotional stress, such as anger or anxiety
• Mental concentration
• Physical effort
• Incorrect tooth alignment
• Drug abuse
• Alcohol abuse
• Eruption of teeth (babies and children).

The link to another sleep disorder

The sleep disorder periodic limb movement syndrome (PLMS) is characterised by uncontrollable jerking of the legs or arms during sleep. It is thought that bruxism and PLMS share an important characteristic. People with these disorders are more likely to ‘act out’ their dreams while sleeping. The reasons for this are not clear, although one theory is that brain centres which control masticatory (chewing) muscle movements lie close to those centres involved with dreaming.

Diagnosis methods

If you suspect you may grind your teeth, see your dentist as soon as possible. Your dentist will inspect your teeth and may take x-rays to gauge the severity of the problem and the damage done to teeth and bone. You may be asked to wear an electrical pressure device while you sleep to help measure the force of the grinding.

Dental treatment options

You should consult your dental professional for their recommended course of treatment. Dental treatment options include:

• Repair of tooth damage
• Adjustment of fillings that may be too high and interfering with the bite
• Devices such as braces or plates to correct tooth alignment
• Mouth appliances to be worn at night (bite splints), so that you grind the device and not your teeth. However, in most cases these appliances will only provide temporary relief of the condition.

Other treatments

Other treatments that may help to manage teeth grinding include:

• Stress management therapy
• Relaxation techniques
• Cognitive behaviour therapy
• Regular exercise
• Muscle relaxant medication.

Where to get help

• Your dentist
• Your doctor
• Psychologist, to help with stress management.

Things to remember

Teeth grinding (bruxism) is involuntary clenching and gnashing of the teeth that usually happens during sleep. Causes can include incorrect tooth alignment, stress and drug abuse. Treatments include bite splints to be worn at night, repair of tooth damage, muscle relaxant medication and stress management therapy.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.