The NobleDentist Blog

This is an article by Ruth Pollard that appeared recently in the Sydney Morning Herald.

Dental services in the state’s country areas are inadequate, with many rural residents waiting between three and five years to access publicly funded dentists and waiting months for private dentistry.

A survey by the Rural Dentist Action Group found 18-month delays for dentures after teeth were removed and 400-kilo metre trips to the nearest school dental program. People in country areas were struggling to afford and get access to even the most basic services.

The survey of 191 Country Women’s Association branches in NSW found more than one-third of respondents did not have a school dental health service in their area, 44 per cent did not have a private dentist and more than 65 per cent did not have a government dental clinic.

Transport was also a substantial barrier. “If you do not have much money, you do not travel two to three hours to have your teeth checked, you wait until there is a terrible problem and then you do it,” said the action group’s spokeswoman, Lucy Needham. “Some of the towns only have the school dental service visiting once a year, where they might do an assessment and refer children on to a private dentist.”

Even in large rural centres such as Orange, where there is a good supply of private dentists, there was still a long wait to get in and many people could not afford the fees, Ms Needham said.

“We have a public dental system in crisis and it is particularly bad in the state’s rural areas,” said Michelle Burrell, acting director of the NSW Council of Social Services.

What was particularly shocking was the sporadic access to school dental services, she said. “Everybody just assumes that program is in good shape. Clearly it isn’t and if we don’t sort out our kids’ teeth we are going to have terrible dental problems later in life.

Ms Burrell called on the NSW and federal governments to make an emergency investment in the public dental system – $170 million in state contributions to stabilise services plus $700 million in recurrent state and federal spending.

“We cannot afford not to invest; what goes on in people’s mouths has a huge impact on their life chances, their ability to socialise, their ability to get a job.”

A spokeswoman for the Minister for Health, John Hatzistergos, acknowledged there was a crisis in the dental health workforce, but said the Government had recruited 26 dentists to work across the state, many in rural areas.

There was also a lack of federally funded dental training places – 45 dentists graduated in NSW a year while far more than that retired, she said.

There was an imbalance of dentists in Sydney and the state, said Hans Zoellner, the chairman of the Association for the Promotion of Oral Health.

The Organisation for Economic Co-operation and Development average is 56 dentists per 100,000 people. In the eastern suburbs it is 89 per 100,000, in south-western Sydney 32 and in rural areas it is below 29.

There were five public dentists per 100,000 eligible patients in south-western Sydney, while in the Northern Rivers area of the state there were eight.

This is an article that was recently published within the Your Oral Health section of the NobleDentist website.

Routine physical examinations including hearing and vision tests help ensure that students are in good health before school begins. When scheduling health care appointments, don’t overlook a dental check up for your child. A dental examination should be a regular part of back-to-school preparations. Children need to see a dentist at intervals recommended by their dentist. Many parents and caregivers don’t realise that serious tooth decay is an infectious disease for which there is no immunisation.

Children and Oral Health

More than one-half of all children aged 5 to 9 years have at least one cavity or filling. A painful tooth or chronic dental problem can lead to difficulty in eating, speaking and concentrating. Children with chronic dental pain may not always voice their dental problem. They may appear anxious, depressed or tired but teachers may not recognise their pain. Dental problems also cause many children to miss school.

Children and Dentists

Regular dental check ups and preventive dental care such as cleanings and fluoride treatment provide children with “smile” insurance. Routine dental examinations uncover problems that can be treated in the early stages when damage is minimal and restorations may be small. This helps prevent painful, chronic conditions and saves money.

When necessary, radiographs (commonly called “x-rays”) are taken to see how the teeth are developing and to spot hidden decay. Every child should have an orthodontic evaluation by age 7. Early examination and treatment may prevent or reduce the severity of malocclusions (or “bad bite”) in the permanent teeth.

Because children’s needs differ, our participating dentists are best able to suggest a schedule of visits for your child. The frequency of dental visits will depend partly on the child’s eating habits, how clean the teeth are kept, past treatment needs, whether the child drinks fluoridated water and other factors that can affect the likelihood of dental diseases.

Protecting a Healthy Smile

Dental sealants are another option for keeping teeth healthy. A sealant is a plastic material that our participating dentists apply to the chewing surfaces of the back teeth (the premolars and molars). Sealants form a barrier that protects teeth from plaque, a sticky film of acid-producing bacteria. Sealants hold up well under the force of normal chewing and usually last several years before a reapplication is needed.

Besides a dental check up, your child may be due for a new toothbrush. The ADA recommends replacing toothbrushes every three to four months or sooner if bristles are worn. A worn toothbrush can’t do a thorough job of cleaning teeth. Select a child-sized toothbrush for ease of use.

Children may be able to brush their teeth by the age of 7 years but may need supervision brushing until about age 10 or 11 years. Flossing removes plaque from between the teeth where a toothbrush can’t reach. However, flossing is a more difficult skill to master. Floss your child’s teeth until about age 10 years after which he or she should be able to floss under adult supervision.

Many injuries that occur on the playground or even while skateboarding can be prevented or minimised if the child is wearing a mouthguard. A mouthguard can be purchased at a sporting goods store or can be custom made by our participating dentists to fit your child’s mouth.

This is an article by Deborah Kotz that was recently published in U.S. News & World Report.

Too tired to floss? Those puffy bleeding gums could increase your risk of pancreatic cancer, according to a new study published this week in the Journal of the National Cancer Institute. Pancreatic cancer is the fourth-leading cancer killer, striking about 34,000 people last year and causing more than 32,000 deaths.

Researchers from the Harvard School of Public Health in Boston surveyed more than 50,000 male health professionals (about half of them dentists) to determine who had periodontal disease, then followed them for 16 years; 216 eventually developed pancreatic cancer. After controlling for known risk factors like smoking, alcohol intake, and body weight, the researchers found that those with gum disease were 64 percent more likely to develop the cancer than those with healthy gums; those who had lost teeth because of severe gum disease had 2.7 times the risk. “Since the cancer is so highly fatal, it’s interesting to have a new risk factor to help us understand the disease better,” says study leader Dominique Michaud, an assistant professor epidemiology at Harvard. The study needs to be replicated, she adds, before a definitive link is made. Also, it didn’t include women, so there is no way of knowing if this finding applies to them.

Previous research has shown that gum disease leads to an increased risk of heart attacks and strokes, possibly because oral bacteria in the bloodstream trigger blockages in arteries. Other studies have shown links between gum disease and diabetes and preterm labor. These same bacteria might also trigger inflammation in the pancreas, suggests Michaud, setting the stage for malignant cells to grow.

“This study certainly adds to what we know about how important oral health is for general health,” says Steven Offenbacher, director of the center for oral and systemic diseases at the University of North Carolina School of Dentistry, who has done research on periodontal disease and cardiovascular risk. “Fortunately, gum disease is preventable and treatable.” To keep gums healthy, the American Dental Association recommends brushing twice a day, flossing once a day, and seeing a dentist for regular checkups.

This is an article that was recently published in the ‘Your Oral Health’ section of the NobleDentist website.

Advances in modern dental materials and techniques increasingly offer new ways to create more pleasing, natural looking smiles. Researchers are continuing their often decades-long work developing esthetically attractive materials such as ceramic and plastic compounds that mimic the appearance of natural teeth.

Today, more patients ask participating dentists about white fillings because they want their teeth to look natural when they laugh, talk and smile.

White fillings, also called composite fillings, are made from tooth-coloured materials that restore the natural appearance of a decayed or previously filled tooth. Because they blend well with tooth enamel and don’t look like fillings, a participating dentist may recommend them if the teeth to be restored are near the front of your mouth.

A composite filling usually requires only one visit, during which the tooth is prepared and restored. An advantage of composite fillings, as with other dental restorations, is that they require less of the healthy part of a tooth to be removed to hold the filling in place. This is due to composite materials’ ability to bond to teeth adhesively.

The procedure for a composite filling may take a little longer than those for other types of fillings because after the decay is removed, the tooth must be kept totally isolated from saliva. A participating dentist carefully applies an adhesive followed by several thin layers of the tooth-coloured composite. Once the filling is in place, it is chemically hardened, or cured, for less than a minute with a special light.

Composites are preferable for obvious cosmetic reasons but if the decayed area is large or is subject to heavy chewing pressure, a participating dentist may recommend another type of material or restoration. Some people may experience some sensitivity to hold or cold temperatures in the newly filled tooth for a few days or as long as a week. If the sensitivity continues beyond that time, contact a participating dentist.

Other types of white fillings include composite inlays and porcelain inlays and onlays. Inlays and onlays are used to restore teeth that are badly damaged by decay or wear. They may be applied to the chewing surfaces of the back teeth when esthetics is of concern.

Some white fillings may be more expensive than other dental materials but most patients find these natural-looking restorations well worth the additional cost. White fillings, like other dental materials, may require periodic replacement. If the edge of the filling eventually pulls away from the tooth, bacteria can get between the filling and the enamel and eventually may cause decay. Tooth decay over time may develop elsewhere on the tooth. Regular dental check-ups are important because they allow a participating dentist to detect a problem in the early stage.

This is an article recently published in the ‘Your Oral Health’ section of the NobleDentist website.

Many patients are discovering the benefits of dental veneers. Unlike a crown which covers the entire tooth, a veneer is a thin covering that is placed over the front (visible) part of the tooth. A participating dentist applies veneers in a simple, comfortable procedure that takes just a few visits.

Veneers are a popular treatment option for several reasons. They generally are placed on upper front teeth that are severely discoloured, poorly shaped or slightly crooked. Veneers may be used to lighten front that are naturally yellow or have a gray cast and can not be whitened by bleaching. Veneers are sometimes used to correct teeth that are chipped or worn. They also may be used to correct uneven spaces or a diastema (a large, noticeable gap between the upper front teeth).

Types of Veneers

There are two types of veneers: ceramic veneers (sometimes called laminates) and resin-based composite veneers.

Ceramic veneers. Ceramic veneers are extremely thin shells made of a strong and durable dental ceramic. A participating dentist removes a small amount of enamel from the front and sides of the tooth. This makes room for the veneer and prevents the restored tooth from feeling or looking bulky or unnatural.

Next, the participating dentist makes an impression of the prepared teeth so that the shape of the preparations and surrounding teeth can be replicated in the dental laboratory. The participating dentist also looks for the shade that will best match or blend with the other teeth. The impressions are sent to a dental laboratory that makes the ceramic veneers to fit your individual teeth. This may take several days.

At the next visit, the participating dentist places the veneers on the teeth to check the fit and shape. After any adjustments, the teeth are cleaned and the ceramic veneers are bonded to the teeth with dental cement. Further adjustments may be done at a subsequent appointment.

Resin-based composite veneers. Resin-based composite veneers generally are placed in one appointment. After the tooth is prepared or reshaped, the participating dentist carefully bonds and sculpts the composite material in a colour that matches your other teeth. A special light is used to harden the composite. The veneer is smoothed and polished to look like a natural tooth.

Choosing Veneers: Considerations

Teeth must be healthy and free of decay and active periodontal disease. Veneers typically require less removal of tooth enamel than do crowns. However, the process is not reversible once the enamel is removed.

Patients who clench or grind their teeth are not good candidates for veneers because the thin veneers may chip, break or peel. Avoid biting your fingernails and chewing on hard objects such as pencils or ice. Like any dental restoration, veneers can be dislodged over time and with wear. In that case, new ones might be needed. As with all your dental care, discuss your expectations and treatment options thoroughly with a participating dentist.

No special maintenance is needed other than good oral hygiene each day. Brush twice a day with fluoride toothpaste and clean between your teeth once a day with floss or another interdental cleaner. Regular dental visits are a must for maintaining healthy teeth.

This is an article recently published within the ‘Your Oral Health’ section of the NobleDentist website.

If you are self-conscious about missing teeth or wearing dentures, there’s an alternative that may be right for you: dental implants. Dental implants are one option for replacing missing or badly diseased teeth. A dental implant offers comfort and stability and, by virtue of the artificial tooth it supports, is a restoration that is the closest thing to a natural tooth.

What is a dental implant?

Implants are manufactured anchors that look like cylinders or screws. They are artificial replacements for natural tooth roots. Implants are used in upper and lower jaws. They are made of titanium and other material that are well suited to the human body. They attach to the jawbone and gum tissue to become a stable base for one or more custom artificial replacement teeth, called dental crowns.

Dental implants have been used for several decades. Patients of all ages have chosen dental implants to replace a single tooth or several teeth or to support partial or full dentures. It’s no surprise. Dental implants and their crowns help restore the ability to chew food. They help fill out a face that otherwise could look sunken because of missing teeth. Unlike dentures, implants and crowns are not removed for overnight soaking and cleaning. No adhesives are needed.

The Dental Implant Process

Treatment generally is a three part process that takes several months.

In the first step, a participating dentist surgically places the implant in the jaw with the top of the implant slightly above the top of the bone. A screw is inserted into the implant to prevent gum tissue and other debris from entering. The gum then is secured over the implant. The implant will remain covered for approximately three to six months while it fuses with the bone, a process called osseointegration. There may be some swelling, tenderness or both for a few days after the surgery, so pain medication usually is prescribed to alleviate the discomfort. A diet of soft foods, cold foods and warm soup often is recommended during the healing process.

In the second step, the implant is uncovered and a participating dentist attaches an extension called a post, to the implant. The gum tissue is allowed to heal around the post. Some implants require a second surgical procedure in which a post is attached to connect the replacement teeth. With other implants, the implant and post is a single unit placed in the mouth during the initial surgery. Once healed, the implant and post can serve as the foundation for the new tooth.

In the third and final step, a participating dentist makes a crown which has a size, shape, colour, and fit that will blend with your teeth. Once completed, the crown is attached to the implant post.
Are dental implants right for you?

Who’s a good candidate for implant treatment?

You are, if you’re in good health and have healthy gums and adequate bone to support an implant. You must be committed to thorough oral hygiene to keep your mouth healthy and to scheduling regular dental visits. Ask a participating dentist if implants are an option for you.

This is an article by Patrice Smith that appeared recently on ABC News (Charleston – South Carolina).

Charleston, SC - If someone you know is in denial about a problem with alcohol, it may not be the first thing you’d think to do, but you may want to send them to their dentist.

According to a study conducted by addiction experts at the Medical University of South Carolina, the dentist may be an ideal source for an alcohol intervention.

Dr. Mark Barry of the College of Dentistry at MUSC says, “Actually in the dental health questionnaire, the question is asked about alcohol and smoking so if they answer yes to the question on the health questionnaire, it kind of prompts a dialogue between patient and dentist.”

Barry has practiced dentistry for 21 years and says there’s a trust between a patient and the dentist that makes them comfortable talking about sensitive subjects.

“The dentist has to build a relationship with the patients and I think that relationship is really the key to patients opening up to the and being able to dialogue with the about potential alcohol problems,” says Barry.

The study talks about the link between alcohol abuse and oral cancer. Heavy drinkers have a 50 percent higher risk of developing oral cancer. Patients who admit to their dentists that they’re having problems with alcohol are provided with referral sources to seek help.

Dr. Barry says a patient can be so comfortable with his dentist that he’ll open up about other addictions as well.

We see addiction to tobacco both smoking and smokeless and that’s an area that dentists can really be involved with because smoking as well as smokeless tobacco has a profound impact on treatment.

The MUSC study appeared in the December journal of the American Dental Association.

This is an article by Miranda Hitti (reviewed by Dr Louise Chang MD) that appeared in WebMD Medical News.

Osteoporosis screening may be helped by dental X-rays, British dental experts report.

They’ve developed computer software that checks routine dental X-rays for possible warning signs of osteoporosis, in which bones become too thin and are more likely to fracture.

The software developers include Keith Horner, PhD, MSc. He’s a professor of oral and maxillofacial surgery at England’s University of Manchester.

Horner’s team tested the software on 652 women aged 45-70 in Belgium, Greece, Sweden, and the U.K.

The women got bone densitybone density scans of their hip and spine using a special type of X-ray called dual-energy X-ray absorptiometry (DEXA).

The women also got routine dental X-rays that were analyzed with the computer software.

The DEXA scans showed that 140 women had osteoporosis. The computerized dental X-ray analysis didn’t flag all of those cases.

But the dental X-ray analysis showed that 119 women were candidates for further bone tests, which later showed that 72 of those women indeed had osteoporosis.

Tapping Useful Information

The dental X-ray software “should not been seen as a replacement” for DEXA, Horner tells WebMD in an email.

Instead, the software may help dentists note patients who might be candidates for further osteoporosis screening, based on their risk factors and medical history.

“The value of our method is that dentists take millions of these X-rays every year for ordinary dental reasons and they contain useful information that isn’t being used,” Horner says.

“People may be apparently healthy and never visit their family doctor, but often regularly go to their dentist for checkups.”

Horner says the analysis could be done without the software, but not as well.

“The software does it automatically and is free from observer errors,” Horner says.

The software isn’t available yet.

“We are currently negotiating with an industrial partner to get the software out from the laboratory into the dental offices,” Horner says.

This is an article that appeared recently on ABC News Online.

Adult Tasmanians who are eligible for public health care will no longer have to pay an emergency dental treatment fee.

The State Government is scrapping the $25 fee from today, following a promise made during the last election campaign to abolish the fee.

Acting Health Minister Michael Aird says adults need a health care card or pensioner concession card to be eligible to public dental treatment.

He says the removal of the fee will benefit thousands of Tasmanians.

“In the quarter to the end of September, almost 3,500 emergency adult services were provided by Oral Health Services,” he said.

“So that’s some indication about the effect this is going to have directly upon people’s oral health issues.”

Mr Aird says the timing of the announcement has nothing to do with what people are likely to be eating over the festive season.

“The fact is that we are making this announcement now and introducing this service as from the first of January on the basis that we had to put in different administrative arrangements,” he said.

This is an article by Helen Gao that appeared recently in the San Diego Union Tribune (California, USA).

Now parents have to do one more thing for their children, if they are not already doing it: Take them to a dentist.

Under a new state law that went into effect yesterday, children must have a dental checkup by May 31 of their first year in public school.

For most children, it should be done for kindergarten. If a child did not attend public kindergarten, the checkup will be needed for first grade.

Dental evaluations performed 12 months before a child’s enrollment are acceptable.

Parents who object or who lack the financial means or dental insurance can be exempted from this requirement. Schools will send home forms for parents to take to dentists to fill out on the condition of their children’s teeth. The same form includes provisions for exemptions.

Students currently in kindergarten or first grade are subject to the requirement.

The California Dental Association, which sponsored the legislation, said the law was intended to raise awareness of the importance of oral health. The Association of California School Administrators, which did not endorse the bill, called it another “compliance and reporting measure.”

But with the law taking effect, the administrators association, the California School Nurses Association and the dental association are all working to help educate schools and parents.

Gayle Mathe, a community health advocate for the dental association, said dental disease is a common cause of school absences. She hopes the law will spur parents to seek out dentists before their children end up with tooth decay serious enough to miss school or land them in emergency rooms.

“We immunize them, look at their eyes and ears,” she said. “It’s really important we look at (dental health) and not leave this out.”

According to a 2000 U.S. Surgeon General’s Report on Oral Health in the nation, more than 51 million school hours are lost each year because of dental-related illness. Dental disease was cited as the “single most common chronic childhood disease” – five times more common than asthma.

The American Academy of Pediatric Dentistry recommends that parents take infants to the dentist by their first birthday for screening and preventive tips.

If a child does not see a dentist until age 4, 5, 6 or 7, it might be too late, said Paul Reggiardo, a pediatric dentist and public policy advocate for the California Society of Pediatric Dentistry.

“Something like 50 percent of the kids entering kindergarten have had dental decay,” Reggiardo said, adding that 80 percent of the decay that children have when they enter kindergarten started by age 3.

The dental assessment form notes whether a child has cavities and fillings and, if there are signs of infection, whether the need for treatment is urgent.

Parents seeking exemptions will be asked to check boxes to indicate why their children didn’t get checkups. Reasons for exemption include financial hardship, lack of access to dental professionals and objection to having their children undergo a checkup.

Schools will send out information on government health programs, such as Healthy Families and Medi-Cal, which provide dental care for the needy.

Forms will be gathered and analyzed by the state Department of Health Services to pinpoint the barriers to dental care.

In San Diego, where water is not treated with cavity-fighting fluoride, dentists say they see a fair number of children with tooth decay.

Stephen Finger, a Mira Mesa pediatric dentist, said dental decay also is common in the region because many children were born in foreign countries where regular dental checkups from an early age are not the norm.

“Unfortunately, dental decay tends to hit the kids who can least afford the dental care,” Finger said. “It’s the lower-income, lower socio-economic groups.”

Marty Stroud, dental coordinator for La Maestra Community Health Centers, a nonprofit that treats many poor families, agrees.

“It’s unfortunate (that) a lot of them don’t come in until they start hurting,” Stroud said. “By then it’s too late. . . . Then they wind up missing school because they need all of these dental appointments to get them out of pain.”

Children are required to get dental checkups by May 31 of their first year in public school.

Parents who object can obtain exemptions.

Schools will make the forms available to parents, to be filled out by the child’s dentist.

For more information, visit the California Dental Association’s Web site at www.cda.org/advocacy_&_the_law/legislation/kindergarten_oral_health_requirement.