Life Style Diseases & Dental Health

Definition of Lifestyle Disease: A disease associated with the way a person lives. Lifestyle diseases include atherosclerosis, heart disease, and stroke, obesity and type 2 diabetes; and diseases associated with smoking, alcohol and drug abuse. Regular physical activity helps prevent obesity, heart disease, hypertension, diabetes, colon cancer, and premature mortality.

A recent disclosure by the World Health Organization (WHO) stated that 4.4 million people die due to raised cholesterol levels, 7.1 million people die because of hypertension, 4.9 million people die from tobacco use, and 2.6 million people die as a result of being overweight or obese. Lack of sleep leads to an increased production of the hormone ghrelin, which stimulates appetite. A recent study showed that sleep-deprived individuals eat more sweet, salty, and starchy foods.

Dentally speaking the same life style factors that contribute to heart attack, stroke, diabetes, and hypertension also contribute to the two primary dental diseases: caries and periodontitis. Over eating, (frequent snacking), poor choice of foods (sugar, soda pop), lack of exercise (as in oral hygiene exercise), self neglect, smoking, drug abuse, failure to obtain professional care and failure to follow wise council (advice) all contribute to dental disease. Dental disease doesn't start in the mouth. It starts in the mind.

According to a recent joint media briefing sponsored by the American Medical Association and American Dental Association, there is a predominance of epidemiological evidence showing a two way association between oral health and systemic health. The strongest evidence shows people with diabetes have more severe periodontal disease, and once they have periodontal disease, their diabetes gets worse.

Ask your dentist for advice on developing a dentally healthy lifestyle. I'm confident they will promote a smart diet, good oral hygiene, and regular professional care. A positive lifestyle is paramount and will help you to live a longer, healthier, more rewarding life.

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Xylitol Gum for Prevention of Cavities

921 children (aged 3-6 years) attending daycare centers in Finland were randomly assigned to receive xylitol chewing gum (one piece, three times a day, each chewed for 5-10 minutes, for a total of 2.5 g/day of xylitol) or to brush their teeth after lunch. The respective treatments were continued for periods of one to three years, with one to four months off during the summers. At age nine years, the proportion of children who were cavity-free was 57% in the xylitol group, compared with 49% in the brushing group (p < 0.05). No significant difference between groups was seen at ages three or seven years.

Comment: These results indicate that regular chewing of xylitol-containing gum is at least as effective as tooth brushing for the prevention of dental caries (or cavities) in children aged 3-6 years. Xylitol is a non-nutritive sweetener that has been demonstrated in several studies to help prevent the development of dental caries. The anti-caries effect of xylitol is presumably related to its capacity to inhibit the growth of Streptococcus mutans, a component of mouth flora that has been implicated in the pathogenesis of caries. The beneficial effect of xylitol chewing gum appears to be most pronounced for teeth that erupt after the commencement of gum chewing, as opposed to teeth that are already present when the child starts using the gum. One study has demonstrated that mothers can prevent the development of dental caries in their children by chewing xylitol gum, beginning three months after the birth of the baby until the child is two years old.

Kovari H, et al. Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland. Acta Odontol Scand 2003;61:367-370.

source: Alan R. Gaby

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Making the Most of Your Dental Insurance

     Most people take full advantage of their medical and vision insurance. They know the policy’s limits, coverage, and deductibles. Dental insurance is not usually thought about until the person has a toothache or other dental issue. This thinking usually causes people not to fully take advantage of their dental benefits each year. This behavior also causes dental patients to not understand their plan benefits. It is important to know exactly what your dental benefits are. The easiest way to determine coverage and to understand the applicable deductibles is to call the dental insurance company. They will give you a snapshot and summary of the plan benefits.

     As with other forms of insurance, annual deductibles apply to most dental insurance plans. For example, the plan year runs from January 1st, through December 31st. There is a $600 deductible for the plan year. This means that the first $600 is paid by the patient. Once the $600 deductible is met, then the plan benefits apply. If you have met your deductible in July for example, it is wise to get as much dental work as possible completed before December 31st , as there will be a new $600 deductible come January 1st. Many dentists are motivated to begin major dental treatments at the end of the plan year to take advantage of the fact that the full deductible has already been utilized for that plan year. Some dentist offices review each patient’s file at the end of each year to assist the patient in taking full advantage of their plan benefits before they expire.

     Most dental insurance plans have a predetermined number of included services per year. For example, a standard dental plan includes two cleanings per year. If you do not have these cleaning completed by December 31st, you lose them. Other similar services include x-rays and gum treatments. Again, use them or lose them!

     Aside from all the great services that you will be losing out on at the end of each plan year, the best reason to use your dental coverage is that it will keep your teeth and gums healthy. The reasoning behind the insurance company offering these services at no cost is to encourage you to get into your dentist’s office on a regular basis. Doing this ensures that cavities and other problems will be caught quickly and not turn into major dental repairs down the road.

It is recommended that each year you develop a strategy for your dental care. First, become the expert on your dental insurance. You should know your plan’s coverage prior to making an appointment with the dentist. This will ensure that you can resolve any coverage misunderstandings with the dental staff quickly. Your dental coverage also consists of more than seeing a general dentist. Most plans cover a visit to the specialist for oral surgery and various conditions of the mouth. Orthodontic coverage is not limited to teens and children. If you are unhappy with the appearance of your teeth, learn what types of services are covered under your dental plan. You may be surprised at the amount of coverage you have and the innovative options that exist for orthodontic services. Most patients are not aware that many orthodontic services are considered necessary and not cosmetic procedures.

     Second, schedule your routine cleanings and checkups at the beginning of each plan year. Dentists are one of the few professionals that are comfortable scheduling appointments months in advance. Finally, if you believe that you have an issue with your teeth, make an appointment before the issue becomes a full-blown problem. As you are responsible for the deductible, catching problems while they are small will mean less money out of your pocket. Your dentist has a vested interest in your teeth. It is his/her goal to keep your teeth healthy and keep you smiling.

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Oral Cancer and Dentistry

When a patient goes to the dentist for a checkup, the last thing he wants to think about is serious illness. Many people think that worrying about decay and periodontal disease is quite enough.

Nevertheless, the mouth is a complicated place. While there are pathological processes unique to the mouth, many diseases not generally thought of as "oral" may also occur or manifest themselves in this location. One such disease is cancer. There are nearly 30,000 new cases of oral cancer each year in the United States, and eight thousand people die each year (2-3% of cancer deaths). 1-3 For all the advances of modern medicine, five-year survival has changed little in several decades.1-3

The risk factors are well known, and have been for years. Tobacco use, alcohol, and chronic sun exposure are all associated with oral cancer. Most victims are male and over 40 years old.
2-3 People who both use tobacco and drink are at much greater risk than those who have only one of these risk factors.4 It should be noted that smokeless tobacco appears to be no safer to the mouth than smoking. Smokeless tobacco has gotten increasing attention as it has become more popular.5 Chronic irritation from ill-fitting dentures and human papilloma virus have also been implicated.

Since early oral cancers are painless, they may be easily overlooked. According to James Sciubba, professor of Oral and Maxillofacial Pathology, SUNY Stony Brook, "Pre-cancers and early stage oral cancers cannot be adequately identified by visual inspection and may easily be overlooked and neglected even by highly trained professionals with broad experience."
6,7

Patients who do not receive regular dental care may never have their mouths examined for signs of cancer, and even those who have regular care may never have an adequate screening. The American Cancer Society observed as long ago as 1967 that:
8

"the dentist too frequently looks only at the patient's teeth; the otolaryngologist, pediatrician, and general practitioner tend to concentrate on the tonsils; the internist on the tongue; and the general surgeon on the thyroid, lateral part of the neck, and lower lip. The angle of the mandible is the “no man's land” in which all these specialties converge, none as yet having staked out a valid claim. Nor has any specialty laid claim to the extracranial head and neck as a whole."
9

The US Department of Health and Human Services, in its program Healthy People 2010, has a reduced mortality rate from oropharyngeal cancers as one of its objectives.10 Dentists thus must be professionally responsible for providing a comprehensive oral cancer examination for their patients.11,12 There is evidence that recent dental school graduates are more likely to screen for oral cancer risk factors and are more likely to conduct regular oral cancer examinations.13 Screening for risk factors and preventive measures, such as counseling patients regarding the use of tobacco and alcohol, may be even more important than efforts aimed at early detection.14 This counseling may be difficult for dentists who have historically felt unprepared to provide tobacco or alcohol cessation education.13

In May of this year, Surgeon General David Satcher released Oral Health in America: A Report of the Surgeon General. It is likely these services may be more easily implemented by referral to appropriate health care facilities.
15 The report found a large disparity in awareness of important oral health issues between different racial and socioeconomic groups. Minorities and the poor were found to be more poorly informed regarding oral health and its implications for general health. This had led to a "silent epidemic" of oral disease among the poor. The Surgeon General called for action to promote access to oral health care for all. Satcher's findings are borne out by the significantly higher mortality rates from oral cancer in blacks, when compared with whites. Increased vigilance of dentists, combined with the acknowledgement of the importance of all aspects of oral care by both health care workers and patients, will go a long way toward decreasing the toll taken by this terrible, largely preventable disease.

References

1. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin 2000;50:7-33

2. Silverman S. Oral cancer. 4th ed. American Cancer Society. St. Louis: Mosby-Year Book; 1998:1-6

3. Swango PA Cancers of the oral cavity and pharynx in the United States: an epidemiologic overview. J Public Health Dent 1996;56(6):309-18

4. Mashberg A, Samit A. Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers. CA Cancer J Clin 1995;45(6):328-51

5.ADA news release--Oral Lesions from Smokeless Tobacco Dissipate after Stopping Use of Tobacco Products, Study Concludes: July 1999

6. Maden C, Beckmann AM, Thomas DB, et al. Human papilloma viruses, herpes simplex viruses, and the risk of oral cancer in men. Am. J Epidemiol 1992;135(10):1093-102

7. Fouret P, Monceaux G. Teman S, Lacourreye L, St. Guily JL. Human papillomavirus in head and neck squamous cell carcinomas in nonsmokers. Arch Otolaryngol Head Neck Surg 1997;123(5):513-6

8. ADA news release--New Oral Cancer Scanner May Help Save Lives, Study Says: October 1999 |

9. American Cancer Society: The paradox of oral cancer. Brochure, 1967.

10. U.S. Department of Health and Human Services. Healthy people 2010, conference edition. Washington: U.S. Department of Health and Human Services; 2000:3-16-17

11. Horowitz AM, Goodman HS, Yellowitz JA, Nourjah PA The need for health promotion in oral cancer prevention and early detection. J Public Health Dent 1996;56(6):319-30

12. Meskin LH. Do it or lose it (editorial). JADA 1997;128:1058-60

13. Horowitz, AM, Drury, TF, Goodman, HS, Yellowitz, JA Oral Pharyngeal Cancer Prevention and Early Detection: Dentist' Opinions and Practices, JADA April 2000
source: Mark Bornfeld

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