Dental Care Options During Trying Financial Times

The reality is that many people who do not have dental insurance or the means to pay for services will not visit the dentist. In these trying economic times hundreds of thousands of people have lost their jobs and their dental insurance along with them. Even those who are fortunate enough to still be employed view dental care as something you get if you absolutely need it. Generally, dental services are viewed by most as a response to an immediate dental condition, such as a cavity, and not a preventative measure, such as mammograms and colon cancer screening.

In the United States, dental care is expensive. Even those who are gainfully employed struggle with their dental co-payments. If they get a cavity it will only be fixed once they can save up the money to do it. Some of them will choose to pay $50 to pull a tooth with a small cavity, because filling the cavity costs $150.

There is also segment of the population who, despite the severity of the situation, cannot afford dental care. These are the people who cannot afford their rent or food for their family if they have to get a tooth pulled. There are literally millions of people who are in this category. They rely on home remedies and over the counter medication like pain killers to relieve the pain, but the pain never really goes away. There are many resources available at the local, state, and Federal level to assist.

This article has been written to examine the dental care options that are available to the general public.

Clinical Trials
Clinical trials are health related research studies using people. Clinical trials follow a strict protocol and are highly regulated by the Federal Government and the FDA. Every year, thousands of patients participate in clinical trials. Dental clinical trials have led to new technologies in fluoride treatments, safety findings, such as the use of mercury fillings, and new materials for prosthetic devices. Clinical trials take dental patients on a volunteer basis to test out new dental procedures. The benefits to the patient are that they gain free access to new dental treatments before they are available to the general public. All services are at no cost and, sometimes, the patient is compensated for their time. There are certain qualifying and exclusionary guidelines for patients seeking to be a part of each individual clinical trial. In general, dental clinical trials are extremely safe and a great benefit to both the patient and the community at large.

Dental School Clinics
Dental schools practice on real patients. The dental student or resident performs the procedures with a faculty member overseeing the work. The faculty member is a licensed dentist with a substantial amount of practical experience.  They ensure that the patient is given quality care. The dental student will do a complete overview of your health and dental history and perform routine services such as x-rays. Most dental schools offer free and low cost services to the community. The only drawback to obtaining services at a dental school clinic is that the process of submitting an application to the school, being screened and then finally receiving treatment is a bit longer than obtaining services from a neighborhood dentist. If you are in need of emergency dental care, a dental school clinic will not be the most practical option for you.

Non Profit and Governmental agencies
The Centers for Medicare & Medicaid Services offer dental plans to low income families. The United Way also has referral services to low cost and no cost dentists in the local community. The service qualifications vary from agency to agency. Some have very liberal income requirements and others offer substantially reduced fees, with no qualifying necessary. Many of these agencies are overlooked by people because they assume that they will not qualify for services based on their income, employment, or citizenship status. This could not be farther from the truth. The agencies offering the care serve a broad spectrum of the community, not only a narrow scope of those who fit a certain profile.

It should be noted that, in response to the economic downturn, neighborhood dentists are now offering low cost financing options and some offer no cost payment plans.

If you need to see a dentist, do not put it off. A little research can uncover a wealth of resources and enable you to afford the care that you and your family need.

Special Needs Patients

People with special needs need dental treatment as much as those without special needs, yet they receive dental care less frequently. Special needs patients may have a mental or physical disability or have a chronic physical condition. There are community based dental programs which specifically aim to improve the dental health of special needs patients. If your community does not have any of these programs, any dentist is qualified to provide the care necessary for dental health. The most common special needs identified by the dental community are patients with immunocompromised disorders, autism, and Down ’s syndrome.

Immunocompromised patients and dental treatment
One challenge for the dental community is patients with immunocompromised disorders. Patients with immunocompromised disorders have issues that tend to be caused by tobacco use, malnutrition, and poor oral hygiene. Patients with leukaemia develop gingival bleeding and purpura. Patients with herpes viral infections develop lesions, ulcers, and periodontal disease. Patients with a low white cell count development oral lesions. This condition is controlled by antiretroviral medication. The dentist should be made aware of all conditions that an immunocompromised patient is afflicted with. The dentist will then take whatever special precautions are necessary to administer the dental services, while protecting the patient’s immune system.

Mentally challenged patients with poor oral health increase their struggle for social acceptance by allowing their teeth to deteriorate. Challenges to treating mentally ill patients include fear and lack of training on the part of dental professionals. Patients with Down’s syndrome and Autism are in the same situation.

Down’s syndrome and Dental treatment
Patients with Down’s syndrome many times have significant impairments of the mouth. Children who are afflicted with Down’s syndrome experience delayed development of the teeth and jaw. Sometimes the first tooth will not erupt until after the first 18 months and the complete set of teeth may not all appear until after three years of age. This, in turn, delays the adult teeth. It is not uncommon for Down’s syndrome patients to be missing adult teeth and many times the teeth are smaller than that of a patient without Down’s syndrome.

Patients with Down’s syndrome require a different approach to a routine dental appointment. The dentist and staff need additional time to explain the procedure and possibly move at a slower pace during the visit to allow the patient to develop a level of comfort. With Down’s syndrome adults and children, it is recommended that the procedure be demonstrated and then the patient be allowed to ask questions and express any concerns. Down’s syndrome patients have a larger and thicker tongue than other patients, which makes it a logistical challenge to accommodate the tongue during cleanings and examinations. In addition, patients with Down’s syndrome have reduced muscle tone in the mouth. This results in less rigorous chewing and additional food particles left in the mouth and on the teeth after eating. For the dentist, this means that cleanings may need to be scheduled more frequently and the patient should be educated on merits of brushing after every meal. The dentist would also want to take additional time to demonstrate the use of an electric toothbrush and floss holders.

Autism and dental treatment
Autism is a neurological disorder that emerges during the first three years of a child’s life. The syndrome affects the areas of the brain that are responsible for social interaction skills and communication. Delayed and reduced social skills, interactive speech limitations, and sensorimotor defects are the main symptoms of Autism. Children with Autism look just like any other child, but they experience challenges functioning and communicating in a social environment. Patients with Autism should be slowly introduced to the dental environment. Autistic patients will be comforted by bringing a familiar item with them for comfort such as a blanket or favorite toy. The caregiver is the best person to guide the dentist on the best method of approach, which would cause the patient the least amount of stress and anxiety in the situation. The dental staff should meet with the caregiver prior to the treatment to ensure that the patient is in a setting that they are comfortable with.
If you or a loved one has special needs, it is important to seek regular dental treatment. It is recommended that prior to making an appointment that you discuss the special needs with the receptionist and ask if their office can accommodate you. If their response is favorable, make an appointment to interview the dentist. Discuss with the dentist the full scope of the patient’s medical condition and what special needs he/she has. Ask the dentist if he treats other patients with special needs and what special training he has to address your specific needs. More often than not, this interview will allow the dentist to develop a treatment plan for the patient. Dentists are doctors committed to oral health. Most diseases and conditions have an effect upon the mouth, teeth, and gums and dentists understand the broad scope of treatments required.

Pregnancy and your teeth

Pregnancy is a special time for couples. It is filled with excitement for the mother to be. Pregnancy can also be a stressful time as pregnancy brings with it the risk of complications like high blood pressure, gestational diabetes, and hypertension. One complication that most pregnant women do not consider is dental complications. If not treated, dental complications can complicate the pregnancy instead of only being a byproduct of the pregnancy. Some of the dental problems that pregnant women are likely to experience are pregnancy gingivitis, pregnancy tumors, and periodontal disease.

While you are pregnant, you should adjust your dental routine and be on the lookout for different indications of a dental issue. It is recommended that you have at least two checkups during your pregnancy; one for a cleaning and the other for a checkup. The optimal time to make the appointments is after the first trimester, as this is after your baby has formed its vital organs. Cleanings are not detrimental during any time during the pregnancy but, to be extra careful, waiting until the second trimester is best. 

If you have any tooth pain or notice changes in your gum line during your pregnancy, you should see your dentist immediately. These symptoms are signs of infection. Any infection, no matter how small, puts your body and baby at risk. 

Pregnancy gingivitis 
Almost 60% of all pregnant women experience gingivitis during their pregnancy. Pregnancy gingivitis causes inflamed and red gums. It also causes bleeding during routine brushing and flossing. This is caused by bacteria between your teeth which cause the gums to become inflamed. Pregnant women are at high risk because of the increased levels of progesterone and estrogen in their bodies. The risk for gum disease increases in the second and third trimester. The best way to prevent pregnancy gingivitis is to continue with a good oral hygiene regimen during your pregnancy. During pregnancy, women find it difficult to keep up with regular doctor visits, let alone go to the dentist. This is a mistake as both are equally important to the baby’s and mother’s health.

Pregnancy tumors 
A pregnancy tumor is a growth that spontaneously occurs in the mouth during the second trimester. Pregnancy tumors are not cancerous and range in size from quite small to large enough to disrupt regular activities. Pregnancy tumors, appearing as a red or purple bump, can occur anywhere in the mouth. Upon closer inspection, the bump is attached to the gum tissue by a thin stem of skin. The tumor will bleed easily and many times will turn into an open sore. While the tumor itself is not dangerous, the appearance can cause alarm.  The dentist removes the tumor during a simple office procedure called a biopsy. The tissue is removed and then examined in a laboratory to ensure that it is benign. Once the woman gives birth, the tumors will become smaller and eventually disappear altogether. Pregnancy tumors can be prevented by having regular cleanings while pregnant. In some instances, however, there is no prevention because higher levels of hormones cause the growth.

Periodontal disease 
Periodontal disease is an advanced form of gingivitis. Unlike gingivitis, periodontal disease affects the gums and jawbone. Periodontal disease is so severe that many times it requires surgical procedures to remove the decayed gums and restore the gum line. As with other pregnancy conditions of the mouth, frequent brushing, flossing and regular cleanings are key to preventing the disease.

If you are pregnant, add a dental exam to your medical schedule by the second trimester. Just as ultrasounds and other exams are vital to a healthy pregnancy, so is a trip to your dentist.

Diabetes and Oral Health

According to the American Dental Association, 21 million Americans have diabetes. Diabetes is a disease that affects the entire body. People with diabetes have a greater risk for health problems because they are unable to control their blood sugar levels. Uncontrolled blood sugar disables the white blood cells’ ability to fight infection. White blood cells are the body’s key defense to infection. Without them working at full capacity, you are at greater risk for infections of the mouth.  People with diabetes who smoke are 10 times higher to develop the following conditions because smoking hinders the blood flow to the gums, which interferes with healing.

Conditions commonly associated with diabetes: 

Dry Mouth – Low blood sugar decreases saliva flow and leads to dry mouth. The condition leads to sores, ulcers, and infections.

Gum Inflammation/Periodontal Disease – Aside from the other complications of diabetes, these people have a high risk for developing an advanced form of gum disease called periodontitis. Diabetes patients can reduce their risk of periodontitis by controlling their blood sugar levels. The mere presence of periodontitis will make your blood sugar harder to control as the disease causes infection in the body.

Diabetes impairs white blood cells, which thickens blood vessels, and ultimately slows down the flow of nutrients and other materials through the body. This causes infection and periodontal disease. Periodontal disease is a bacterial infection, and since diabetics are less able to fight infection, they will experience a more severe periodontal disease than non diabetics.   

Periodontitis causes your gums to pull away from your teeth. When this happens, pockets form between your teeth and gums. These pockets trap bacteria and germs, which eventually turn into puss. The more material that is in the crevices, the bigger they get. The only way to reverse periodontitis is oral surgery. If the condition is not treated, the teeth will decay to the point of requiring extraction and the remaining teeth will shift. In advanced cases of periodontitis, teeth have been known to simply fall out. 

Slow or poor healing in the mouth – People with diabetes, in general, heal slowly. This is due to the impaired blood flow that uncontrolled blood sugars causes. Even a simple cavity can be a major event for a diabetic.

Thrush – Diabetics are prone to fungal infections. One such fungal infection is called Thrush.  It develops in the mouth and tongue. Thrush thrives on the high sugar levels in the saliva when diabetes is uncontrolled.  Thrush also produces a burning sensation in the mouth and the tongue. 

The best way for diabetes patients to prevent these conditions is to control your blood sugar levels. There is a direct link between high glucose levels and oral disease. Develop healthy oral habits such as brushing regularly, flossing, and dental checkups twice per year. Don’t smoke. While smoking is not good for anyone, diabetes patients are several times as likely to develop smoking related conditions than non diabetic patients. 

Dental care and diabetes –It is imperative that diabetics stick to a good oral healthcare routine because they are at a higher risk for the diseases mentioned above. The first habit is to never miss a checkup visit. When identified early, infections and conditions of the mouth can be treated before they become a serious problem. At each visit, update your dentist on your diabetes condition and blood sugar levels. Share your diabetes doctor’s contact information prior to any oral procedures. Brush with a soft bristled toothbrush, floss regularly and have your teeth cleaned twice per year.

Common questions and myths about diabetes: 

Does diabetes increase the risk of cavities? 
The answer is yes and no. People with diabetes that control their blood sugar levels and have good oral hygiene are not at greater risk for cavities. When diabetics do not control their blood sugar levels, bacteria that cause cavities increases and the result is more cavities. In addition, since diabetics typically eat more meals throughout the day to control their blood sugar, they need to brush their teeth more frequently. In contrast, diabetics refrain from eating high sugar foods, which would put them at a lower risk than a non-diabetic person who eats those foods. As long as the disease is under control, the risk is mitigated.

Are diabetics at higher risk for complications when undergoing oral surgery? 
Diabetics are at greater risk when undergoing any surgical procedure because they heal slower and are at greater risk for infection. This risk is managed by administering antibiotics prior to the surgery and additional follow up visits after surgery to monitor the healing process. If the patient smokes, they must not smoke two weeks before and at least two weeks after oral surgery. Smoking increases the risk of infection in a non-diabetic patient. For diabetics, smoking increases the chance of infection ten times that of a non- diabetic person.

If you are diabetic, speak with your dentist about preventative measures that will ensure your oral health. Taking a proactive approach will save your teeth in the long run. The less damage you do to your teeth, the better off you will be down the road. You have only one set of teeth; treat them right!

Parents – How to make sure your kids are taking care of their braces

More and more teens are getting braces than ever before. Braces are more than a means to a pretty smile. They set the stage for healthy teeth and gums for years to come. The thought of a healthy mouth makes it worth the cost of the braces. For the teen, however a healthy mouth many years down the road has little value when compared to the here and now. It is a parent’s responsibility to educate their teen on the proper care and maintenance of braces. While the braces are on, they do require special care. If the brackets are broken off due to negligence, you will be charged a fee to replace them. In addition, if your teen does not implement a teeth and gum cleaning regimen, then they will experience problems down the road.

If you are a teen who has braces, you know by now how important it is to take care of your braces, teeth and gums. It may seem like a never-ending ritual that takes way too much time, but in reality, it is a simple routine that is easy to implement.

Stepped up Brushing and Flossing Regimen - Orthodontic brushing and flossing is by far the important factor in caring for your mouth. Where you once brushed and flossed three times per day, you now need to brush after every meal and before going to bed. The metal brackets and wires are easy places for bacteria and plaque to hide and fester. The food particles eventually turn into cavities. Your orthodontist may recommend a 4% fluoride toothpaste instead of the regular toothpaste found at the grocery store. The additional fluoride assists in strengthening your teeth and avoiding cavities.

Increased Flossing - Flossing is mandatory with teen braces. The only way to floss around the brackets is with floss threaders. They allow you to get the floss under the wires. Flossing needs to be done on a daily basis, no exceptions.

Foods to Avoid – Teen braces are strong, but not unbreakable. They are designed to break off under certain conditions to protect the teeth. Because of this, certain foods need to be avoided when wearing braces. You don’t want to eat anything too sticky, such as taffy, or too crunchy, such a CornNuts. If you eat apples or carrots, cut them up into bite size pieces. Finally, chewing hard candy and gum is not allowed. If you are a teen who smokes, you will need to stop. Firstly because of the obvious health benefits of doing so and, secondly, because smoking discolors the teeth, but not the place where the bracket is. When the braces are removed, you could see little white squares on your teeth where the brackets were and yellowing where the brackets were not.

A little care will go a long way in keeping your teeth healthy.

 

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Smoking and Your Teeth and Gums

Mothers have a hard enough time keeping a child’s hands clean, let alone caring for the little one’s teeth! It is difficult to know when is the right time to begin brushing your child’s teeth or even schedule the first visit with the dentist. Many parents make the mistake of thinking that their child is too young to see a dentist. Some children do not see a dentist until they enter school.

The fact is that you can begin training your children to become comfortable with brushing their teeth as early as a few months old. Infants should have their gums cleaned once per day either with a clean washcloth on the end of your finger or by using a gum cleaner specially made for infants. The baby will welcome the cleaning as it massages their tender gums and alleviates some of the pain associated with teething.

Brushing your child’s teeth on a regular basis lays the foundation for a lifelong routine of oral care. Just as it takes time to train a child to use the potty or wash their hands before eating, it takes time to instill healthy oral hygiene.

Most people think that gum disease only affects the elderly or people who do not brush their teeth. This is not accurate. Teens are at the same risk for gum disease as adults. In addition, brushing and flossing alone does not guarantee that you will not get gum disease. It is estimated that more than 75% of people have some form of gum disease and out of those, 90% have no symptoms to alert them that they have a problem.

Simply stated, gum disease, also known as periodontal disease, is an infection of the gums. The infection is specifically located in the small space between the tooth and gums. The disease attacks the area of the gum that attaches to your teeth and causes the gum line to break down. As the tissue breaks down, a pocket is formed. The worse the disease is, the deeper the pocket becomes. 

There are two stages of gum disease, gingivitis, and periodontitis. Gingivitis is a mild and reversible form of the disease. Gingivitis only affects the gums. Periodontitis is the advanced form of the disease that affects the gums, teeth, and bone. If left untreated, gum disease will cause the teeth to shift, and they may be need to be extracted. Serious cases of periodontital disease have been known to cause teeth to simply fall out! 

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of gum disease. Periodontists spend an additional three years studying the disease beyond what is required in dental school. 

The American Academy of Periodontology educates the public on the dangers of tobacco use and its effect on the gums. Along with the American Medical Association and the American heart Association, the American Academy of Periodontology has been educating people for years about the risks associated with tobacco use. Those risks include cancer, heart and lung disease, and low birth weight babies. Despite the risks that we all are aware of, people continue to smoke. There is another very good reason to quit smoking and that is your oral health. Smoking increases your risk for periodontal disease. 

The American Dental Association estimates that smoking and tobacco use may be responsible for more than 50% of the instances of periodontal disease. A study conducted by the American Academy of Periodontology found that smokers are more than 4 times at risk for periodontal disease than those who have never smoked. After quitting smoking for at least 10 years, former smoker’s chances of developing periodontal disease is about the same as those who have never smoked. Dentists agree that tobacco use is the single greatest preventable risk factor for gum disease. There has also been a direct link established between the number of cigarettes smoked per day and the chances of developing the disease, with those who smoke more than a pack per day at more than 7 times the risk for developing the disease. 

To increase the public’s awareness of the pitfalls associated with smoking, the American Cancer Association holds the Great American Smoke out each year. The goal is for everyone to quit smoking for one full day, and encourage others to do so as well. The hope is that this may be the first step in people quitting forever. 

Smokers are also at greater risk for developing a hard plaque on their teeth called calculus. The calculus can only be removed during a professional cleaning at your dentist’s office. If the calculus is not removed, it will cause your gums to pull away from your teeth. This leads to periodontal disease. 

In addition to smoking, chewing tobacco and cigars also produce the same negative effects on your teeth. If you are a tobacco user, it is important that you schedule regular checkups with your dentist. If you can quit, then that is the best way to save your teeth. 

Gum disease is treatable by either a general dentist or a periodontist. It is recommended that the least invasive method be chosen to treat periodontal disease. The treatment for gingivitis, the least severe form of gum disease, it a non-surgical treatment that includes scaling and cleaning of the teeth and root surfaces. This treatment cleans the tartar from the periodontal pockets. In most cases, this is the only treatment that is necessary, aside from ongoing maintenance to keep the disease from returning. 

If the gingivitis becomes full-blown periodontitis, then surgery is usually the next step. This step is recommended when the tissue around the teeth is not healthy and needs to be surgically corrected. The surgery aims to reduce pockets and lengthen the crown. 

New Treatment Options 
Periodontists are now using lasers to treat gum disease as a less invasive treatment. The laser result in less bleeding, swelling and a quicker recovery time than the other treatments available. Lasers can also be adjusted to treat both mild and advanced gum disease as well. There is also a treatment method that uses mouth trays, similar to the ones used in home teeth whitening.

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Pull or Save That Tooth?

You have a toothache, but you ignored it because you couldn’t find the money or the time to get it fixed. Before you knew it, your cavity will require some serious drilling. So now you are faced with the decision to pull or repair the tooth. There are several pros and cons associated with each.

Pulling the tooth
Pulling the tooth is the most affordable option. Extracting a tooth costs between $50-$200 to perform. Once it is pulled, problem gone. The problem with pulling the tooth is that it leaves a gap in your bite. Over time, the other teeth may shift and your bite will be affected. The alignment changes can have a substantial impact on your dental health. If the teeth shift substantially, it could also affect the look of your smile as well. Removing a single tooth has the ability to cause problems with chewing, speaking and overall jaw functioning. The gaps are also prone to trap food and grow bacteria that lead to tooth decay and gum disease. You can opt for a dental implant or other dental appliance down the road to replace the extracted tooth and keep the teeth from shifting.

Tooth extraction may be necessary if the tooth is gone beyond repair. If the tooth has an excessive amount of decay, then there may not be enough of it left to repair it after the decay is removed. If the tooth is cracked or broken, extraction may also be the best option.

Teeth with moderate to advanced gum disease usually have a compromised bone support and should be pulled and not repaired. As the gum disease worsens, the tooth will become loose so it makes sense to pull it. Teeth that are nonfunctional, such as wisdom teeth, are many times pulled and not repaired.

How is a tooth pulled?
The dentist numbs the area with a topical anesthetic and Novocaine. Laughing gas is also used to relax the patient. Using dental pliers, the dentist slowly pulls the tooth by rocking it back and forth. Once it is a little loose, he pulls a little harder and then POP! The tooth is out. After the tooth is extracted, the dentist will provide you with aftercare instructions. Usually, the first 24 hours after a tooth extraction you are instructed not to eat any solid food on the side of the mouth where the tooth was pulled. You are also required to gargle with salt water. If the gap begins to bleed, simply bite down on a piece of gauze to control the bleeding. Essentially, pulling a tooth is a routine procedure that usually requires only a day of downtime.

Whichever option you choose, you will need to find a good dentist. While all dentists are trained how to perform a repair and extraction, each dentist has their own methodology. Some dentists are very sympathetic to patient anxiety and pain management, while others prefer to perform them naturally whenever possible. Make an initial appointment to ask questions about the procedure and to get to know the dentist before having the procedure performed. If you are not comfortable with the dentist, get a second opinion. The decision to pull or save your tooth is very important and a dental professional can walk you through the process.

 

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