The Race to Health Equity

Oral Health Disparities Persist Among Racial & Ethnic Minorities 

Jessamin E. Cipollina, M.A.

Health service access, affordability, and use varies for all Americans. Promotion of health equity across the health care landscape requires elimination of disparities in access to care, as these disparities impact individuals’ abilities to receive affordable, comprehensive and quality care. Regular primary care visits and preventive care are under-utilized by racial/ethnic minority groups, due to a long history of discrimination. Racial inequity throughout the health care system is well-documented in the literature, and research shows how racial/ethnic minority groups are impacted by multiple social determinants of health. Despite being integral to promoting overall health outcomes, oral health is a frequently forgotten component of overall health. Due to access barriers, such as lack of dental insurance or low socioeconomic status, there are significant oral health disparities among U.S. racial/ethnic minority populations.

Studies have found that people from racial/ethnic minority groups are less likely to have health insurance than their White counterparts. Implementation of the Affordable Care Act (ACA) in 2010 led to significant gains in health coverage over the past decade, yet substantial discrepancies remain for racial/ethnic minorities. As of 2018, 12% of Black adults, 19% of Hispanic adults, and 22% of American Indian and Alaskan Natives are uninsured, compared to only 8% of White adults.1 Individuals belonging to a racial/ethnic minority group are less likely to seek medical help and preventive care for serious chronic health problems – heart disease, diabetes, and cancer, to name a few – and are more likely to have poor health outcomes and higher mortality rates.2-4 The high costs of health care, combined with an extensive history of racial stereotyping, coupled with experiences that have built mistrust, prevent racial/ethnic minority individuals from achieving better health outcomes within their communities.

Dental care is not included as an essential benefit in many commercial health plans. The ACA does include oral health as an essential benefit for children only, not for adults and older adults. The CHIP program covers dental care in all 50 states for children insured by Medicaid, but only 35 states have an adult Medicaid dental benefit.5 According to the ADA Health Policy Institute, the most common reason for delaying or not pursuing dental care is cost as many individuals and families cannot afford out-of-pocket care costs.6 Moreover, there are a limited number of dental practices that will accept Medicaid-insured patients, making access and availability a crucial issue.6 Finally, a high proportion of racial/ethnic minority individuals live in communities without fluoridated water and schools that have fluoride varnish and sealants programs, which are shown to be highly effective in preventing oral health problems.7

Prominent health inequities persist in oral health care within racial/ethnic minority groups, which are also associated with lower socioeconomic status and high rates of poverty. In the US, people are unable to afford regular preventive dental care, and many vulnerable communities lack access to transportation to appointments or lack fluoridated water.3,8 As a result, we see oral health disparities across the lifespan among racial/ethnic groups. In U.S. children aged 2-5, 33% of Mexican American and 28% of Black children have had cavities in their primary teeth, compared to 18% of White children.8 Black and Mexican American U.S. adults are twice as likely to have untreated caries than their White counterparts, and older non-Hispanic Black and Mexican American adults have 2 to 3 times the rate of untreated cavities as older White adults.8 Periodontal disease is most common among Black and Mexican American adults; a study using data from the 2009-2014 National Health and Nutrition Examination Survey and found that the highest rates of moderate-severe periodontitis were in Black (42%) and Mexican American (46.4%) adults, while white adults had the lowest rate at 31%.9 Oral cancer, which affects about 54,000 Americans every year,10 shows a 41% survival rate for Black men, more than 20% lower than White men.9

Despite strong evidence that oral care and overall care are connected, dental care continues to be treated as a silo component of health care, separate from other health care professions. Interprofessional health education may be the answer to solving this dilemma! Think about how we can expand current interprofessional initiatives that bring dental, nursing, medical and other health professions together for classroom, simulation, and “live” clinical experiences to learn from, with, and about each other while learning about oral health and its links to overall health, as well as the related social determinants of health. Think about the oral health contributions that can be made by clinicians in primary care settings; think about the contributions the dental team can make to improving overall health. This perspective is particularly important when providing primary care or dental care for racially and culturally diverse patients especially those with disabilities, without dental insurance, or difficulty accessing affordable dental care.

Expanding a diverse health professions workforce is crucial to promoting oral health and primary care utilization among racial/ethnic minority Americans. Presently, approximately 20% of the nursing workforce (RNs, NPs, and MWs),11 20% of physicians,12 10% of dentists are from racial/ethnic minority backgrounds.13 Practitioners from racial/ethnic minority backgrounds are best equipped to work in those communities that align with their background, as they can lend their own experiences to providing culturally-competent care and improve trust of health professions among racial/ethnic minority groups. Decades of racial bias and discrimination in health care settings, and resulting mistrust, are major factors contributing to low health care utilization and poor health outcomes in racial/ethnic minority populations.2-4,14 Increasing the number of racially/culturally diverse health care professions students and clinicians can contribute greatly to expanding health care access and satisfying health care experiences for individuals and families from underserved communities and improve health care perceptions and trust among Americans from racial/ethnic minority communities.

The COVID-19 pandemic has underscored the physical, financial and sociopolitical barriers that disadvantaged populations face in accessing regular oral care and treatment. COVID-19 has exacerbated the impact of the social determinants of health; financial strain, transportation limitations and general distrust of the health care system have prevented many Americans from visiting their dentists. Oral care education, practice and policy initiatives need to incorporate the social determinants of health in understanding how to best treat vulnerable patients. Racial/ethnic minority identity often overlaps with several social determinants that impact health outcomes, namely low socioeconomic status.2,3,14 Oral health curricula, simulation and clinical experiences should incorporate social determinants of health in patient interactions by addressing economic disadvantages, insurance complications, experiences of discrimination and environmental barriers to care among vulnerable populations. Interprofessional education experiences are crucial to promoting quality integrated health care that speaks to a wide spectrum of care interventions for racial/ethnic minority patients. Oral health literacy products that address common oral-systemic complications can be disseminated to minority and disadvantaged communities to improve oral health and overall health outcomes. The responsibility falls on health care teams that include oral care professionals to engage with their communities and encourage health care utilization to reduce oral health and overall health disparities and to build a better health future for racial/ethnic minority Americans across the lifespan.

  1. Artiga S, Orgera K, Damico A. Changes in health coverage by race and ethnicity since the ACA, 2010-2018. Kaiser Family Foundation. Published March 5, 2020. Accessed February 23, 2021. At: https://www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/
  2. Manuel JI. Racial/ethnic and gender disparities in health care use and access. Health Serv Res, 2017;53(3):1407-1429. doi: 10.1111/1475-6773.12705.
  3. Egede LE. Race, ethnicity, culture, and disparities in health care. J Gen Intern Med, 2006;21(6):667-669. doi: 10.1111/j.1525-1497.2006.0512.x.
  4. Frakt, A. Bad medicine: the harm that comes from racism. The New York Times. Published January 13, 2020. Updated July 8, 2020. Accessed February 23, 2021. At: https://www.nytimes.com/2020/01/13/upshot/bad-medicine-the-harm-that-comes-from-racism.html
  5. American Dental Association, Health Policy Institute. Dental benefits and Medicaid. Accessed February 23, 2021. At: https://www.ada.org/en/science-research/health-policy-institute/dental-statistics/dental-benefits-and-medicaid
  6. Yarbrough C, Nasseh K. Vujicic M. Why adults forgo dental care: evidence from a new national survey. American Dental Association Health Policy Insitute. Published November 2014. Accessed February 23, 2021. At: https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1114_1.ashx
  7. Griffin S, Naavaal S, Scherrer C, et al. School-based dental sealant programs prevent cavities and are cost-effective. Health Affairs, 2016;35(12). doi: 10.1377/hlthaff.2016.0839.
  8. Centers for Disease Control and Prevention. Disparities in oral health. Updated February 5, 2021. Accessed February 23, 2021. At: https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm
  9. Eke PI, Thornton-Evans GO, Wei L, et al. Periodontitis in US adults: national health and nutrition examination survey 2009-2014. J Am Dent Assoc, 2018;149(7):576-588. doi: 10.1016/j.adaj.2018.04.023.
  10. The Oral Cancer Foundation. Oral cancer facts. Accessed February 23, 2021. At: https://oralcancerfoundation.org/facts/
  11. Rosseter R. Enhancing diversity in the workforce. American Association of Colleges of Nursing. Updated April 1, 2019. Accessed February 23, 2021. At: https://www.aacnnursing.org/News-Information/Fact-Sheets/Enhancing-Diversity
  12. Association of American Medical Colleges. Diversity in medicine: facts and figures 2019. Accessed February 23, 2021. At: https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018
  13. Peterson, B. How diversity in the dental profession could mean better care for minorities. Chicago Crusader. Published June 3, 2019. Accessed February 23, 2021. At: https://chicagocrusader.com/how-diversity-in-the-dental-profession-could-mean-better-care-for-minorities/
  14. Healthy People 2030. Discrimination. Accessed February 23, 2021. At: https://health.gov/healthypeople/objectives-and-data/social-determinants-health/literature-summaries/discrimination

Good Eating: Linking Oral Health and Nutrition in Older Adults

Jessamin E. Cipollina, MA

Older adults often struggle with maintaining proper nutrition, which can lead to many adverse health outcomes. Chronic health problems contribute to changes in appetite, taste and smell, which contribute to decreased food intake and lack of motivation to cook and prepare food. Trouble chewing related to ill-fitting dentures and loose or missing teeth, as well as oral pain from tooth decay, abscesses or xerostomia, also make it difficult to enjoy eating. The COVID-19 pandemic has exacerbated many of the challenges older adults already face including, but not limited to: food shopping, enjoying meals with friends, or have food preparation help from a home aide, who may be at risk for spreading the virus. It is clear to see that for older adults, nutrition, oral health and COVID-19 are inextricably linked!

The important relationship between oral health and nutrition for older adults is minimized in our health culture, but a healthy mouth and teeth are vital to the idea that nutrition contributes to a healthy body. The majority of adults 65 and older have one or more chronic conditions, many of which have an oral-systemic connection. There is a great need for more awareness about the links between inflammation, infection and the chronic conditions that have related to oral health problems that can affect a person’s nutritional status and overall health. Chronic conditions, including diabetes, cancer, heart disease and depression, impact older adults’ ability to maintain both proper oral hygiene and nutrition Older adults are at risk for oral infections related to tooth decay, gum disease and tooth loss, all of which make chewing and swallowing difficult.1-3 Poor oral hygiene is a prominent and harmful barrier to getting adequate nutrition.

There are many physiological and metabolic changes in aging that put older adults at risk for nutrient deficiencies. Day-to-day activity and energy needs decline significantly, along with muscle mass, senses and overall ability to absorb nutrients. These declines can be associated with a total lack of appetite, along with inspiration to cook and eat healthful food.2 Behavioral and mental health issues are often neglected in health care across the lifespan, especially the connections between behavioral, oral and nutritional health.1,4-7 Older adults are particularly susceptible to feelings of hopelessness and loneliness due to losing their partners, friends and family in old age. The grief or loss that this group experiences related to illness and death of friends and family is often related to or can lead to depression, addiction and substance abuse. As a result, the symptoms that older adults experience impact their ability and motivation to shop for food and eat alone or in the company of others as these activities become less interesting.5-7 Similarly, oral health issues like tooth loss or poor dentition can greatly affect older adults’ self-esteem, making them reluctant to socialize due to their appearance. Social support from family, friends and the community are greatly important in improving older adults’ quality of life, and positive mental health is a hugely important factor in promoting positive health outcomes in this age group.4-7

When thinking about nutrition and oral health with this age group, the social determinants of health (SDOH) need to be considered. Age-related changes associated with oral health impede ability to eat and drink. Those older adults who experience economic disadvantages, lack of insurance, and are in racial/ethnic minority communities are shown to have the most oral health complications. Those older individuals with disabilities or who are homebound or institutionalized are also at increased risk for poor oral health, especially in the midst of a global pandemic where access to care is limited for this age group.2-3 Food insecurity is common among older adults in the US: approximately 5 million adults over 60 rely on SNAP benefits, and households with older adults have only $125 per month for their food budget.Food insecurity, being on a fixed income, and other related social and environmental factors are often overlooked in the health care system. Due to the COVID-19 pandemic, vital food delivery service programs have been halted and older adults may no longer receiving regular hot meals. With a limited budget and necessary social distancing precautions, access to healthy food is greatly restricted for this age group. Without the motivation and financing to buy, cook and eat healthy foods, older adults’ poor nutrition can lead to serious physical health complications.2,4

Promoting accessible, affordable and available oral health care is a responsibility that falls on the entire health care system. This age group has complex care needs that benefit from an interprofessional team of health care professionals to effectively address nutritional, oral health and overall health issues. Connecting students and clinicians across the health professions to provide effective whole-person care is a must, yet dentists and nutritionists are often left out of this team! Interactive classroom, simulation, case study, and live clinical experiences provide opportunities for interprofessional teams of students and clinicians who collaborate to develop management plans that address the spectrum of physical, behavioral, dental, nutritional, and social support interventions needed by this complex patient population.9-10 Oral health and nutrition education can also be integrated by faculty using web-based curricula integration tools that weave nutrition, oral health and overall health and interprofessional competencies. These types of experiences prepare students to promote interprofessional teamwork and care in clinical practice, providing comprehensive whole-person care to their patients.9-10 Health professions educators, students, and clinicians are equally responsible for promoting another important intervention, health literacy, to educate patients and providers alike about the links between oral health, nutrition, and overall health. Oral health and nutrition are inseparable key components of older adults’ health and play a vital role in influencing their ability to eat and get the nutrients they need to thrive.

  1. The Gerontological Society of America. Oral Health: An Essential Element of Healthy Aging. 2017. Retrieved from https://www.geron.org/images/gsa/documents/gsa2017oralhealthwhitepaper.pdf
  2. The Gerontological Society of America. What’s Hot: A Newsletter of the Gerontological Society of America. 2020. At: https://www.geron.org/images/gsa/documents/whatshotnutritionoralhealth.pdf
  3. CDC. Oral Health for Older Americans. CDC, 2020. https://www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm. Accessed August 14, 2018.
  4. Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health. 2012;102(3):411-418. doi:10.2105/AJPH.2011.300362
  5. Chen Y, Feeley TH. Social support, social strain, loneliness, and well-being among older adults. J Soc Pers Relat. 2014;31(2):141-161. doi:10.1177/0265407513488728
  6. Rouxel P, Heilmann A, Demakakos P, Aida J, Tsakos G, Watt RG. Oral health-related quality of life and loneliness among older adults. Eur J Ageing. 2017;14(2):101-109. doi:10.1007/s10433-016-0392-1
  7. Cipollina JE. Eating, Chatting and Laughing: Oral Health Improves Social Support and Quality of Life of Older Adults. 2020. At: https://all4oralhealth.wordpress.com/2018/08/21/eating-chatting-and-laughing-oral-health-improves-social-support-and-quality-of-life-of-older-adults/
  8. National Council on Aging. SNAP and Senior Hunger Facts. At: https://www.ncoa.org/news/resources-for-reporters/get-the-facts/senior-hunger-facts/
  9. Haber, J., Hartnett, E., Cipollina, J., Allen, K., Crowe, R., Roitman, J., Feldman, L., Fletcher, J., & Ng, G. Attaining Interprofessional Competencies by Connecting Oral Health to Overall Health. Journal of Dental Education. Published in Early View. doi: 10.1002/jdd.12490
  10. Greenberg SA, Hartnet E, Berkowitz GS et al. Senior oral health: A community-based interprofessional educational experience for nursing and dental students. 2020, Journal of Gerontological Nursing;46(8):37-45. doi: 10.3928/00989134-20200527-03

It’s Back to School for Everyone: Promoting Children’s Oral Health in a Pandemic

Jessamin E. Cipollina, M.A.

Thanks to the COVID-19 pandemic, students have missed out on in-person learning since early spring when the virus shut down pre-K to PhD programs in academic institutions across the globe. Faculty were left scrambling to find ways to connect with their students while isolated in their homes. Administrators were challenged to stayed up to date with ever-changing information about the coronavirus and how to provide essential education to rapidly growing young minds. Parents were tasked with guiding their children through a new system of online learning by setting up their young children with the technology and materials they might otherwise have access to in their school.

As schools across the US launch a new academic year, we see a variety of learning modalities – socially distant and masked in-person classroom learning, at-home virtual lessons, or a complex combination of the two. Administrators, faculty and parents alike have been working tirelessly to develop effective curricula that takes into account many limitations that come with keeping everyone safe and healthy.

How can we as health professionals provide guidance and support to schools and families about keeping their loved ones safe as we begin the new school year? We can make an important contribution to keeping children healthy, from birth through adulthood, by encouraging them to take care of their mouths.

The mouth is the gateway to the rest of the body, and it is especially important to take care of teeth, tongue and gums. A recent study in the UK examined the connection between oral health and COVID-19 infection. The study found a significant association between high bacterial load in the oral cavity and severe COVID-19 infections. Good oral hygiene plays an important role in keeping teeth and gums healthy, and preventing harmful oral bacterial infections including tooth decay and periodontal disease.

Oral health is linked to overall health at all ages. Children should be encouraged to take charge of their oral health from a young age. Parents need to guide their children’s oral hygiene activities until they are able to do so on their own, just as they would with learning to tie their shoes. It is important for children to maintain a good oral hygiene routine day and night, and a regular brushing routine, along with healthy nutrition, is essential to promote their health now and as they move into young adulthood. You can learn more about oral health care at home from our previous blog Oral Health Home Habits for Healthy and Happy Smiles.

Efforts to reduce the transmission of germs among younger students are especially important given the current climate. Teachers and parents are at the forefront of enforcing healthy habits and classroom policies for minimizing the spread of illness. Wearing a mask, sanitizing hands,  maintaining social distance and asking children to not touch their face are simple public health strategies that decrease risk of spreading and contracting COVID-19. The graphic below illustrates methods for minimizing the spread of germs at snack and lunch times.

Back to SchoolSource: http://www.teachergoals.org

It truly takes a village to ensure our children are equipped with the physical, mental and emotional tools they need to thrive in a pandemic environment. The past six months have tested the power of families, educators and communities to rapidly adjust our daily routines in the face of a glowering pandemic. Educators and parents alike continue to do what they do best: provide a supportive and engaging learning environment for our children, whether at school or at home. We must overcome the logistical, social and financial challenges to promote the oral and overall health and well-being of our children as we strive to resolve the COVID-19 pandemic.

Oral Health Home Habits for Healthy and Happy Smiles

Jessamin E. Cipollina, M.A.

In a matter of weeks, our world has been turned upside down due to the present coronavirus (COVID-19) pandemic. The Centers for Disease Control and Prevention (CDC) and other national and global health organizations are promoting hygiene practices to prevent transmission of the virus. Schools, universities, and colleges have moved to remote instruction; non-essential employees are working from home to implement social distancing practices so people can better protect themselves and their loved ones and prevent the spread of COVID-19. Health care professionals across the globe are working tirelessly and fearlessly to treat the hundreds of thousands of patients with this life threatening infection. With over 800,000 reported cases and counting, it is all hands on deck for health care workers as hospitals overflow and medical supplies remain scarce worldwide.

Given such sudden and drastic changes to our everyday routine, it is common for folks to neglect  basic daily health practices. As you know, oral health shares many links to other health problems, especially chronic conditions. Diabetes, cardiovascular disease, kidney disease, respiratory conditions like pneumonia and conditions where people are immunocompromised, like those with cancer, organ transplants, and auto-immune diseases, are among those for whom daily oral hygiene is especially important to prevent oral disease. If you or a loved one experiences an oral health issue that requires immediate attention, the ADA recommends contacting your dentist instead of going to the ER, as hospitals and frontline health professionals are overwhelmed with caring for patients affected by COVID-19.

OHNEP always has and will continue to advocate for all health professionals to integrate oral health in their primary, acute, home, or long term care setting or practice to reduce the burden of oral disease on overall health. So to keep your message simple; please remind your patients to:

Brush…

  • Brush teeth, tongue and gums with a clean, soft-bristled toothbrush
  • Replace toothbrushes every three to four months
  • Use fluoride toothpastes to help prevent against tooth decay

Floss…

  • Floss at least once per day
  • Floss all teeth, and all spaces
  • Consider investing in a power air or water flosser if you are unable to visit your dentist for a regularly scheduled cleaning

Rinse…

  • Rinse mouth to prevent harmful build-up of plaque and tartar
  • Rinse with warm water after meals
  • Rinse with antibacterial mouthwash

Right now, many of us feel isolated and powerless with the looming uncertainty of what implications the current pandemic will have for our world. One health practice that each of us can be in charge of is our oral hygiene! If there is anything that we can be in control of in such an out-of-control world, it is our own health. Before we can support others, we need to look after ourselves, and practicing good oral hygiene is one simple and effective way to practice self-care every day.

 

 

Sources:

Burger, D. ADA recommending dentists postpone elective procedures. American Dental Association. Published March 16, 2020. https://www.ada.org/en/publications/ada-news/2020-archive/march/ada-recommending-dentists-postpone-elective-procedures.

Businesswire. DentalPlans.com Provides Tips for At-Home Dental Hygiene. Published March 24, 2020. https://www.businesswire.com/news/home/20200324005050/en/.

Intimate Partner Violence Shocks the Head and Mind

Jessamin E. Cipollina, M.A.

Intimate Partner Violence (IPV) is defined as any physical and sexual violence, stalking, or psychological harm by a current or former partner.1 The CDC identifies IPV as a “serious, preventable public health problem” that affects millions of people in the U.S. every year and can result in many negative health consequences including anxiety, substance abuse, and traumatic brain injury.1,2 Recent statistics show that about 1 in 4 women and 1 in 10 men have experienced some form of IPV in their lifetime, many of whom report experiences before the age of 18.1 IPV affects both men and women at any age and can result in lifelong emotional, physical and fiscal trauma to survivors and their families, not to mention the lasting oral health consequences  that can severely impact overall health and quality of life.

According to a report from the Health Resources and Services Administration (HRSA), approximately 75% of injuries from IPV occur around the head, neck and mouth.2 This can result in serious injuries to the mouth and teeth. Ongoing physical abuse from a partner such as slapping or hitting across the face can lead to serious head trauma and brain injury, including broken jaw, facial and mouth lacerations, loosening of teeth and traumatic evulsion of teeth. 2 Primary care physicians, nurse practitioners, midwives, nurses, physician assistants, dentists and dental hygienists are a few of many clinicians who are well-positioned to identify signs of IPV and take initial action to address abuse. But clinicians and staff may not be aware of what to look for in patients or what questions to include in screening protocol.2,3

Examples of Clinical Signs of IPV

Obvious

  • Broken teeth
  • Fractured jaw
  • Cuts
  • Facial bruising
  • Bite marks
  • Bruises on neck
  • Wrist, arm or ankle strains
  • Patches of missing hair

Subtle

  • Headaches
  • Depression
  • Fatigue
  • Lack of eye contact
  • ER trips for vague reasons
  • Self-inflicted cuts
  • Hidden cuts
  • Passive interaction
  • Eating disorders

The findings of recent studies demonstrate a need for IPV competencies to be integrated in oral health care and increased self-efficacy among all health professions in IPV screening. IPV screenings and know-how are especially important in primary care practice, urgent care and ER settings that are frequented by men and women who have sustained injuries from physical abuse. Several studies report that many health professionals, particularly dentists and dental assistants, do not receive education or training in identifying and approaching IPV in their offices. As such, continuing education in identifying signs of abuse is warranted.2,3 These findings also reveal some reluctance among oral health professionals to screen due to lack of expertise in detecting IPV. They recommend promoting adoption of IPV screenings in dental offices.2,3 Mandatory reporting of abuse is required in many states, but practitioners may not be equipped with adequate resources to report abuse as well as refer their patients to safe services if they are in imminent danger.

HRSA’s Strategy to Address Intimate Partner Violence includes four Priorities for addressing and raising awareness of IPV in clinical settings. This initiative aims to increase IPV knowledge within the health care workforce and increase access to IPV-informed health services, with the ultimate goal of earlier intervention and prevention of IPV.2,3 In addition to the primary care workforce, HRSA purports that practitioners and office staff also are perfectly poised to recognize both obvious and subtle indicators of IPV and should be aware of screening questions and methods that can be used with patients to assess their safety.2,3

Sample Screening Questions

  • “Since your last visit, I see that you have two broken teeth. How did that happen?”
  • “I notice you have a bruise on your jaw. How did that happen?”
  • “You seem upset/distracted today. Is there anything you would like to talk about with me?”
  • “You mentioned that things have been stressful at home. Can you tell me more about what has been going on?”

HRSA also describes several trauma-informed practices that can be adopted by health professionals and staff to make their clinic a safe space, as well as “activating” clinic environments to promote IPV education and practices.2,3

Trauma-Informed Practices for Health Professionals

  • Schedule longer appointments to get a patient acclimated to procedures in mouth
  • Provide a consultation room in the dental offices to further engage with patient
  • Identify a “quiet room” in the dental office where procedures can be done
  • Ask assessment questions using an open-ended and non-judgmental manner that encourage patient disclosure
  • Allocate a portion of the visit to just involve your patient, excluding visitors
  • Provide interpreters for your patients
  • Offer patients immediate and private access to an advocate in person or over the phone
  • Develop a list of referral resources at the ready for patients that need immediate attention
  • Familiarize yourself with the IPV reporting requirements in your state
  • LISTEN to your patients
  • Evaluate your attitudes and beliefs about IPV
  • Decide that you aren’t here to diagnose or treat IPV, but to create an opportunity for patients to share these and other experiences that may impact their overall health

There is a compelling need to integrate IPV competencies into oral health clinical education and practice! This clinical issue exemplifies the importance of interprofessional education and practice that includes collaboration between and among clinicians from different professions to effectively address IPV as a population health problem. It is the responsibility of health care professionals to ensure that their clinical setting has safe spaces and that productive, thoughtful conversations about IPV and related trauma topics can take place. IPV is one of many national public health concerns that can have irrevocable effects on oral health and overall health. Studies demonstrate that practitioners need to make progress in acquiring the competencies and resources necessary to identify signs of IPV and address them in clinical practice settings.

Resources for Patients and Practitioners

National Domestic Violence Hotline
thehotline.org
1-800-799-SAFE (1-800-799-7233)
Provides information on identifying domestic abuse, 24-hour helpline and online live chat for immediate support and referrals

Safe Horizon
safehorizon.org
1-800-621-HOPE (1-800-621-4673)
Advocacy organization with 24-hour helpline and online live chat, including resources for safety and support

National Coalition Against Domestic Violence (NCADV)
ncadv.org
Provides resources for domestic violence victims and their families to find immediate aid and plan for a safe future

 

 

1Centers for Disease Control and Prevention (CDC). Intimate Partner Violence. Retrieved from https://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html

2Health Resources and Services Administration, Office of Women’s Health. The HRSA Strategy to Address Intimate Partner Violence. Rockville, Maryland: 2017.

3Health Resources and Services Administration, Office of Women’s Health, Office of Planning, Analysis and Evaluation, & Bureau of Primary Health Care. Lunch and Learn: Intimate Partner Violence and Oral Health. Presentation. April 4, 2018.

4Harris CM, Boyd L, Rainchuso L et al. Oral health care providers’ knowledge and attitudes about intimate partner violence. J Dent Hyg. 2016;90(5);283-96. https://www.ncbi.nlm.nih.gov/pubmed/29118181.

5Lemich SA, Freudenthal JJ, Neill K et al. Dental hygienists’ readiness to screen for intimate partner violence in the state of Texas. J Dent Hyg. 2018;92(3);47-55. https://www.ncbi.nlm.nih.gov/pubmed/29976793

6Parish CL, Pereya MR, Abel SN et al. Intimate partner violence screening in the dental setting: results of a nationally representative survey. J Am Dent Assoc. 2018;149(2);112-21. https://www.ncbi.nlm.nih.gov/pubmed/29389334

Why You Should Take A Powder on Brushing with Charcoal

Jessamin E. Cipollina, M.A.

Charcoal has become a recognized active ingredient over the past couple of years, finding its way onto our restaurant menus and into our makeup bags. Spend any amount of time online and you will find ads from so-called “health gurus” and social media influencers sporting messy black smiles to promote the health benefits of brushing with charcoal. Beauty product manufacturers, celebrities and social media platforms are highly influential in promoting activated charcoal to not only brighten teeth, but also ingest as part of a cleansing “detox” regimen. Although charcoal appears to be a “proven” cure-all for our teeth and bodies, there is insufficient evidence that using charcoal products provide any significant health benefits. With new health and beauty crazes on the rise, health professionals and researchers are now responsible for keeping checks and balances on whether these fads are helpful or hurtful.

Activated charcoal is known for its ability to bind to organic matter, and producers of charcoal toothpaste claim that it is able to bind to plaque and other bacteria in the mouth to effectively clean teeth and remove staining. Many manufacturers claim that activated charcoal is a natural product that has been used for centuries to cleanse the body inside and out. With roots in ancient Greece, charcoal and ash composites were reportedly used to clean teeth and freshen breath.1 Charcoal is also well known for its detoxifying effects; activated charcoal can prevent poisonous substances and chemicals from being absorbed into the bloodstream, and thus is now sold as a “detox” additive for food and drinks. These are unfounded claims with no scientific evidence backing them up. There also are many other reasons to be wary of using charcoal tooth whitening products beyond the unknown.2

Many medical experts agree that although charcoal toothpastes may be effective in removing stains, there is no evidence of any significant whitening effects. In fact, long-term use of charcoal products on teeth can wear down tooth enamel due to their abrasive nature and further expose dentin in teeth making them look yellower than whiter. Prolonged use can also irritate gums and increase tooth sensitivity. Most charcoal toothpastes also do not contain fluoride, proven to keep teeth and gums healthy and protect against decay.1-3

A recent article from the British Dental Journal provides an in-depth review of current knowledge surrounding charcoal toothpastes and powders, and how the risks of using such products could outweigh the benefits.1 The authors argue that there is very little evidence supporting manufacturers’ claims that charcoal can whiten teeth and improve oral health. Rather, there is sufficient evidence that charcoal dentifrices may ultimately cause more harm than good. In addition to charcoal toothpastes not containing fluoride, potentially abrading dentin, irritating gums and increasing tooth sensitivity, the authors cite another potential risk of charcoal as a carcinogen. It is possible that long-term use of charcoal products could have dire outcomes.1,2 Overall, there is simply not enough evidence to support that charcoal promotes oral health and hygiene, as the proposed risks appear to offset the wildly under-researched “benefits”.

Activated charcoal products are promoted as handy tooth-whitening tools among other over-the-counter tooth whitening gels and films. Although these regimens are considered safe, consumers should at the very least be aware of potential risks and common side effects of tooth whitening. Both tooth whitening and bleaching products contain chemicals that lighten tooth color. As might be expected from using chemicals, increased tooth sensitivity and gum irritation are common and often to a mild degree. More serious side effects, particularly from repeated or prolonged use of whitening regimens, include enamel softening, tooth roughness, and demineralization, along with increased susceptibility to dehydration.4 It is important to point out that white teeth are not necessarily a sign of healthy teeth; maintaining good oral hygiene by brushing twice daily for two minutes with a fluoride toothpaste, daily flossing, and regular dental check-ups is ultimately the best way to guarantee a healthy and happy smile.

 

Sources:

1Greenwall LH, Greenwall-Cohen J, Wilson NHF. Charcoal-containing dentifrices. Br Dent J. 2019;226(9);697-700. https://www.nature.com/articles/s41415-019-0232-8. Accessed January 7, 2019.

2Santos-Longhurst A. Charcoal toothpaste for teeth whitening: the pros and cons. Healthline. https://www.healthline.com/health/dental-and-oral-health/charcoal-toothpaste. Updated June 18, 2019. Accessed January 7, 2019.

3Vyas K. The truth about activated charcoal. Interesting Engineering. https://interestingengineering.com/the-truth-about-activated-charcoal. Published September 13, 2019. Accessed January 7, 2019.

4Carey CM. Tooth-whitening: what we now know. J Evid Based Dent Pract. 20114;14(Suppl);70-76. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058574/. Accessed January 7, 2019.

Motivational Interviewing: A Step in the Right Direction to Better Interprofessional Oral Care

Jessamin E. Cipollina, M.A.

Motivational interviewing (MI) is an evidence-based counseling style that promotes healthy lifestyle changes and behavior patterns. It is used to help patients resolve issues with self-doubt and challenge negative thinking. For example, Nurse Practitioners, Registered Nurses, and Physician Assistants use motivational interviewing with patients with diabetes to engage them in goal setting about making lifestyle changes related to diet, exercise, and weight loss. These lifestyle changes are recognized as health enhancing behaviors that contribute to preventing or delaying the onset of Type 2 Diabetes and improving glycemic control for those who have this chronic condition.1

Many dentists encounter patients who have little to no oral health education due to lack of access or guidance. Dentists want to make the most of their time with patients, especially with first-timers and those with dental anxiety. Much anxiety around visiting the dentist and other doctors comes from not knowing what to expect at the office, or self-doubt about personal health. Telehealth and virtual dentistry have the ability to increase health literacy in disadvantaged or hard-to-reach populations; conducting motivational interviewing with patients about their health is a very important part of this process.

A research team at the University at Buffalo recently received a $438,000 grant from the National Institutes of Health (NIH) to develop an online MI intervention for dentists to use with patients. This study aims to demonstrate the effectiveness of MI in improving oral health behaviors as well as develop an effective and low-cost program.2 A previous study had great success in improving oral health among those struggling with alcohol abuse using MI; this current study will develop a similar program delivered to dental patients electronically. 2

Evidence-based research is growing around the success of using MI to improve oral health as an alternative to current education strategies. A study conducted in 2017 utilized MI to improve oral health in adolescents. They compared standard health education to an MI intervention and MI combined with risk assessment. Both MI interventions showed improved oral health behaviors, including less snacking and more frequent tooth brushing, among participating teens.3

A similar 2018 study compared the effects of a conventional education program with a program that included MI with teens with orthodontics. The results showed that the MI program had significant immediate and long-term outcomes on oral hygiene among participants, as well as greater plaque reduction and gingival care than the conventional education group.4 MI may be the missing piece to improving oral health care and education in the dental setting.

The use of telehealth technology is growing in dental care. Dentists are utilizing telehealth services to address several health care delivery needs, namely improving access to care for urgent dental issues to reduce emergency room spending nationwide.5 Dental clinics across the U.S. have reported success in using virtual health applications with patients to answer questions and provide guidance with oral problems requiring immediate care. 5 Telehealth also has the capacity to connect all health care professionals involved in patients’ health care teams and to better promote the importance of oral hygiene in patients’ overall health.6 In this vein, telehealth technologies have the potential to include providing MI to patients who have fears or doubts about visiting the dentist, whether for dental procedures or a regular check-up.

We know that motivational interviewing is a valuable tool used to engage patients in improving both physical and mental health. Telehealth and virtual dentistry have the potential to improve access to care in underserved areas, as well as provide easy and consistent access to health literacy tools and programs. The ability to receive immediate care and assistance from a dentist has great potential to reduce the instance of emergency dental care and further reduce nationwide spending on dental care. These unique approaches to providing dental care are exciting as they show promise in improving oral health care access and literacy along with reducing dental care costs. It is encouraging that multiple health professions are adopting the use of technology to advance health promotion through use of motivational interviewing. A growing body of evidence supports use of these practices as their own to contribute to the growing demand for health care strategies that make a real difference in the lives of people in urban, suburban, and rural communities.

 

 

 

1Vorderstrasse AA, Melkus G, Pan W et al. Diabetes LIVE (Learning in Virtual Environments): testing the efficacy of self-management training and support in virtual environments (RCT Protocol). Nurs Res, 2015; 64(6):485-493. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624251/.

2Robinson M. Too lazy to brush and floss? research team will motivate you with online counseling. University at Buffalo News Center, 2019. Retrieved from www.buffalo.edu/news/releases/2019/03/011.html.

3Wu L, Gao X, Lo ECM, et al. Motivational interviewing to promote oral health in adolescents. J Adolesc Health, 2017; 61(3):378-384. doi:  10.1016/j.jadohealth.2017.03.010.

4Rigau-Gay MM, Claver-Garrido E, Benet M, et al. Effectiveness of motivational interviewing to improve oral hygiene in orthodontic patients: a randomized controlled trial. J Health Psychol, 2018; doi: 10.1177/1359105318793719.

5Wicklund E. Dentists use telehealth to improve access to care – and fight a phobia. mHealth Intelligence, 2019. Retrieved from https://mhealthintelligence.com/news/dentists-use-telehealth-to-improve-access-to-care-and-fight-a-phobia.

6Glassman P, Harrington M, Mertz E, et al. The virtual dental home: implications for policy and strategy. J Calif Dent Assoc, 2012; 40(7):605-611. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477859/#__ffn_sectitle.

Prescribing Savvy Can Make a Dent in the Opioid Crisis

Jessamin E. Cipollina, M.A.

The current opioid epidemic in the U.S. is heartbreaking. Recent statistics tell a harrowing story of opioid addiction. In 2016, 11 million Americans reported abusing prescription opioids, with an estimated 1,000 people being treated for opioid misuse every day.1 The opioid overdose death rate is even more shocking; in 2016, nearly 64,000 people died from opioid overdoses, and over 40% of these deaths involved a prescription opioid.2 A recent report from DrBicuspid shows that people are more likely to die from an accidental overdose than from a car crash as of 2016. This puts opioid overdoses in second place on the list of causes of unintentional and preventable death – suicide is number one.2

Opioids are prescribed for a number of complaints, namely post-surgery relief and chronic illnesses. Recent research shows that dentists are responsible for 12% of opioid prescriptions, and two-thirds of these prescriptions are for oral surgery.3,4 It is also important to consider what happens beyond the prescription – unused opioids from dental procedures cause approximately 1,500 deaths each year.3 Many health organizations are calling on physicians, nurse practitioners, physician assistants, dentists and oral surgeons to evaluate pain management more closely and take on a more conservative approach to prescribing potentially harmful and addictive pain relief medications.

Opioid addiction is a major public health concern in the U.S. that has garnered an overwhelming amount of attention from government organizations, media outlets and healthcare agencies. As a result, there has been an influx of research studies examining the overall impact of opioid use and abuse, including reports on prescribing practices and the increase of addiction among teens.5

For example, a recent study found that teens given prescription painkillers after dental procedures were 10 times more likely to be diagnosed with opioid abuse than teens who had not received a prescription.6 Another report found that between 2010 and 2015, the number of dental opioid prescriptions for adolescents per year had increased dramatically from 99.7 per 1000 patients to 165.9 per 1000 patients.7 Even after prescriptions run out, addicted teens may find ways to buy prescription or illegal opioids elsewhere, leading to overdose and even death.8 These growing numbers of opioid prescriptions and adolescents’ evident vulnerability to addiction demonstrate how dentists need to seek alternatives to opioid painkillers for dental procedures.

Health professionals and organizations are actively promoting the use of Tylenol and Advil as a pain management alternative that proves to be just as effective as opioids.5,7-11 Reducing the number of prescriptions for routine dental procedures can greatly reduce the risk and instance of opioid addiction and abuse, further reducing the amount very preventable opioid-related deaths.

Dentists and other health professionals can play a significant role in curbing high rates of opioid addiction and overdose by limiting opioid prescriptions, especially for younger patients, and using alternative pain management regimens. Many health professionals agree that acetaminophen and ibuprofen are equally effective in managing pain as opioids, and do not come with the risk of addiction.9-11 Dentists can also limit the amount of opioids they prescribe. The CDC recommends prescribing three days worth of medications at fewer than 50 morphine milligram equivalents per day.1 This prevents patients, their family or friends from misusing leftover pills – any leftover pills should be returned to the pharmacy or disposed of properly, either by returning them to the pharmacy or mixing them with water and an unpalatable substance (cat litter, used coffee grounds, etc.) before being thrown away.9,10

While opioid overdoses have increased significantly over the past several years, a recent study revealed that between 2012 and 2017, new prescriptions for opioids, meaning those that receive an opioid prescription for the first time, dropped by half, along with a significant decrease in the number of physicians prescribing first-time opioids. Although the numbers had decreased, the dose and length of prescriptions remained in excess of the CDC recommendations.12 This represents an overall lack of attention to patients who receive opioids for short-term care, such as post-op pain management – similar to what dentists would prescribe after such procedures as wisdom teeth removal.

New prescriptions by dentists and other health professionals need to be the larger focus of the current opioid epidemic, since these prescriptions readily available for misuse, and lead to abuse if leftover medications are kept in the household and taken by others after the patient no longer needs them. Policies around opioid prescriptions, namely for teens and first-time users, need to be strengthened; awareness around non-opioid pain management needs to be investigated and promoted. Dentists and other health professionals are in a prime position to help reduce this national crisis by more closely evaluating patient needs and pain management tools that are potentially less harmful.

1Centers for Disease Control and Prevention. Opioid overdose: understanding the epidemic. CDC. Updated December 19, 2018. Retrieved from: https://www.cdc.gov/drugoverdose/epidemic/index.html

2Pablos T. Opioid overdoses eclipse car crashes for accidental deaths. DrBicuspid. Published January 25, 2019. Retrieved from: https://www.drbicuspid.com/index.aspx?sec=log&URL=https%3a%2f%2fwww.drbicuspid.com%2findex.aspx%3fsec%3dsup%26sub%3dapm%26pag%3ddis%26ItemID%3d324123

3Janakiran C, Chalmers NI, Fontelo P, et al. Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid. J Am Dent Assoc 2018;149(4):246-255. DOI: 10.1016/j.adaj.2018.02.010

4Moore PA, Ziegler KM, Lipman RD, et al. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. J Am Dent Assoc 2018;149(4):256-265.e3. DOI: 10.1016/j.adaj.2018.02.012

5Dana R, Azarpazhooh A, Laghapour N, Okunseri C. Role of dentists in prescribing opioid analgesics and antibiotics: an overview. Dent Clin North Am 2018;62:279-294. DOI: 10.1016/j.cden.2017.11.007

6Schroeder AR, Dehghan M, Newman TB. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med 2019;179(2):145-152. DOI: 10.1001/jamainternmed.2018.5419

7Gupta N, Vujicic M, Blatz A. Opioid prescribing practices from 2010 through 2015 among dentists in the United States: what do claims data tell us? J Am Dent Assoc 2018;149(4):237-245.e6. DOI: 10.1016/j.adaj.2018.01.005

8Marso A. Teens get addicted to opioids after wisdom teeth removal. Insurers are cracking down. Personal Liberty. Published March 6, 2019. Retrieved from: https://personalliberty.com/teens-get-addicted-to-opioids-after-wisdom-teeth-removal-insurers-are-cracking-down/

9Garrity M. Dental health plays significant role in opioid epidemic. Becker’s Dental and DSO Review. Published February 25, 2019. Retrieved from: https://www.beckersdental.com/dentists/34391-dental-health-plays-significant-role-in-opioid-epidemic.html

10Biuso T. The impact of the opioid epidemic on oral health. AZ Big Media. Published February 11, 2019. Retrieved from: https://azbigmedia.com/the-impact-of-the-opioid-epidemic-on-oral-health/

11Cohen R. Unwise and unnecessary: opioids for wisdom teeth extractions. The Washington Post. Published March 3, 2019. Retrieved from: https://www.washingtonpost.com/national/health-science/unwise-and-unnecessary-opioids-for-wisdom-teeth-extractions/2019/03/01/f3600a3c-2e33-11e9-86ab-5d02109aeb01_story.html?noredirect=on&utm_term=.cd675dca4adc

12Park A. Doctors are writing half as many new opioid prescriptions as they used to, study says. Time. Published March 13, 2019. Retrieved from: http://time.com/5550686/opioid-prescribing-patterns-drop/

Vaping: The Smoking Gun of Poor Oral Health in Teens

Jessamin E. Cipollina, M.A.

February is National Children’s Dental Health Month, a great opportunity to promote the importance of children’s dental resources and raise awareness about good oral health practices for tiny teeth. Although pediatric dental health often focuses on younger children, oral health education and resources for teens are often overlooked because this group, on the cusp of adulthood, is expected to maintain good oral health care developed in early childhood. However, with adolescence comes many personal health and social changes that parents and practitioners alike should be aware of in assessing teen oral health risk behaviors.

A major public health concern across the U.S. is the high rate of teens who smoke electronic cigarettes. Originally marketed for those looking to quit smoking tobacco, nicotine vaporizers and e-cigarettes are replacing traditional cigarettes.1 As a result, teens are largely misinformed about the oral and overall health risks of vaping, which is now viewed as an overall “healthier” alternative to smoking tobacco by teens and the general public. This group is widely influenced by myths and advertising for e-cigs and vapes, and there is a need for greater awareness and education on the health risks of vaping in this group.1,2

There are a variety of factors that contribute to poor oral health in teens, and many oral health risk factors are directly linked to complications with overall health. The American Dental Association (ADA) discusses the oral health risks of smoking and ingesting tobacco products, including gum disease and oral cancer, but they neglect to include the oral health risks of smoking e-cigarettes and non-tobacco products.3 Many anti-smoking campaigns and smoking education for teens focus on tobacco-related health problems, but the recent surge of non-tobacco smoking products and the health risks associated with nicotine and other chemicals makes a compelling case for addressing these issues.

According to the National Institute on Drug Abuse (NIDA), the vaping epidemic affects teens as early as 8th grade and throughout high school. Various reports show that junior and senior high school students are twice as likely to use e-cigarettes as traditional cigarettes, yet roughly a third of these teens will start smoking tobacco products within 6 months.4 Although e-cigs and vaporizers are indeed tobacco-free, this does not mean that the effects of nicotine are any less brutal. It is still a highly addictive chemical that is known to cause cancer and increase risk for a range of health problems, namely heart disease and cancer of the lungs, pancreas, gastrointestinal system and breasts.3 Nicotine and other chemicals in vapes and e-cigs are especially bad for teeth and gums; frequent vaping means high amounts of nicotine in your bloodstream that reduces blood flow and saliva production and can increase muscle tension, particularly in teeth and gums. All of this can lead to painful gum disease and tooth decay, not to mention teeth grinding and persistent bad breath.3

Due to early marketing of e-cigarettes as an option for those looking to quit smoking tobacco, many people falsely view e-cigs as a healthier alternative to cigarettes. This leads to drastic misinformation absorbed by teens that is proven to be just as poisonous as vaping. High school students are especially vulnerable to these mixed messages, with 30-50% of them exposed to ads for vaping and e-cigs through all forms of advertising including retail, internet, TV and magazine ads.4 This pervasive promotion of the products demonstrates an urgent need for oral health literacy tools to educate adolescent youth about the severe negative impact that these products can have on oral and overall health.

Adolescence is known to be a tumultuous period in a person’s life. Expectations to perform well in school and extracurricular activities are high, along with impending pressure about life after high school and making important decisions about the future. During this time, teens are learning how to balance multiple responsibilities while also staying happy and healthy. Many teens seek out ways to combat these new stressors and, unfortunately, smoking is and always has been promoted as a great stress reliever. Smoking e-cigarettes is often seen as a safer alternative to smoking and/or ingesting tobacco products, but there are many serious oral health problems that can result from long-term and frequent vaping. In 2018, the Food and Drug Administration (FDA) revised its current anti-smoking campaign The Real Cost to include the destructive effects of e-cigarettes and to raise awareness about the epidemic of vaping in schools.5 Continuing to market e-cigarettes as a “safer” alternative will cause irreparable harm to today’s teens and future adolescents, making the need for oral health education regarding e-cigarettes especially important. As health professionals, we need to act now to educate our teens about the perils of e-cigarettes and vaping!

1Waitt, T. Vaping and oral health: It’s worse than you think. American Security Today. Published on January 28, 2019. Retrieved from: https://americansecuritytoday.com/vaping-and-oral-health-its-worse-than-you-think-learn-more-videos/

2Allen, B. E-Cigarettes: Vaping and dental health. Delta Dental. Published on June 5, 2018. Retrieved from: https://www.deltadentalwa.com/blog/entry/2018/06/ecigarettes-vaping-dental-health

3Mouth Healthy. Concerns. American Dental Assocation. Published 2019. Retrieved from: https://www.mouthhealthy.org/en/teens/concerns

4National Institute on Drug Abuse. Teens and e-cigarettes. National Institutes of Health; U.S. Department of Health and Human Services. Updated February 2016. Retrieved from: https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

5U.S. Food and Drug Administration. The real cost campaign. U.S. Department of Health and Human Services. Updated February 5, 2019. Retrieved from: https://www.fda.gov/TobaccoProducts/PublicHealthEducation/PublicEducationCampaigns/TheRealCostCampaign/default.htm

Blueberries May Be “Juiced” What the Dentist Ordered

Jessamin E. Cipollina, M.A.

New year, new you! The first few months of any new year are a time for evaluating your lifestyle choices and making positive changes to improve health and happiness. Improving your overall health often includes changes to diet, exercise and routine. Recent studies show that fruit extracts from blueberries and other fruits contain nutrients that may lower the risk of tooth decay, plaque and gum disease.1,2 Many scientific studies have examined the health benefits of berries and other fruits, but new research specifically focuses on the oral health benefits of certain nutrients and compounds in fruit extracts that help protect teeth and gums.1-3 This year, to fight both candy cravings and cavities, keep in mind how blueberries can help prune-vent tooth decay.

Dark colored berries, namely blueberries and cranberries, have many health benefits beyond oral health; they are the best natural source of antioxidants and fiber, and help protect us from many serious illnesses including cancer and heart disease.3 These berries also contain polyphenols, which are natural compounds that fight bacteria in the mouth and protect teeth from decay.1-3 Chief Executive of the Oral Health Foundation, Dr. Nigel Carter, suggests utilizing these natural extracts in oral health care products, such as toothpaste and mouthwash, or adding them to water and drinks as they are flavorless and dissolve in water.3

Although berries evidently have many health benefits and should certainly not be taken for pome-granted, they are often high in sugar and acid and should not be consumed in large quantities. Dr. Carter advises that although fruits contain natural sugar as opposed to unhealthy added sugar, consistently eating more than the daily recommended amount can lead to oral and overall health problems.3 Despite concerns, consuming raisin-able portions of these power-packed fruits is the key to keeping a happy and healthy smile.

Studies have examined the effects of fruit extracts on bacteria and the potential protective functions of nutrients and compounds in fruits. One study conducted in the UK tested the effects of blueberry, cranberry and strawberry extracts on Streptococcus mutans (S. mutans) bacteria, a bacteria that contributes to dental caries.1 The researchers found that cranberry and blueberry extracts were most successful in compromising the activity and expression of S. mutans bacteria; strawberry extracts did not deter the bacteria in any way.1 A similar study focused on the effects of polyphenols found in blueberries on periodontitis, and found that these specific polyphenols had significant antibacterial and anti-inflammatory effects on the active components of periodontitis.2 These studies support the potential for berry extracts and polyphenols to protect against tooth decay, and further support recommendations to incorporate these extracts into dental products to fight dental disease.

Obviously many health benefits can come from adding more blueberries and cranberries to your new diet, but it is important to do so in moderation. The World Health Organization (WHO) provides guidelines on sugar intake for both adults and children for medical professionals to utilize. For adults, the daily recommended amount of sugar is no more than 25 grams of sugar a day, or about 6 teaspoons. This makes up about 5% of the average adult’s daily calorie intake.4,5 A recent article examined the use of these guidelines in dental practice and provided suggestions on how dental professionals can provide nutrition and diet advice that includes the importance of limiting both natural and “free” added sugars. Although the authors maintain that it is important to encourage patients to eat fresh fruit and avoid free sugars, they also acknowledge that excessive amounts of fruit should be avoided and that current guidelines provided by WHO should be followed.4

This year, why not add good oral health practices to your new year’s resolutions? Healthy eating is an important component of oral health and overall health at any age. Mindful eating can, in the long run, help prevent oral diseases along with visiting the dentist twice a year and brushing and flossing two times a day. An abundance of recent research supports that consuming blueberries, cranberries and other dark berries high in polyphenols pack a punch in the fight against tooth decay and other oral health complications. But before you chow down on a dry pint of blueberries, keep in mind that consuming high amounts of sugar can negate these positive effects by increasing risk of caries. In plum, adding more berries to your diet is a tasty and fruitful way to keep your mouth happy and promote good lifelong oral health practices. Orange you glad you took the time to read this?

 

  1. Philip, N., Bandara, H.M.H.N., Leishman, S.J. & Walsh, L.J. (2018). Inhibitory effects of fruit berry extracts on streptococcus mutans biofilms. European Journal of Oral Sciences, 1-8. DOI: 10.1111/eos.12602.
  2. Lagha, A.B., Dudonné, S., Desjardine, Y., & G, Daniel. (2015). Wild blueberry (Vaccinium angustifolium Ait.) polyphenols target fusobacterium nucleatum and the host inflammatory response: Potential innovative molecules for treating periodontal diseases. Journal of Agricultural and Food Chemistry, 63(31), 6999-7008. DOI: 1021/acs.jafc.5b01525.
  3. Oral Health Foundation. (2019). Cranberries and blueberries – why certain fruit extracts could provide the key to fighting tooth decay. Retrieved from https://www.dentalhealth.org/news/cranberries-and-blueberries-why-certain-fruit-extracts-could-provide-the-key-to-fighting-tooth-decay.
  4. Moynihan, P., Makino, Y., Peterson, P.E., Ogawa, H. (2017). Implications of WHO guideline on sugars for dental health professionals. Community Dentistry and Oral Epidemiology, 46(1), 1-7. DOI: 10.1111/cdoe.12353.
  5. Jaslow, R. (2014). World health organization lowers sugar intake recommendations. CBS News. Retrieved from https://www.cbsnews.com/news/world-health-organization-lowers-sugar-intake-recommendations/.