Tiniest Patients Need Care Too
By Debra Belt
Mothers of young children often have similar stories about finding dentists
for their children. In attempting to provide the recommended care, they
call the dentist for a "first year" exam. Then the surprise
comes. They are often told the visit isn’t necessary; the child is too
young. Sometimes the parent is advised to bring the child in when he is
older -- around 3 or so.
This situation leaves parents in limbo since, after all, they are trying to follow guidelines set by the American Dental Association, the California Society of Pediatric Dentists and the American Academy of Pediatric Dentistry.
"First-year dental visits are the recommended standard of care in pediatric dentistry," said Ray Stewart, DMD. Stewart is currently helping draft a position paper for the California Dental Association on early childhood caries, which recommends a visit to the dentist at one year or within six months of the eruption of the first tooth.
So why do parents often have a hard time getting a dental appointment for their 1-year-olds? As in many situations, there is not a single quick answer. The scenario plays out as a result of changing ideology, supply and demand, and logistics.
"This is still a new concept," explained Dave Perry, DDS, president-elect of the California Society of Pediatric Dentists. "Traditionally, we would wait until a child has a cavity. But with this preventive school of thought, we see a child early and talk to parents about prevention and avoiding early childhood caries. It takes a new idea such as this a while to be assimilated, and we are still in that transition period."
As the idea continues to become more accepted and demand for early exams increases, dentistry is faced with the age-old issue of supply and demand.
"Unfortunately, the number of pediatric dentists is small compared to dentistry as a whole," said Wayne Grossman, DDS, immediate past president of CSPD. "We are a graying population and many of us are retiring. Our resources are limited as a group, and we want to make sure general dentists provide this service or offer a referral to someone who does."
"There aren’t enough pediatric dentists to go around," Stewart said. "We are hoping to convince general dentists that these early exams are important so they will begin to look around for C.E. courses on what is involved in conducting these early risk assessments."
Stewart and Grossman are not alone in their call to general dentists to become involved in helping provide this service.
"As dental health care providers, this is our best opportunity to practice truly preventive dentistry by intervening before problems are allowed to occur," said Suzanne Berger, DDS, past president of CSPD and member of CDA’s Council on Community Health. "We must see children early, interact with parents and provide anticipatory guidance. There are not enough pediatric dentists to care for all of the children, so all dentists need to be examining young children in order to be proactive and make a difference. It’s smarter to stop decay before it starts."
In advocating early exams, dentists familiar with the routine say there are a few basic elements involved: Attaining a medical history; conducting a risk assessment evaluating parents’ oral status and feeding habits of the baby; providing anticipatory guidance counseling; performing the oral exam; and intervening with appropriate treatments such as fluoride varnishes if necessary.
"Sometimes you have to be a little bit of politician," said Grossman, who has been performing "well-baby" dental exams for 15 years. "You want to involve the key caregivers and sometimes that is a grandparent or another relative. There are situations where you have to get people from another generation or culture on your side."
"The idea is for dentists to have the opportunity to talk to caregivers about several things, including their own dental care as well as feeding habits of the baby," Stewart said. "If parents have dental decay, they can pass cariogenic bacteria on to their child during a ‘window of infectivity’ occurring between 1 and 2 years of age," Stewart explained. "If we have the chance to talk to parents and find out when their last dental visit was and if they have decay, we can do some good with chlorhexidine rinses, brushing, and awareness of bacteria transmission."
"We want to initiate a discussion with parents or caregivers about the many different things that can cause dental caries," Perry said. "You want to find out if a child is sleeping with a bottle and if so ask what is in the bottle."
Grossman said diet is one of the most important things he emphasizes. "It has the most impact on avoiding decay. I have a list of recommended snacks and Krispy Kreme doughnuts are not on the list. I suggest keeping kids away from snacks such as crackers and chips as oral bacteria thrives in an environment rich in carbohydrates."
In performing the actual exam, dentists who routinely see young children concur on the use of the "knee-to-knee" examination technique where the baby sits on the lap of the parent and then lies back so his head is in the dentist’s lap. "The knee-to-knee is key," Berger said. "It is comfortable and safe for the child, the dentist has better control, and the parent can see what is going on."
This is also a good time to offer advice on how to clean the child’s teeth and gums using a small soft brush or clean cloth.
In providing these preventive exams, dentists use different scheduling techniques. "It is a bit of a balancing act," said Grossman, who sets an entire morning aside to do the exams. "You have to prioritize time, energy, and staff to make it all happen. Auxiliaries can handle the discussion portion of the visit, although I tend to like to do a lot of question and answer routine myself. I do this as a service and trust that things will work out."
U.S. Issues New Medical Privacy Rules
The U.S. government in December released the nation’s first standards for protecting the privacy of Americans’ personal health records. This new regulation will protect medical records and other personal health information maintained by health care providers, hospitals, health plans and health insurers, and health care clearinghouses.
"For the first time, all Americans -- no matter where they live, no matter where they get their health care -- will have protections for their most private personal information, their health records," said Donna Shalala, secretary of the Department of Health and Human Services. "Gone are the days when our family doctor kept our records sealed away in an office file cabinet. Patient information is now accessed and exchanged quickly. With these standards, all Americans will be able to have confidence that their personal health information will be protected."
The regulation was mandated by Congress when it failed to pass comprehensive privacy legislation. The new standards limit the nonconsensual use and release of private health information; give patients new rights to access their medical records and to know who else has accessed them; restrict most disclosure of health information to the minimum needed for the intended purpose; establish new criminal and civil sanctions for improper use or disclosure; and establish new requirements for access to records by researchers and others.
The Department of Health and Human Services received more than 52,000 comments on its proposed privacy rule published in 1999. The standards just released further strengthen patients’ protection and control over their health information by extending coverage to personal medical records in all forms -- including paper records and oral communications. The earlier proposal had applied to electronic records and to any paper records that had at some point existed in electronic form. The final regulation provides protection for paper, oral, and electronic information, creating a privacy system that covers all personal health information created or held by covered entities.
"Comprehensive protection of personal medical records is what Congress called for in the law, and it’s what American patients and their providers want and need," Shalala said. "Protection for all records is the most logical, workable, and understandable approach for patients and providers alike."
The final rule also requires that most providers get their patients’ consent for routine use and disclosure of health records, in addition to requiring their authorization for nonroutine disclosures.
Whassup? Wasabi!
Brush, floss, and eat soybean and tomato salad with wasabi dressing.
You may want to consider giving those instructions to your patients if the findings of new research are borne out by further study. Soybeans, tomatoes, and wasabi have all been found to have properties that may have positive affects in the oral cavity.
* Soybeans: A chemical derived from soybeans showed promising results in shrinking abnormal growth that can lead to oral cancer, according to a clinical study at the University of California at Irvine College of Medicine.
Researchers at UC Irvine found that a chemical called Bowman-Birk inhibitor reduced the size of precancerous oral leukoplakia in about one-third of the participants in the trial. They said the findings are among the first in humans indicating the soybean-derived inhibitor could prevent oral cancer.
* Tomatoes: The pigment that gives tomatoes their distinctive red color could prove to be effective in preventing and treating oral cancer, according to research results from Hebrew University of Jerusalem.
Lycoprene, which forms the pigment in tomatoes, has been linked to reduced risk of many cancers, including breast, prostate, pancreas and colorectal. When researchers added the chemical to oral cancer cells in culture as a control in an experiment on the effect of orange carrot pigment on tumor cells, the cancer cells began to die. The effects of lycoprene will next be tested on people with oral cancer.
* Wasabi: The powerful pale green paste used as an accompaniment to Japanese cuisine could fight cavities by preventing bacteria from lodging in the teeth and gums, according to a report.
In a test tube, Japanese researchers found that the compounds that give wasabi its flavor can block decay-causing bacteria from sticking to the teeth. This is probably because they render useless the molecule that converts sugar to the substance that helps them stick to teeth.
Other research suggests that wasabi has a number of other health benefits, including inhibiting the growth of cancer cells in test tubes and preventing platelets from forming blood clots. In addition, wasabi has antimicrobial properties.
Oral Piercing Can Lead to Gingival Recession
According to a report in the November issue of the Journal of Periodontology, piercing the tongue, lip, or cheek could cause localized gingival recession. This can lead not only to an unattractive defect, but also leaves the tooth root more vulnerable to decay and periodontal disease.
Researchers analyzed the case of a 26-year-old female who had localized gingival recession around the area of her lip piercing. The patient noticed soon after getting the oral barbell that her gums started to progressively recede in the area of the piercing. The barbell had direct contact with the area where the gums were receding. Since the patient's gingival recession was present only in the area of the oral metal device, the piercing was considered to be the cause of the gingival recession.
"Oral piercing has become a popular trend, and most people do not seek advice from a dental or medical professional prior to the piercing," said Michael McGuire, DDS, president of the American Academy of Periodontology. "Another important concern is hygienic maintenance of the pierced oral area. The mouth contains millions of bacteria, and infection is a common complication of oral piercing."
Other consequences of oral piercing may include swelling, increased flow of saliva, pain, fractured teeth, interference with speech, and metal hypersensitivity.
"Many people with oral piercing do not think about the harmful effects it can have on their oral and overall health," McGuire explained. "In this particular case, the doctors were surprised that the patient had a history of mitral valve prolapse, and she was unaware of the consequences of piercing on her medical status. In fact, a case of infective endocarditits following nasal piercing has been reported."
Flu Vaccine May Shoot Down Heart Attacks
Getting a flu shot may cut the risk of having a heart attack, according to research published in Circulation: Journal of the American Heart Association.
While recent evidence has linked various infections to heart disease, researchers have established the first link between vaccination and a reduced risk of heart attack. In a study of 218 heart attack patients, researchers linked flu vaccination to a 67 percent lower risk for a second heart attack.
Researchers at the University of Texas -- Houston Health Science Center studied heart patients during one flu season. Those who suffered a second heart attack were put in one group, while those who did not were considered controls.
Just 47 percent of patients who had second heart attacks had received a flu shot that year, compared with 71 percent of those whose hearts remained stable, the report indicates. The control group also reported a higher rate of previous flu shots. The protective effect of flu vaccination held after the researchers considered heart disease risk factors such as smoking and high blood pressure.
The findings are published in the December 19/26 issue of Circulation: Journal of the American Heart Association.
Dentist Gain Spot in Annual Honesty Poll
Dentist have made up a little of the ground they have lost recently in the Gallup Organization’s yearly Honesty and Ethics poll by moving up to the 8th spot for 2000, according to results released Nov. 27. Nurses took the top spot for the second year in a row.
Medical practitioners have consistently garnered high ratings for ethics according to Gallup. The honesty and ethics of elected officials, on the other hand, continue to draw skepticism from most Americans, judging by the poll results. As with every previous year, less than half the public said any elected official on Gallup’s list had "very high" or "high" honesty and ethics
The top 10 in the 2000 Honesty and Ethics poll were:
1. Nurses
2. Pharmacists
3. Veterinarians
4. Medical doctors
5. Grade and high school teachers
6. Clergy
7. College teachers
8. Dentists
9. Engineers
10. Police officers
Correction
In the January issue of the Journal of the California Dental Association, Philip Wolkstein, DMD, was inadvertently left off the list of members of the Council on Peer Review. We apologize for the omission.
Honors
Anthony L. Perez, DDS, of Ventura has been awarded fellowship in the Academy of Dentistry International.
Web Watch
HIV/AIDS
HIV/AIDS section of the National Prevention Information Network Web site is designed to facilitate the sharing of information and resources on HIV and AIDS for all individuals searching for prevention information. It is a part of the Centers for Disease Control and Prevention.
ÆGIS utilizes a combination of FidoNet (connecting 32,000 electronic bulletin boards in 66 countries) and Internet communication tools to relieve some of the suffering and isolation caused by HIV/AIDS, and foster the understanding and knowledge that will lead to better care, prevention, and a cure. The site includes a comprehensive news database that covers 1983 to the present. It is updated daily
TheBody.com is a well-respected, award-winning multimedia AIDS and HIV information resource.
At this site, the University of California at San Francisco provides comprehensive and reliable information on HIV/AIDS treatment, policy, research, epidemiology, and prevention.
Upcoming Meetings
2001
Feb. 9-10 Interdisciplinary Care Conference, Dallas, (314) 993-1700, Ext. 260
Feb. 21-22 American Equilibration Society 46th Annual Meeting, Chicago, (847) 965-2888, www.occlusion-tmj.org.
Feb. 28-March 4 American Academy of Dental Practice Administration Annual Meeting (open to nonmembers), San Antonio, Texas, (800) 689-7515
March 4-10 U.S. Dental Tennis Association Spring Meeting, Longboat Key, Fla., (800) 445-2524
March 21-24 Academy of Laser Dentistry 8th Annual Conference & Exhibition, (954) 346-3776, www.laserdentistry.org
April 18-20 The Periodontal-Systemic Connection: A State-of-the-Science Symposium, Bethesda, Md, (312) 787-5518, www.perio.org
April 19-22 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470
May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477
May 18-20 California Society of Periodontists, San Francisco, (805) 962-7144
July 19-21 Forensic Dentistry 2001: A Symposium With Workshops, Chicago, (312) 440-2895
Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470
To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853, or fax the information to (916) 443-2943.
