Wednesday, June 7, 2017
Want to Raise Inspired Kids? A Navy SEAL Commander Says Teach Them These 10 Things
Thursday, May 25, 2017
Our Teeth Are Making Us Sick
The left side of Jacquelyn Garcia’s face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled.
Paradoxically, this could make her mouth worse off. Dentists say pulling a tooth can lead to a cascade of other problems: the teeth start shifting, the bone diminishes, the skin sags and the risk of gum disease increases. But Ms. Garcia didn’t have any choice. Her tooth had been rotting from the inside out for more than a year. She didn’t have dental insurance and didn’t want to pay the high fees until the pain had surged and she couldn’t stand it anymore.
As Americans debate medical coverage, the problem of our teeth has remained almost entirely unaddressed. About 114 million Americans don’t have insurance coverage for their teeth – more than twice the number of people who didn’t have health insurance before the Affordable Care Act.
“Oral health is a neglected issue nationally,” said Julia Paradise, an associate director of the program on Medicaid and the Uninsured at the Kaiser Family Foundation. “This is a big problem. The mouth and the head – mental health and dental health – somehow remain outside of what people think of as general health.”
Lots of people (including politicians) think of dental care as a luxury – pleasant, sure, but not vital. But that’s just not true, experts say. Gum disease can increase the risk of heart disease and diabetes, and among pregnant women it is correlated with lower birth weights for their babies.
“It’s a lot more than just having a pretty smile,” said Peter Polverini, a dean emeritus at the University of Michigan School of Dentistry. “It’s not uncommon that you wind up with people being hospitalized because they can’t afford care.” Emergency room visits for dental problems – when teeth are often too ruined to save — cost the U.S. health care system an estimated $1.6 billion a year.
It’s virtually an accident of history that dental care isn’t considered part of medical care. The medieval barber-surgeon used to attend to all the human ailments that required a knife: bloodletting, tooth extraction, shaving. In the 1840s in the United States, the heirs to the tradition wanted to become professionals; they didn’t want to keep wandering from town to town selling their services. They asked physicians at the Medical College at the University of Maryland if they would include dentistry in the medical coursework, but the physicians refused. Soon after the dentists opened a separate dental school nearby.
This “historic rebuff,” as some historians have called it, is the creation myth of modern dentistry. The central tension in the tale – the separation between doctors and dentists (and the health of the mouth and the health of the body) – continues to plague patients today.
Obamacare doesn’t require plans to include dental coverage for adults and Medicaid has no required adult dental benefits, so coverage varies widely state-by-state, and even year-to-year. In addition, more than 51 million people live in federally designated “dental professional shortage areas,” where there are simply not enough providers to cover the need, according to Mary Otto’s new book Teeth. In many places, Medicaid offers such skimpy reimbursements that dentists don’t want to participate.
Experts have long observed that people’s teeth both reflect and reinforce poverty.
“I’ve been a public health researcher for about 25 years. I’ve worked with a lot of different populations of people,” said Harold Pollack, a scholar of poverty at the University of Chicago. “One common element of every severely vulnerable population I’ve worked with is people always have bad teeth. And they have always borne a real stigma for that.”
In New York, non-profits, teaching schools, and clinics that receive federal money have popped up to fill the demand for care, but the result is a patchwork system.
At the N.Y.U. School of Dentistry, some patients suffer traumatic injuries, but others simply never had preventative care and have reached the point of emergency. Dr. Laurie Fleisher, the amiable director of urgent care, recalled seeing a sixteen-year-old girl who hadn’t been to the dentist in five years. She came to the clinic in terrible pain. Neither the mother nor her daughter had realized how bad the damage to the girl’s teeth was, and soon they were both crying.
“I have to turn away sometimes, walk out,” said Dr. Fleisher. “Because I cry.”
In attempts to cheaply stem tooth pain, patients sometimes make their problems worse. Dr. Fleisher said she regularly sees patients crush aspirin onto their gums, hoping to soothe their mouths; instead, it burns away the gum tissue.
At the Institute for Family Health clinic in Harlem, which receives federal funds to treat the uninsured, a couple described taking two buses and a train from Long Island to reach an affordable dentist.
Dentists at the Institute recently saw a 12-year-old girl with such swollen gums that they wrote a case study about her to teach other medical professionals. “Kate,” as they refer to her in the study, had dental troubles that were affecting nearly every aspect of her life. She weighed only 69 pounds, likely because she was drinking liquids to avoid chewing. She barely spoke and rarely participated in school; her mother said she was bullied.
In the South Bronx, Diana Cardona works as a dentist out of a giant blue truck, in a program run by the Children’s Health Fund and the Children’s Hospital at Montefiore. The program gets federal funds to serve poor communities.
“Can you fix this?” a woman once asked as she spat six crowns into her hand one by one.
Dr. Cardona sees patients who haven’t been to the dentist in decades, who tell her they don’t want to work in the front of the office, or talk to people, because they’re too humiliated by their teeth. They fear that rotting teeth will be seen as evidence of poverty, homelessness, or bad hygiene. (“My family’s distress over our teeth – what food might hurt or save them, whether having them pulled was a mistake – reveals the psychological hell of having poor teeth in a rich, capitalist country,” the essayist Sarah Smarsh wrote.)
Dentists and public health officials say ignorance and indifference are primary reasons dental care still isn’t included in general healthcare nationwide. Burton Edelstein, a professor at Columbia’s College of Dental Medicine, recounted a visit to lawmakers, seeking an adult dental benefit.
Lawmakers quickly rebuffed him, he recalled, saying in effect, “Dental doesn’t matter. Adults can take care of themselves.”
So the advocates tried again, pitching a dental benefit for disabled adults to the lawmakers. That didn’t work. Finally, they proposed something even more minimal: dental care for pregnant women. Lawmakers refused.
As Julia Paradise from Kaiser noted, “Unlike a lot of chronic disease where we’re still struggling with the science of how to prevent these diseases, we know how to do this in oral health. This is actually a problem we can solve.”
Justin Rader DDS
Monday, February 20, 2017
When it comes to diet trends, there are a few heavyweights that top the list, including the low-carb, low-fat, South Beach® and Atkins® diets. There are, however, a few others gaining speed, including vegan, slow-carb and Paleo. All of these diets have negatives and plusses, and generally speaking, most physicians advise patients to pursue a “balanced” approach appropriate to your physical makeup, habits and lifestyle. The open-ended question is: are these diets good or bad for your teeth? We’ve looked at a few others already, so let’s look at The Paleo Diet®.
What is The Paleo Diet?
The Paleo Diet takes its lead from the food consumption habits of humans who lived in the Paleolithic era – the period between about 2.5 million and 20,000 years ago. These hunter-gatherers, who lived during the period more commonly referred to as The Stone Age, lived on a diet of wild plants and animals. The Paleo Diet is modern man’s attempt to mimic that consumption pattern.
Meat, Fresh Fruit, and Veggies. What’s not to Like?
At first glance, Paleo’s recommendation to focus on lean meats, fish, fruit, and vegetables, seems like the perfect plan for healthy living. And, to a large degree, if you were to fill your refrigerator with these foods, your doctor would be pretty happy with your decision.
That said, because Paleo excludes dairy and grains, your doctor and your dentist might ask you to aim for a bit more balance once you’ve achieved any weight loss goals you might be chasing. Let’s see how the Paleo plan stacks up when it comes to your teeth.
Positive Oral Health Aspects of a Paleo Diet
- Fiber: We could all use more fiber, and with all the fruit and vegetables you’re going to be consuming, getting the 22-34 grams a day recommended for adults should be a breeze. Your teeth will love you for it as well, because fiber has somewhat of a detergent effect on your mouth, scrubbing away plaque and debris as you chew. This is one reason why celery is great for teeth – it’s like built-in floss!
- Potassium: Bones (like the ones that comprise your jaw and hold your teeth in place!) love potassium, and it’s a difficult nutrient to get unless you’re consuming a ton of bananas and V-8® juice. Muscles, too, thrive on potassium, so if you’re an athlete, or just someone who likes to remain active, you’ll likely notice the boost you’re getting from higher numbers of fruits and vegetables.
- Vitamin B-12: Thank your lean meats and fish for good numbers in this area. B Vitamins are essential for healthy gum tissue, and on a Paleo diet you’ll have no problem accumulating the recommended 2.4 micrograms a day.
- Vitamin C: We all know Vitamin C is good for us, and once again, it’s fruit to the rescue. Vitamin C is critical in the development of collagen and healthy gum tissue and has the added benefit of keeping you free from the ravages of scurvy. Not a bad deal.
- Low-Glycemic Carbs: Since you’ll be avoiding all sorts of refined sugars and starchy vegetables on The Paleo Diet, your teeth are going to get a break from the sticky sugars that are the primary cause of teeth decay. As we always say, what’s good for your waistline is often good for your teeth.
- Unprocessed Oils, Nuts and Seeds: Healthy fats from olive and sesame oils, avocados, nuts and seeds protect teeth by helping them re-mineralize. When it comes to nuts, though, binge eating is a real concern – don’t eat too many if you’re concerned about your fat intake.
- A Healthy Reliance on Water: The Paleo Diet shuns beverages that are bad for your teeth. Nut milks are okay when unsweetened, but water remains the beverage of choice for the majority of Paleos. Is water good for your teeth? You betcha. Swish it around and remove all that junk from your teeth, stimulate saliva flow, and keep that oral cavity properly hydrated!
Oral Health Concerns with the Paleo Diet
- Getting Energy from Sticky Fruit: Carbohydrates provide the fuel our bodies need to function, and the majority of us meet those needs with grains first, and vegetables second. However, since The Paleo Diet avoids grains, and consuming the larger volumes of vegetables necessary to get the same amount of energycan prove difficult for most adherents, many opt to get their carb boost from the natural sugars in fruit.
While this isn’t a terrible idea (fruitarians, for example, consume only fruit), many Paleo dieters rely on dried fruit – which give you energy in spades, but are bad for your teeth because they tend to stick. So, keep a toothbrush and floss handy if you find yourself overdoing it on dried fruit.
- Excessive Fruit Acid: Lots of fresh fruit means lots of fruit acid – and, that’s bad for tooth enamel. Choose less acidic versions as often as possible, and keep a bottle of water handy to rinse between portions. Also, be sure to wait at least 30 minutes after eating before brushing. Doing so earlier can drive the acids in your mouth deeper into your teeth. Not good!|
- Lack of Vitamin D, Magnesium, Calcium and Iron: While supplements can appear to solve just about any nutrient deficiency, any doctor or nutritionist will also tell you there’s nothing like getting your nutrition in its original package. Paleo fans will find they’re lacking in a few vitamins essential to healthy teeth and bones (not to mention an overall healthy body), and may wish to consider supplementation if on the diet long term. Please know that it can be harmful to over consume some nutrients, especially if you’re already taking a multi-vitamin, so do not supplement without consulting with your physician.
- No Dairy: No yogurt. No cheese. No milk. No exceptions. You’ll find many arguments for and against dairy out there, and for some populations with allergies, or intolerance, it’s something that has to be avoided no matter what. The trouble for Paleo dieters, though, is without a medical necessity preventing the consumption of dairy, avoiding this entire food group does lessen opportunities for teeth to repair themselves through the natural process of re-mineralization. And while meat does play a role in re-mineralizing, dairy is by far the bigger player.
Justin Rader DDS, Generations Dental
Monday, October 3, 2016
8 Secrets to a Successful Back-to-School Dental Checkup
Encourage Age-Appropriate Dental Habits at Home
Timing Is Everything
Make One Child a Model
A Hungry Child Is Not a Happy Patient
Leave Your Anxiety at the Door
Keep Cool If Your Child Won’t Cooperate
Take a Card (or Three) on Your Way Out
Tuesday, August 9, 2016
When they say “age is all in your head,” they’re probably right. But then, your teeth ARE in your head -- so you likely can’t escape having to pay a little more attention to them after the age of 50. Although some oral health concerns are seen as common as we age, if you adopt a proactive mindset and educate yourself, these concerns do not have to be common for you. Anticipating and recognizing changes in your mouth can help you be on top of your health in this area -- so let’s take a look at the main ones you have to watch out for.
- Dry Mouth: The most common oral health concern you’re likely to experience as you age is dry mouth. In the medical world, dry mouth goes by the name xerostomia, and can be brought on by a number of contributing factors, including the over-consumption of drying beverages like coffee and alcohol, as well as the frequent consumption of salty foods. Another big offender is the medication we take over a lifetime to treat various illness. And the list isn’t a short one – there are at least 400 medications that can contribute to xerostomia, including medications for high blood pressure and depression. Many of our Patients manage dry mouth with various methods to include increased saliva production by chewing gum, xylitol lozenges, or xylitol mints. Some prefer mouthrinses like Biotene for dry mouth. Others consume more water. I do like it when people can make more of their own saliva with dry mouth lozenges.
- Ill-fitting Dentures: First off, it’s important to note that the need for dentures is not a must as we age. Today, healthier living and better access to dental care has reduced the percentage of seniors wearing dentures to 27% from nearly 50% just a few decades ago. That said, should dentures be a part of your life, or that of a loved one, wearing properly-fitting dentures is critical.Sometimes, all that’s needed is a denture reline. Give us a call at 208-664-9225 to see if we can help. Dentures that cause pain or shift in the mouth tend to alter a person’s eating habits, which can lead to nutrition deficits if healthy, but hard-to-chew, foods are avoided. Ill-fitting dentures can also cause thrush.
- Physical Obstacles to Good Oral Care: As we age, we sometimes find ourselves having to contend with physical ailments that limit our desire to maintain good oral care. Arthritis, vision loss, or injuries are a few of the most common. To combat these concerns, using a floss pick to get between teeth can be helpful, and the regular use of oral rinses can assist in dislodging difficult-to-remove food debris, while adding to the overall health of one’s mouth and gum tissue. Here’s how to choose the best mouth rinse for your needs!
- Naturally Receding Gums: The old expression “long in the tooth” isn’t just a quaint idiom about how one accumulates wisdom with age – it also refers to how our teeth appear to “lengthen” as we age. In other words, it’s a fancy way of saying our gums are receding. While some degree of gum recession is indeed natural as we get up in years, this predisposes us to cavities along the root structure of the tooth where enamel doesn’t exist. So, as one ages, flossing, brushing and rinses are more important than ever.
- Gum Disease: Natural gum recession is one thing, and a part of “growing up,” if you will. Gum disease, however, is preventable. So, if it’s been longer than six months since you’ve seen us, please do give us a call at 208-664-9225. Each of the above items in this list can contribute to gum disease, and good oral care can prevent it. Failing to do so can lead to a need for dentures at its most extreme, and pain and swollen gums at its least. We’d prefer you experience neither concern!
- Tooth Loss: If a tooth is lost due to trauma or decay, and not replaced with an implant or other prosthetic, it can have serious complications for the health of the jawbone. Teeth can shift out of place and fall out, and bone tissue can be resorbed back into the body. Not a good thing.
- Loss of Insurance Coverage: Retirees without dental coverage can sometimes cover the expense of dental care on their own; sometimes they cannot. But a lack of funds to take care of one’s teeth can be devastating to the health of our mouths, and our overall health. So we need to plan for two things: a care routine that allows us to take care of our teeth as much as humanly possible and some sort of financial backup plan for when problems do arise. So, please do check with our in-office dental plans and multiple payment plans to aid it times when outside dental coverage is low to none. 208-664-9225. GenerationsDentalCDA.com
Tuesday, April 5, 2016
Saving Space for Permanent Teeth with a Space Maintainer
If your little one's teeth have begun to fall out, and their permanent replacements appear to be lagging far behind, you may wish to consider a space maintainer to minimize future orthodontic work. Believe it or not, the absence of your child's teeth might seem cute now, but those tiny little gaps can cause deep gouges in your pocketbook as you watch them fill up with teeth that don't belong there. Space maintainers are simple to use, kids get along fine with them, and they have become the de-facto standard for protecting the cosmetic and functional aspects of your growing child's mouth.
Why Your Child Might Need a Space Maintainer
When a child's tooth is lost early due to trauma, tooth decay, or nature's insistence that it drop out before its permanent replacement is due, a space maintainer can be used to hold back the natural inclination of teeth to move forward. Without preventing this movement, teeth that should be in the rear of our mouths end up along the sides, and take up precious real estate destined for another tenant. The result is overcrowding, and in some cases impacted teeth. In the end, it's always easier to save the space now, then create it later.
How They Work
Space maintainers are very similar in purpose and design to an adult "bridge," but instead of placing artificial teeth over the gap, the space is kept open to accommodate its future resident. At Generations Dental we make most space maintainers out of metal, (sometimes both metal and plastic), and custom-mold them to the shape of your child's mouth. In most cases, the maintainer is made up of a metal band attached to a rectangular-shaped wire that butts up against the tooth across the gap. This acts to temporarily preserve the space where the baby tooth once was, so its replacement can erupt without obstruction. To some, the final product looks like an old Radio Flyer® snow sled, or a shoe horn you might use to maintain the shape of unworn shoes.
Does My Child Need One?
It's important to note that dental space maintainers are not required for all childhood tooth loss, and that we’re not going to suggest you create a decade worth of space maintainers as each tooth falls out of your child's mouth. Our bodies are quite effective at saving space for the loss of our front teeth as well as our incisors - it's the teeth along the sides of our mouths that tend to cause the majority of complications. Of course, each mouth is different, so be sure to discuss with us the best course of action for you and your child. If your child has recently lost a tooth, or several teeth, and it’ll be awhile before they’re scheduled to see Dr. Rader, give us a call at (208) 664-9225 to see if you should come in a little earlier.
Using a space maintainer is an affordable and effective way to ensure your child's teeth come in where they are supposed to, and when they're ready. It can have a positive effect on your wallet, reduce the amount of time your child needs to wear braces, and control the cosmetic appearance of your child's teeth and mouth.