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