Should dentists screen for diabetes?

A new study suggests that dentists can accurately screen patients for diabetes and prediabetes using results from two measures they already routinely assess in the clinic. Even so, whether most dental offices will add this to daily clinical practice remains a question mark.

                                           *hcg411.info

Columbia University investigators studied new patients who presented for dental care at the Columbia University College of Dental Medicine Triage Clinic between April 2009 and March 2010. They included in their study people who had not previously been told they had prediabetes or diabetes and who were non-Hispanic white individuals older than 40 years of age or Hispanic or nonwhite individuals older than 30 years of age.

Study subjects also self-reported at least one of the following risk factors: family history of diabetes, hypertension, high cholesterol, overweight/obesity, and continuing to receive a periodontal examination and a point-of-care HbA1C test.

A total of 535 patients received a periodontal examination and a point-of care HbA1C test. HbA1c testing was done with a fingerstick blood sample and a benchtop analyzer. Following an overnight fast, 506 patients also returned for a second appointment for a fasting plasma glucose test to identify potential prediabetes (100-125 mg/dL) or diabetes (0.126 mg/dL).

The team identified 182 individuals as having abnormal fasting plasma glucose. Of these, 21 (4.2%) were potentially diabetic and 161 (31.8%) were potentially prediabetic. The average age among people with abnormal fasting plasma glucose was significantly higher than among the other patients, at 51.4 versus 55.6 years (p 0.01).

Furthermore, the number of missing teeth and percent of deep pockets were both significantly higher in the abnormal fasting plasma glucose group. The prevalence of self-reported hypertension, hypercholesterolemia, and being overweight was also significantly higher in the abnormal fasting plasma glucose group.

Using statistical analyses, the investigators determined that the optimal cut-off for identifying diabetes or prediabetes is the presence of at least 26% of deep pockets or at least four missing teeth. They found that, together, these two measures could correctly identify 73% of true cases with previously unrecognized hyperglycemia. The addition of a point-of-care HbA1c of 5.7% increased correct identification to 92%.

"This should be part of what we do; we're treating the whole patient so we should care about their overall health," said lead author Evie Lalla, DDS, of the Columbia University College of Dental Medicine. "The main goal of the study was to make this screening procedure as simple as possible and as quick as possible so we don't interfere a lot with the everyday doings. This is nothing outside of what we do every day -- except the HbA1c, which is optional -- it's just putting the pieces of the puzzle together. Our findings provide a simple approach that can be easily used in all dental-care settings."

However, it is unclear how many dentists will actually add diabetes screening to their daily practice, even with the simplified technique described by Dr. Lalla and her colleagues. Marc Whitmore, DDS, who heads Whitmore DDS in Plano, TX, said that while he agrees the suggested screening procedure is easy and that screening is important, it is unlikely most dental offices will do it.

"In fact, much like comprehensive oral cancer screening, it is unfortunately a niche service," he told DrBicuspid.com. "Some dentists and dental personnel are actively educating patients about their overall systemic health and the implications of the oral health markers. But is this level of concern common in our profession? Sadly, no."

Nonetheless, Dr. Lalla believes in having "more dentists embrace the idea and become more willing to do this."

Article from: dentist.net

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The Top 7 Reasons We Avoid the Dentist

                                                       *fitsugar.com

Many people dread the dentist, even though dental visits are the No. 1 key to dental health. Once you understand the reasons for all those skipped appointments, you can start to overcome your dental anxiety.

Has a painful past experience given you a fear of the dentist? Do you fear getting bad news about your dental health? Whatever the reason, you’re not alone — many Americans are simply skipping visits to the dentist. Overall, about 65 percent of us go to the dentist, but in some states, that number is much lower, even as low as 51.9 percent in Mississippi.

This is more than unfortunate — it can be downright dangerous, because regular dental visits are a key component of overall dental health. “We use our teeth multiple times a day, every day,” says Jennifer K. Shin, DDS, a dentist in private practice in New York City. “They take on a lot of abuse, so coming in twice a year gives us an opportunity to assess any changes that can be easily addressed. If problems are caught early, the solutions are easy, quick, and inexpensive. But a cavity left undiagnosed can lead to a toothache, requiring much more extensive and costly treatments.”

Why We Fear the Dentist

Why are people avoiding dental visits? The answer includes a wide range of reasons:

Cost. High prices are the major factor preventing many people from getting regular dental checkups. A recent survey found that 44 percent of people were not visiting the dentist because they don’t have dental insurance. “The truth is that if you take good care of your teeth and mouth, yearly dental visits won’t cost a ton of money,” says John Dodes, DDS, a dentist in Forest Hills, N.Y., and author of Healthy Teeth: A User’s Guide. “Easy additions to your routine, like flossing and rinsing with a therapeutic mouthwash like Listerine, can help get and keep your mouth healthy.”

Dental anxiety. Many people simply are afraid of the dentist’s office, but David S. Keen, DDS, a dentist in private practice in Beverly Hills, Calif., says there are a number of things you can do to minimize this. An effective way to make the experience positive is to speak with your dentist about your fears, and consider listening to pleasant music to promote an environment that is positive and soothing, more like a spa, he says. “Communication is usually the best way to develop a positive dental experience.”

Fear of needing dental work. “I’ve found in my 40 years of practice that very few patients are afraid of the actual cleaning, but rather they don’t want to hear any bad news about their teeth or any dental problems they’ve acquired,” says Dr. Dodes. “Avoidance and denial are strong human emotions, which can play a role in why people don’t visit the dentist as often as they should.”

Fear of instruments. The reason people fear that bad news, Dodes adds, is that treatment might be a painful or frightening procedure involving a scary dental instrument. Luckily, this is rarely the case today. “There have been so many new advances in dental care, including laser dentistry, which usually requires no Novocain,” says Jeffrey Gross, DDS, a dentist in the Cleveland area. “Also, the drills used today are so advanced that there is little noise or discomfort.”

Bad memories. Even the most advanced dental techniques can’t erase bad memories from dental visits of years past. “Many people fear the dentist because when they were children, they were told to not be afraid,” says Dr. Gross. “This actually instilled fear that has lasted many years. Dental visits today are very different, with many dentists offering music, TVs, and new high-tech procedures that can help erase old memories.”

Just too busy (or lazy). Sometimes, people have too much going on in their lives or just don’t want to make the effort to go to the dentist. “We are all creatures of habit,” says Gross. “If we don’t build it into our routine, it becomes one of those things that we have to ‘get around to doing.’ Once we skip a visit or more, it is out of our routine. This is why progressive dental offices work so hard on reminding people and setting up their visits. These programs are specifically designed to combat these issues.”

Fear of getting lectured. Nobody likes to be lectured about their dental health. And if you've been neglecting your brushing and flossing for some time, then you might fear that a lecture is coming. “In my office, I recognize this fact, and ‘lecturing’ or reprimanding is the last thing on my mind,” says Gross. “These types of comments are counterproductive — the patient’s discomfort, which brought them into the office, is reprimand enough. But the fear of a lecture is a pervasive thought on the minds of many patients. Many times this is due to guilt as they know better, and they simply don’t want to hear any more about it.”

The best way to address your personal reasons for avoiding dental visits is to voice them to your dentist. Give him or her the opportunity to reassure you and get you back on course for good dental health.

Article from: everydayhealth.com

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Recognizing and Treating Oral Thrush

Oral thrush, also known oral candidiasis, is a condition that occurs when a fungus called Candida albicans builds up on the lining of your mouth.

Anyone can develop oral thrush, but babies, young children, older adults, or anyone with a compromised immune system due to an illness such as HIV are more susceptible. Conversely, candidiasis lesions can be an early sign of an HIV infection.

                                                     *sorbonnedental.com

The main symptom of oral thrush is creamy white lesions in the mouth, usually on the tongue or inner cheeks. In some cases, the lesions may appear on the roof of the mouth or on the back of the throat.

Interestingly, oral thrush is not caused by poor oral hygiene. Thrush is caused when the naturally occurring fungi in the body get out of balance, which is why the very old, very young, and people with weak immune systems are at higher risk. Good oral hygiene, however, is an essential part of treating oral thrush. Healthy adults and children can recover fairly easily from the infection, especially if they follow a complete oral care routine of twice-daily tooth brushing and daily proper flossing.

If you have thrush, here are a few things to keep in mind:

• Change your toothbrush more often. Replace your toothbrush more frequently than the standard recommendation of every three months. Once the thrush infection clears, you can use your toothbrush for as long as three months or until it appears worn.
• Choose any floss. As long as you follow proper flossing technique, any type of floss or dental tape can be used as part of your oral care routine if you have thrush. If your mouth is tender, try Oral-B’s Satin Floss, which will help remove plaque and promote a healthy mouth without irritating your gums. An electric flosser is fine, too.

Thrush is common in infants and toddlers because their immune systems are not fully developed. If you notice white lesions in the mouth of your infant or toddler, see your doctor or dentist, but healthy toddlers may need no real treatment other than proper oral hygiene. Also, healthy children and adults can add unsweetened yogurt with acidophilus to some meals and snacks. Acidophilus is a healthy bacteria that can help treat the thrush infection by helping to restore a healthy balance of bacteria in your body. Your doctor or dentist also may prescribe a short-term antifungal medication to help fight the infection.

For breastfeeding mothers, your doctor may recommend an antifungal cream to apply to your nipples to help resolve the infection in your infant. Breastfeeding mothers should be alert to signs of thrush during a healthy newborn’s first two weeks—that is when the infection is quite common. An infant with thrush may be especially fussy and resistant to feeding, and parents should be sure to check a newborn’s mouth for signs of lesions.

In addition, a baby with thrush can transmit the infection back to the mother. New mothers should be alert to these signs:

• Pain in the breast or nipples during nursing.
• Stabbing pain deep in the breast at non-nursing times.
• Especially red or sensitive nipples.
• Flaky skin surrounding the nipples.

Most doctors or dentists can diagnose thrush by looking at the lesions, but if you or your doctor or dentist suspects that an underlying medical problem may be associated with thrush, it’s important to have a physical exam and blood tests to pin down the problem.

Also, if you’re recovering from oral thrush, try to limit your intake of yeast breads, beer, and wine, because the yeast in these products may promote the growth of candida organisms.

Article from: OralB.com

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Vitamin D May Prevent Tooth Decay

                                                               *lakeforestdentalarts.co

The sunshine vitamin's potential role in preventing tooth decay is the latest on its long list of health benefits.

Vitamin D might help prevent tooth decay, a new review of existing studies published in the journal Nutrition Reviews found.

The review includes data from 3,000 children enrolled in 24 clinical trials published from the 1920s to the 1980s. Overall, the trials showed that vitamin D supplementation led to a 50 percent drop in the incidence of tooth decay, perhaps because vitamin D helps the body absorb the tooth-building calcium it needs.
In the trials, the vitamin was delivered either via supplemental UV radiation or by diet products, such as cod liver oil, which contain it.

Philippe Hujoel, PhD, DDS, of the University of Washington, conducted the trial, saying his main goal was to summarize the existing research, so dental professionals could "take a fresh look at this vitamin D question."
But Hujoel's results come as no surprise to researchers who have also studied vitamin D and dental health. "The findings from the University of Washington reaffirm the importance of vitamin D for dental health," Michael Holick, PhD, MD, professor of medicine at the Boston University Medical Center told Science Daily. He went on to say that children who are vitamin D deficient experience late teething and a risk of tooth decay.

Dental caries, or decay, among children are increasing while vitamin D levels among many populations have dropped, Hujoel said in the study. "Whether this is more than just a coincidence is open to debate," he said. "In the meantime, pregnant women or young mothers can do little harm by realizing that vitamin D is essential to their offspring's health," also noting that systematic reviews do have some flaws based on possible biases in some of the clinical trials that damaged the results. 

In recent years, vitamin D has gained a reputation as sort of a vitamin cure-all. Most recently, women with the highest levels of vitamin D were shown to have the lowest risk of developing Alzheimer's disease by researchers at the VA Medical Center in Minneapolis. A second separate study found that low vitamin D levels results in a greater Alzheimer's risk, even when isolating for other lifestyle and health factors such as body-mass index, diet, and cognitive performance. Other strong links have been identified between low levels of vitamin D and cancer and low levels of vitamin D and heart disease.

Article from: everydayhealth.com

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Dentists Could Soon Diagnose Cancer By Looking At Your Saliva

New tools that extract disease biomarkers from saliva could make your dentist your first line of diagnostic defense. 

                                                                                    *popsci.com

Your dentist could soon be your new doctor. Don’t cancel your annual physical just yet, but promising research coming out of UCLA’s School of Dentistry suggests that salivary diagnostics--or “salivaomics”--could become a potent resource for early detection of a broad range of potential health problems like autoimmune diseases, diabetes and even life-threatening conditions like cancer.

In a paper published in the Journal of the American Dental Association, UCLA researcher Dr. David Wong describes his research into the biological makeup of saliva and the various indicators of health that live there. Human saliva is made up of molecules, after all, and in those complex molecules doctors or dentists looking for the right things can find everything from proteins to DNA to RNA--or basically the entire genome and a slew of other supporting characters. With these molecules identified and isolated researchers can then apply any number of scientific tools to them--things like gemomics, proteomics, and transcriptomics (putting the “omics” in “salivaomics”).

Salivary diagnostics itself is a relatively young field, but diagnosis through biomarkers is not and that’s essentially what this is. The difference, of course, is that it is extremely non-invasive, requiring nothing more than a saliva sample. Wong and associates think saliva could be just as meaningful as blood and other bodily fluids in diagnosing a range of conditions and disorders.

The authors note that 20 percent more Americans see their dentists more often than their doctors, so salivaomics deployed in the dentist's office could become an effective tool for early detection of any number of common ailments--without the patient ever stepping foot in the doctor's exam room. That means your dentist could soon become the first line of diagnostic defense against conditions affecting not just your oral health but your entire body.

Article from: popsci.com

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Crown Lengthening for a Better Smile

If you’re bothered by a “gummy” smile or teeth that you feel are too small, you may want to consider crown lengthening. Also known as a gum lift, this cosmetic dentistry procedure can beautify your smile by exposing more of your teeth.

“Crown lengthening has been used by dentists for years to improve dental health, but it’s recently been gaining popularity as a cosmetic dentistry technique,” says Kimberly Harms, DDS, a dentist in Farmington, Minn., and consumer advisor for the American Dental Association.

 What Is Crown Lengthening? 
 
Crown lengthening is an oral surgery treatment that involves removing excess gum tissue, and possibly some bone, around the upper teeth to make them look longer. It’s a common procedure performed by dentists and periodontists, or gum specialists.

“If the gum line is uneven, crown lengthening can also sculpt the gum line to produce a more symmetrical smile,” says Dr. Harms. Crown lengthening may be done for dental care and medical reasons as well as for the cosmetic effect. If there’s decay or fracture under the gum line, for example, crown lengthening can help expose more of the tooth’s crown in order to support a filling or porcelain crown.

                                                     *scottmhealeydentistry.com

What Does Crown Lengthening Involve? 
 
Crown lengthening involves oral surgery performed under local anesthesia. After the area is numbed, the dentist or periodontist makes small cuts to pull the gums away from the teeth and remove excess gum. In some cases, removing gum tissue is all that is needed to expose more of the crown. But if there is too much soft tissue and bone covering the crown, a tiny bit of bone may need to be taken out, too. After the surgery is completed, the gums are washed with sterile salt water and stitched up.

Pros and Cons of Crown Lengthening
 
Although crown lengthening is a common and safe procedure, it does involve surgery, which always has risks. So it’s important to weigh the pros and cons before going under the knife.

Advantages of crown lengthening: Unlike many cosmetic dentistry treatments, crown lengthening only needs to be done once, with no requirement for touch-ups down the road. In addition to creating a wider, more symmetrical smile, crown lengthening can provide some dental care benefits as well. “It can reduce the risk of tooth decay because more of the tooth is exposed for brushing and flossing,” says Harms. The surgery can usually be completed in 30 minutes to an hour.

Disadvantages of crown lengthening: This cosmetic dentistry treatment can be pricey. Expect to pay $1,000 to $4,000 for crown lengthening. If the procedure is medically warranted, insurance should pick up some of cost, says Harms. As with other types of cosmetic surgery, you may experience swelling and pain afterwards. Recovery can take a few days to a few weeks, depending on how extensive the surgery is. Possible complications include excessive bleeding and infection, but these are rare.

Recovery From a Crown Lengthening Procedure
 
Following surgery, you’ll be given a prescription for a pain reliever and instructed to use ice to reduce any swelling. You’ll want to eat a diet of fairly soft foods and brush your teeth carefully in the area near the stitches, which will come out in 7 to 10 days.
Complete healing of the gums can take up to three months, however. At that point, you may opt to have veneers or another cosmetic dentistry procedure done, such as bonding or tooth whitening.

Is Crown Lengthening Right For You? 
 
If you’ve always been bothered by a smile that shows too much gum, crown lengthening may be worth the cost and the short-term discomfort. But, for people who have wide teeth, crown lengthening could backfire. “You could end up with teeth that look too big,” says Harms. (Some dental practices offer computer imaging, which will show you what the final result will look like.) On the other hand, if you are especially susceptible to tooth decay, crown lengthening can make it easier for you to take proper care of your teeth and perhaps decrease your risk of decay.

If you have excessive or uneven gums, crown lengthening can transform your smile and give you just the right look — and as an added bonus, it may just improve your overall dental health as well.

Article from: everydayhealth.com

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Finding the Right Dentist

                                                                                       *oralb.com

Finding the right dentist for you and your family involves a combination of factors. But it all comes down to the four C’s: Competence, convenience, compatibility and cost.

First and foremost, you need your dentist to be competent, which means that he or she maintains a high level of professionalism and knows the latest treatments and developments in the dental field. To ensure competent dental care, look for a dentist who is a member of the Academy of General Dentistry. Dentists who are members of the AGD must meet requirements for continuing education and are pledged to uphold the highest standards of ethics and patient care.

A dentist may have a degree that says DMD (Doctor of Dental Medicine) or DDS (Doctor of Dental Surgery). These degrees apply to general dentists and represent the same training programs, but different dental schools use different terms.

Convenience is another important factor in finding a dentist. You’ll be much more likely to keep appointments if you choose a dentist whose office is convenient to your home or workplace. Also, look for a dentist whose office hours fit with your schedule. Do you need evening or weekend appointments? Do you have children who could see a dentist after school? These are the type of questions to consider.

Also, a convenient dentist is one who participates with your dental insurance plan. Most dentists in the United States participate with the large dental plans offered by most employers, but you won’t know until you ask. If you have insurance, your insurance company can provide a list of dentists who participate with your plan.  Take that list and ask your friends, family, neighbors and co-workers for recommendations. 

Next, consider compatibility. For example, some dentists are specialists in treating patients who are fearful of dental procedures, whether it’s filling a cavity or performing a root canal. So if you tend to be a nervous dental patient, ask your friends and colleagues to recommend a dentist that they like because he or she puts patients at ease. And ask a potential dentist whether he or she offers sedation dentistry, which involves treating you with a sedative via a pill, inhaled gas, or intravenous drug therapy prior to a dental procedure to help you relax.

If you have children, you may want to look for a dentist who has extra training in pediatric dentistry, although most general dentists manage a family practice and are expert at treat patients of all ages. Of course, some dentists are more comfortable and better at working with children than others. It may be worth asking other parents to help you find a child-friendly dentist, because positive experiences with dental care in early childhood can help encourage children to develop and follow consistent oral health care routines as they grow up.

Trust your instincts: Is the office clean and neat? Are your records in order when you arrive? Is there a plan in place for after-hours dental emergencies? Find a dentist who makes you feel comfortable about asking questions, and who explains treatments and procedures so you can understand them.
Finally, consider cost. Some people are very loyal to a dentist they like and will stick with him or her regardless of what their insurance does or doesn’t cover. Others give more weight to cost.

Many insurance plans cover 100 percent of the cost of at least one basic dental checkup and professional cleaning per year, and many plans cover two checkups per year. So it’s always worth the effort to find a quality dentist who participates in your insurance plan. If you need a dental procedure that your insurance plan doesn’t cover, contact the American Dental Association to find out about dental clinics operated by dental schools in your area. These school-based clinics are operated by the schools and supervised by licensed dentists. They often offer advanced procedures as well as basic dental care, often at a reduced cost.

If you have no dental insurance, you may be able to set aside money in a Flexible Spending Account through your employer to help cover a dental procedure, such as orthodontia, that you’re planning in advance.

Another option to consider is the Bureau of Primary Health Care, which is part of the Health Resources and Services Administration, funds community health centers that often provide dental care (as well as medical care) at reduced cost. For more details about finding a dentist through this program, contact HRSA by calling  1-888-ASK-HRSA or by visiting ask.hrsa.gov/pc.

Article from: Oral B

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