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PREVENTION FIGHTING PLAQUE TOOTH BY TOOTH
GUM DISEASE LOOK OUT FOR SNEAKY SYMPTOMS
EXERCISE: KEEP ON STEPPINâ€™ FACT OR FICTION? HEALTHY RECIPE
Oral health A GLIMPSE INTO YOUR GENERAL HEALTH
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Be Healthy is published by Banner Publications, Inc. 1100 Washington St., Dorchester, MA 02124 Volume 6 • Number 1 Fall 2018 © 2018 Banner Publications Be Healthy is printed by TC Transcontinental Printing, 1603 Boul. Montarville, Boucherville, Québec, J4B 5Y2 Printed in Canada COVER PHOTO: THINKSTOCKPHOTOS.COM/ BIG CHEESE PHOTO
Editor’s note: The information presented in Be Healthy is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate for your age, sex, race and risk factors and make timely visits to your primary care physician.
Oral health Summer 2018
Types of dentists
There’s a dental professional for every type of issue.
Berry yogurt popsicles
Prevention Pediatric oral health Gum disease Patient story Fact or Fiction?
10 12 14 16 17
Nutrition Exercise Recipe
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The issue: Oral health
Plaque: The invisible enemy of teeth The constant battle with bacteria WE COME INTO THE WORLD WITHOUT TEETH. TOO OFTEN WE EXIT IN THE SAME CONDITION. That’s an odd outcome, given that enamel, the white part of the tooth, is the hardest substance in the body. Human teeth are actually as hard as sharks’ teeth, a group of scientists from Germany discovered. Sharks have advantages over us, though. Rows of sharks’ teeth are replaced throughout life, while loss of a permanent human tooth requires a prosthesis in the form of a bridge, crown, implant or dentures. If our teeth are so strong, why then are 19 percent of the population 65 years old and older completely edentulous, or toothless? Sharks again provide part of the answer. They don’t get cavities — and with good reason. Sharks don’t eat sugar, but we do, and apparently, plenty of it. Added sugar, such as table sugar, honey and high fructose corn syrup, are the major culprits here, but all sugars and starches play a role. The World Health Organization recommends no more than 25 grams of added sugar a day, which amounts to 20 pounds a year. Yet, the average American consumes 82 grams a day, or 66 pounds a year. 4 Be Healthy | Summer 2018
Plaque — step one to cavities The teeth are covered by plaque, a soft, invisible sticky film teeming with bacteria — some good, some bad. Plaque is always in the mouth even after you brush. That’s because bacteria are hardy creatures and multiply very rapidly. The problem begins when you start to eat. When you eat sugars or any carbohydrate or starch, like rice and bread, the bad bacteria start eating too. They feed off sugars, and that combination of sugar and bacteria is not a good thing. It produces an acid which starts the destructive process of tooth decay called caries or cavities. The problem is that plaque will not remain soft and sticky. If not brushed away after a period of time, it turns into a hard yellowish substance called tartar, which can be removed only by a dentist or dental hygienist. Dental caries is very common in this country. Approximately 91 percent of U.S. adults aged 20 to 64 had dental caries in permanent teeth, according to a 2015 data brief by the National Center for Health Statistics. Apparently, this process starts
at an early stage. More than 43 percent of youth between the ages of two and 19 had both treated and untreated cavities in primary or permanent teeth. Minorities are hardest hit. Blacks, Hispanics and Native Americans have the poorest oral health of any racial and ethnic groups in the United States. In addition, less educated adults experience untreated tooth decay nearly three times that of adults with at least some college education.
Gum disease Plaque is not confined to the teeth. It can also initiate an infection of your gum tissue and bone surrounding your teeth. The initial stage of gum disease is called gingivitis, which is characterized by redness and bleeding gums particularly when brushing or flossing. With good oral care, this stage is reversible. It can, however, progress to periodontitis, which can result in permanent tooth loss. What’s worse is that the inflammation can have an impact on chronic diseases, such as diabetes and heart disease. “The mouth is part of the body,” said Dr. Susana Tejada, a dentist at The Dimock Center. “Bacteria that affect the mouth can travel
The issue: Oral health Susana Tejada, D.M.D., a general dentist at The Dimock Center, explains the importance of good oral health care to a patient.
PHOTO: RACHEL KORKODILOS
to the rest of the body. It’s all connected.” Research has found that plaque builds up in people with diabetes that is poorly controlled. “People with diabetes are three to four times more likely to have gum disease,” she explained. The reverse is also true. Gum inflammation makes it harder to control diabetes. It’s not just diabetes that’s affected by poor oral health. The heart may suffer as well. Some studies suggest that clogged arteries that contribute to heart disease and stroke may have a connection to gum inflammation, according to the Mayo Clinic. Women with periodontitis have a higher risk of premature birth and low birth weight.
AT A GLANCE: TYPES OF DENTISTS General dentist: General dentists are your primary dental providers who manage your overall dental health. They provide cleanings and x-rays, diagnose dental conditions and perform several dental procedures, including fillings and extractions. At times, however, a specialist is required. n Endodontist: Specializes in root canals n Oral surgeon: Performs complex extractions and surgeries on the mouth and jaw n Orthodontist: Develops braces or other devices to straighten teeth n Pedodontist or pediatric dentist: Specializes in dental care for children n Periodontist: Specializes in the prevention, diagnosis and treatment of diseases that affect the gums, such as gingivitis and periodontitis n Prosthodontist: Responsible for replacement of missing teeth and the repair of a person’s natural teeth by means of bridges, crowns, implants and dentures
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The issue: Oral health
SHARING OF RESPONSIBILITY
THE TEETH FUNCTION IN CONCERT By the age of 21, most people have 32 permanent teeth, including four wisdom teeth. Although they act in unison to help us talk and chew, there are four different types of teeth that are distinguished by shape and role.
Premolars UPPER JAW Molars
PREMOLARS The eight premolars that sit behind the canines have a flat biting surface. They help crush and grind food.
INCISORS The eight incisors in the front of the mouth are used for biting and cutting food. They also help in proper pronunciation of certain words. MOLARS The twelve molars are the largest teeth with a large, flat biting surface. Like the premolars, they crush and grind food. CANINES The four canines are pointed teeth situated beside the incisors on both the top and bottom teeth. They have a sharp biting surface and are used to grip and tear food.
ALL TOGETHER NOW To eat an apple, you take a bite with the incisors, but the four canines assist. The premolars and molars then take over to grind the apple into a digestible state.
Dry mouth Saliva — known more familiarly as spit — does not have the best reputation. Your mother taught you not to spit. Several states — including Massachusetts — have laws on the books forbidding residents to spit on a public sidewalk. In the Commonwealth, that antiquated law carries a whopping $20 fine. These laws and your mother’s admonition give the impression that there’s something sinister about spit. Yet, saliva is nourishing to the mouth. 6 Be Healthy | Summer 2018
“It washes away food particles and moistens the mouth,” explained Tejada. “It prevents tooth decay by neutralizing the acids produced by bacteria.” Low production of saliva results in a condition known as dry mouth. Patients complain that it feels like “cotton balls in the mouth,” or “everything seems to stick.” Dry mouth is often a side effect of certain medications, such as those to treat depression, high blood pressure, anxiety and pain. Even over-the-counter drugs, including antihistamines and
decongestants can cause the condition. It is more common in older people, but more probably a factor of increased use of medication than passing years. Therapy for head and neck cancers, tobacco, alcohol and marijuana use are other possible causes. Dry mouth is more than just annoying. A more serious complication is its link to increased plaque and tooth decay. There’s no moisture to wash away the food, and therefore no protection of the teeth from acid formation. Roughly 30 percent of all
ILLUSTRATION: CALEB OLSON
The issue: Oral health tooth decay in older adults is caused by dry mouth, according to the Oral Cancer Foundation. Over-the-counter remedies such as mouth sprays and sugar-free gum, are available to reduce the symptoms. Tejada offers an easier and free solution. “Drink a lot of water” she advised. “Sip it frequently throughout the day.”
PHOTO: DAVIDE GUGLIELMO
Yet, tooth decay and gum disease are largely preventable. You need a toothbrush, floss and fluoride toothpaste … and you have to use them. It’s easy on the budget. All together that can set you back roughly $10 every three months. Check-ups with the dentist can help spot a problem before it balloons into a more serious condition. In spite of this relatively low cost athome treatment, cavities remain one of the most common chronic diseases in the U.S. More than 70 percent of the residents in Massachusetts receive fluoridated water. Studies have shown that people who drink fluoridated water have a lower incidence of tooth decay. Fluoride replaces minerals in the teeth that are lost due to acid formation by bacteria. We can drink the water, but it is necessary to do more than just imbibe and brush. Other habits do their fair share of damage. Smoking decreases the production of saliva, which leads to dry mouth, and in turn the risk of gum disease. But it’s the diet that causes the most problems, and two of the biggest offenders are soda and coffee. Roughly half of the U.S population drinks an average of three glasses of soda every day. In addition, the average coffee drinker sips two to three cups a day, but coffee is very acidic. That means we are constantly coating our teeth with both sugar and acid, an ill-fated duo. By age 21 we have 32 teeth. At 81 we should still have 32 teeth. Tooth loss is not inevitable with age, warned Tejada. “They do not have to go hand in hand.”
HAVE A DRINK WATER: THE BEST BEVERAGE FOR YOUR MOUTH In a way, water multi-tasks. It curbs our thirst, rids the body of waste and keeps the skin refreshed. It is also the best beverage for the mouth. Some foods “demineralize” or weaken the teeth, but drinking fluoridated water strengthens the teeth and helps fight tooth decay. Fluoride is called “nature’s cavity fighter.” Water also keeps the mouth clean. Many other drinks, such as soda, sports drinks, and even 100 percent juice, contain sugar, which can eventually lead to acid formation and tooth destruction. Water, on the other hand, washes away leftover food and residue and dilutes acids produced by bacteria. Low production of saliva can lead to dry mouth and an increased risk of caries. Drinking water keeps the mouth moist. What’s even better is that it does all this work without adding one calorie to your diet.
MORE THAN JUST YOUR PEARLY WHITES Your teeth multitask. They work as a team with saliva and the tongue as the first stop in the 30foot digestive system. The teeth allow you to take a bite of a food and then grind it to a digestible form. The saliva moistens the food and helps break it down further. The tongue then guides the food to the second stage of the digestive tract. Teeth help you talk. The vowels are pretty simple, but some consonants get garbled without their help. For instance, try pronouncing “F.” That sound is made by the juxtaposition of the upper teeth and lower lip. The letter “V” is formed similarly. To make the “TH” sound your tongue comes in contact with the upper row of your teeth. And of course the teeth give your face structure and most important a beautiful smile.
RISK FACTORS Inadequate brushing is the most common cause for caries, or cavities, but other factors make it difficult to maintain perfect oral health. n Tooth location: Premolars and molars have grooves and pits that are magnets for food particles. They are also harder to reach to brush. n Inadequate fluoride: Bottled water has surpassed carbonated soft drinks as the most popular beverage consumed in the United States. Most bottled water, however, does not contain fluoride. n Alcohol and cigarettes: Excessive use, particularly of both, is a leading cause of oral cancer. n HPV: HPV is more associated with
cervical cancer, but it is an increasingly frequent indicator of oral cancers. n Older age: Certain medications reduce saliva flow and can cause dry mouth, which increases the risk of cavities. n Heartburn: GERD or heartburn can cause stomach acid to flow into the mouth, which can wear away tooth enamel. n Morning sickness: Acid from the stomach can contribute to tooth erosion. Instead of brushing immediately, it is recommended to swish with baking soda and water to neutralize the acid.
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By the numbers: Oral health
17.1% Prevalence of untreated cavities in black youth, aged 2-19
Tooth decay is four times more common than asthma in adolescents, aged 14-17
Percentage of adults in the U.S. with treated or untreated tooth decay
School absenteeism is three times more common in children with dental pain
We’re here for you For adults and children of any age, in Greater Boston and beyond, Dimock's integrated continuum of healthcare and services are here for you every step of the way. Call us today to make an appointment at 617-442-8800 or visit us at www.dimock.org
Spending for dental services in 2016
80% Dental sealants prevent 80 percent of cavities in the back teeth, where 9 in 10 cavities occur.
Our health center offers these services: • Adult, Adolescent and Pediatric Care • Obstetrics and Gynecology (OB/GYN) • Eye & Dental Care for Adults & Children • HIV Specialty Care • Behavioral Health Services • Onsite Pharmacy
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Focus:Oral health Some helpful tips
PHOTO: JOHN KELLEY
»Prevention 10 »Pediatric oral health 12 »Gum disease 14 »Patient story 16 »Fact or fiction? 17
Although more than 90 percent of U.S. adults have had at least one cavity, tooth decay is largely preventable. It is also one of the most common chronic conditions in children. baystatebanner.com/category/health/be-healthy | Be Healthy 9
Nailah R. Tillman, D.D.S., M.S. is a general dentist at Mattapan Community Health Center. Tillman is currently training in Dental Public Health at Harvard University College of Dental Medicine due to her passion for improving access to oral health care.
Fight against plaque BRUSHING ONE’S TEETH AND FLOSSING ARE NOT HIGH ON THE LIST OF FAVORITE THINGS TO DO. Some people avoid it altogether. That is not a wise thing to do. The consequences can cause you pain, suffering and cost. Yet, with minimal effort, tooth decay and gum disease are largely preventable. To that end the American Dental Association has established guidelines on not only when to brush, but also the proper technique. 10 Be Healthy | Summer 2018
Brushing It’s all about the plaque — that slick film of bacteria that perpetually invades the teeth and anything else in its path in the mouth. It’s everywhere — on the tongue, the roof of the mouth, even the inside of the cheeks. The ADA recommends brushing your teeth twice a day in an attempt to keep the plaque at bay. Brushing after every meal is better, according to Dr. Nailah R. Tillman, a general dentist with Mattapan Community Health Center. That’s because when you feast on sugars and starchy foods, like cakes
and crackers, the bacteria feast as well. But the combination of sugar and bacteria in the mouth is not a good thing. It produces acid, the first step in tooth decay. Tillman actually recommends a broader approach to cleaning. “Brush your mouth,” she said. Do a gentle sweep of all surfaces in the mouth, and pay particular attention to the tongue. She likened it to a sponge that attracts its fair share of the bacteria. The tongue can be cleaned with the toothbrush or a tongue scraper. Tillman also advises people with
PHOTO: JOHN KELLEY
One tooth at a time
AT A GLANCE 1. Brush at least twice a day 2. Brush at night and first thing in the morning 3. Floss at least once a day 4. Use a toothbrush with soft bristles 5. Replace your toothbrush every three to four months 6. Use toothpaste that contains fluoride and is approved by the ADA 7. Get dental checkups every six months
ON THE WEB If you’re unsure of a dental product, visit: www.ada.org/en/science-research/ ada-seal-of-acceptance/ada-seal-products
bridges and other dental prostheses to brush more frequently than twice a day. Bacteria tend to form more quickly on those surfaces, she explained. The preferred times to brush are in the evening and upon waking. “When we sleep, whatever food is left in the mouth becomes a breeding ground for bacteria,” she said. “The closed mouth is dark, warm and wet.” In addition, the production of saliva decreases during sleep, thereby robbing the mouth of its natural protection. It’s not only the frequency of brushing but also the length of time. Two minutes is the suggestion — generally one minute for each row of teeth. The technique for brushing has changed over the years. No more side to side or up and down. Hold the brush at a 45 degree angle against the teeth and move in a circular motion. Make sure the bristles are going in between the teeth and underneath the gums. Pay special attention to the back molars where decay typically forms. Spit after brushing to remove the dislodged debris. Some dentists recommend against rinsing out the mouth, however, as it will wash away the fluoride in the remaining toothpaste.
Toothbrush The number and different types of toothbrushes are mind-boggling. Some bristles rotate, others spin, while still others vibrate. Some have floss tip bristles that are slightly longer for a deeper reach. Some come with cheek and tongue
cleaners. Regardless of what you choose, the good old-fashioned manual will do the trick as well. It’s not the brush. It’s the brusher that makes the difference. There is one thing that dentists tend to agree on. Use only soft bristles. Brushing too hard can destroy the enamel of the teeth, and enamel will not grow back, Tillman warned. Toothbrushes should be changed every three to four months, but sooner if you’ve had a cold or sore throat to prevent re-contamination. Some brushes come with color-wear bristles to remind you to change. Once the color disappears, its time is up. There is a difference of opinion on how to store toothbrushes. The ADA recommends standing the brush upright, and drying it in the open air taking precaution to avoid contact with other brushes. Tillman disagrees. “The bathroom is a hub for bacteria,” she explained. The Environmental Protection Agency is on her side. The EPA affirms that the quality of indoor air can be up to five times more polluted than outdoor air. The quality of the air next to the toilet is questionable. A possible solution is storing toothbrushes in plastic covers that have air vents to allow proper drying. When the toothbrush is tossed, the cover should be tossed along with it.
Toothpaste It used to be easy to buy toothpaste. There wasn’t much variation. Now the choice is overwhelming. Toothpaste promises to
whiten, kill plaque and freshen the breath all at the same time. It comes in mint, peppermint, spearmint and even apricot or peach flavors. There’s only one ingredient that you need to look for, however, and that’s fluoride. The paste can make any promise that attracts you and come in any flavor that suits your fancy, but if it lacks fluoride, it will not provide the protection the teeth need. Another tip is to look for ones that carry the approval by the ADA.
Flossing The tools for flossing have gone the way of toothbrushes and toothpaste — there are a lot of choices. There are floss picks, interdental brushes, water picks or the old stand-by dental tape. The ADA recommends flossing at least once a day, but Tillman advises to try to do it after every meal to improve oral hygiene. The type of floss does not matter, but the technique does. If you use string floss, make a “C” around each tooth, and slide it through, making sure you go below the gum line. Be careful not to use that same section of tape on another tooth. That’s just spreading the bacteria from one area to another. Tillman recognizes that she has her work cut out for her. “Caries is the most preventable and most common disease in the world,” she said. She takes it one step at a time. “If I can get someone to floss once a day, perhaps they can soon floss twice a day.”
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A lifetime of good oral health Starting early is the key A BABY’S TOOTHLESS GRIN IS HEART-WARMING. That
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For children younger than three, the American Dental Association recommends limiting the amount of fluoride toothpaste to no more than the size of a grain of rice (left). For children three to six, use no more than a pea-sized amount of fluoride toothpaste (right).
ubiquitous film of bacteria that invades everyone’s mouth, can build up on the gums. It’s recommended to wipe the baby’s gums with a moist washcloth after every meal. The cleaning not only prevents the buildup of plaque, but can also help infants develop a tolerance to oral care. When the first tooth erupts, the washcloth is traded for a baby toothbrush with just a dab of fluoride toothpaste about the size of a grain of rice, recommends the American Dental Association. Brush twice a day. It’s best not to rinse out to help get the maximum benefit of fluoride. There’s no alarm if the baby swallows this tiny amount of fluoride. The scant amount should cause no harm. By age three the ADA advises increasing the fluoride toothpaste to the size of a pea. Flossing is added to the routine when two teeth touch. String floss is not necessary. Flossers with handles are easier. Ng admits it’s a bit tricky to brush and floss, particularly the top front teeth and back teeth. Positioning is important. “Hold the baby from behind,” she advises.
“Cradle the head on your belly and gently stretch out the lips.” Tooth brushing does not take long — about 30 seconds for infants. Brush along the gum lines as well. Parents should continue to brush their child’s teeth at least twice a day. By the age of seven or eight the child can brush the teeth by him or herself, but the parent must still supervise. At a year, or no later than six months after the first tooth comes in, an infant should have the first visit to the dentist and establish a dental home. “Consider it a well-child visit,” she said. Visits are typically spaced six months apart, but more frequently if decay is already present.
Obstacles to preventive care There are some things that parents do unwittingly that prove to be harmful to the child’s teeth. For instance, baby bottle tooth decay develops when babies are put to sleep with a bottle filled with milk, juice or other forms of sugar. The ADA recommends that babies finish their bottle prior to being put down for a nap or the
PHOTO: AMERICAN DENTAL ASSOCIATION
smile can light up a room. Surprisingly, the 20 primary teeth are lurking in the gums, but typically do not peek above the surface for six to 12 months. Within 33 months all 20 primary teeth usually have made their appearance. These baby teeth have a lot of responsibility. They not only hold space in the jaw for permanent teeth, but also help to chew, speak and smile. They eventually move on to make way for their replacements. When all is said and done, each person has 32 permanent teeth … and they have to last a lifetime. Unfortunately, most times they do not. Forty-three percent of youth between two and 19 have already experienced tooth decay, according to a recent report by the National Center for Health Statistics. Nine percent of kids between the ages of two and five have untreated cavities, and that percentage increases with age. The prevalence is highest among Hispanic youth and those of lower income. Yet, tooth decay is almost completely preventable. One reason for poor dental health in children may be attributed to myths and misunderstandings. According to a survey sponsored by the Children’s Dental Health Project, at least 40 percent of the respondents did not realize that sugar in natural fruit juice can cause cavities in children. At least 40 percent believed that you shouldn’t start brushing a child’s teeth until the age of three. Not so, explained Dr. Man Wai Ng, Dentist-in-Chief of the Department of Dentistry at Boston Children’s Hospital. Actually, dental care should start even before the first tooth appears. Plaque, that
FOCUS: Pediatric Man Wai Ng,D.D.S., M.P.H., Dentist-in-Chief of the Department of Dentistry at Boston Children’s Hospital, is a board-certified pediatric dentist. Ng provides general as well as specialty dental services for children.
PHOTO: COURTNEY D’ELIA
evening or allow only water in the bottle. Vertical transmission is another. That’s a technical term for the sharing of oral bacteria between mother and child. When a caregiver tastes or blows on food before feeding it to a child, or shares cups and utensils, those bad bacteria that cause tooth decay just stroll from one mouth to the other. The oral state of the mother is often reflected in the child, thus an incentive for her to take care of her teeth as well. The biggest obstacle to good oral health, however, is nutrition. Tooth decay forms when the bad bacteria in the mouth interacts with sugar, carbohydrates or starch. And children are no strangers to these foods — crackers, chips, cookies, candy, pizza and sugar-coated cereal. Even healthy sugars are to blame. The American Academy of Pediatrics recommends limiting 100 percent fruit juice to no more than four to six ounces a day for children between the ages of one and six. Actually the
Academy now says no juice before the age of one. Whole fruit is preferred. “That’s why we discourage frequent snacking of processed carbohydrates. Instead we recommend moving from carbohydrates to proteins,” explained Ng. Better choices are cheese, nuts and seeds that reduce the acids and raise the pH of the saliva in the mouth. Drink juice and milk only at meal times and encourage water other times.
A barrier to decay Sealants are plastic coatings that are applied to the grooves of the permanent and sometimes primary molars that are prone to decay. The sealants prevent bacteria and food particles from attaching to the surface of the teeth, and may be re-applied if necessary. Although 70 percent of residents in Massachusetts have access to fluoridated water, some parents have concerns about its safety for their children. Ng does not agree. Fluoride prevents tooth decay by
making teeth stronger, she explained. It can even halt dental caries in its track. The first step of caries leaves a tell-tale white spot on the tooth. Fluoride can reverse such early tooth decay. In addition, dentists and pediatricians apply a fluoride varnish to teeth to prevent and control dental caries. Persistent parents, however, sometimes resort to xylitol, a sugar substitute that helps reduce the development of cavities and plaque formation. It also increases the flow of saliva to help repair of damaged tooth enamel. Xylitol is found in many products, including toothpaste, chewing gum and mints. After snacking, if a toothbrush is not handy, older children and adults may chew xylitol and other sugar-free gum to clear away sugars and acids. Yet, xylitol does not trump daily brushing with fluoride toothpaste and flossing. It may be possible to keep all 32 teeth free of decay, but you have to start from day one.
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FOCUS: Gum disease
AT A GLANCE Gingivitis (inflamed and receding gums) Gingiva (gums)
Gum disease: The symptoms sneak by you Linked to chronic disease IT STARTS SURREPTITIOUSLY. You brush your teeth and notice a tiny spot of blood when you spit. It’s small enough to ignore really. Surely you brushed a little too hard and a bristle accidentally caused a nick. That is possible. Yet, if this scenario is oft repeated, you probably can no longer blame your toothbrush and a little heavy handiness. It may be one of the first signs of gum, or periodontal disease. The problem is that many people say they think that bleeding is a normal part of brushing or flossing. It’s not. Almost half of the adults in this country aged 30 and older have some form of gum disease, according to the Centers for Disease Control and Prevention. That number increases to 70 percent by age 65 and beyond. It is more common in men, smokers and those living below the poverty line.
Gingivitis Gingivitis is the initial stage of periodontal disease. Gums can become red, swollen and bleed easily, but cause little 14 Be Healthy | Summer 2018
if any discomfort. The symptoms may be ignored or not even noticed. Several factors, such as smoking, stress, inadequate nutrition and poor oral hygiene contribute to gingivitis. It develops when plaque, a sticky film of bacteria, forms on the teeth after eating foods high in sugar and starch. If not removed, plaque turns into tartar, which can irritate the gums. The good news is that gingivitis is reversible with professional treatment and good oral home care.
Periodontitis If untreated, however, it’s another story altogether. Gingivitis can advance to periodontitis, a more severe form of gum disease. The bacteria from plaque can grow and spread below the gum line. At this point the body actually turns on itself, as explained by the American Academy of Periodontology, and becomes a toxic wrecking ball. Toxins produced by the bacteria cause a chronic inflammation that breaks down and destroys the tissues and bone that support
Almost every adult in this country experiences some form of gum disease. RISK FACTORS n Smoking n Diabetes n Poor oral hygiene or poor nutrition n Stress n Heredity n Female hormonal changes n Immune suppressing disease, such as AIDS n Certain medications SYMPTOMS n Swollen or puffy gums n Gums that are red or bleed easily n Gums that pull away from your teeth (recede), making your teeth look longer than normal n New spaces developing between your teeth n Pus between your teeth and gums n Bad breath or loose teeth n Painful chewing
the teeth. Gums separate from the teeth and form spaces or pockets between the teeth and gums. It can even weaken the bone holding the teeth in place and cause the gums around the neck of the teeth to recede, thereby loosening the teeth. Periodontitis is the leading cause of tooth loss in adults. This is no minor infection. The inflammation is not confined to the mouth — it can enter the bloodstream and wreak havoc on the cardiovascular system. Research suggests that periodontitis is linked to the formation of plaque in the arteries of the heart and brain that can result in a heart attack or a stroke. It is also linked to premature birth, low birth weight and respiratory conditions. Its impact on diabetes is well documented, and described as a two-way relationship. Diabetes increases the risk of periodontitis, and uncontrolled periodontitis impedes glucose control.
Stop it before it starts Periodontitis can cause irreversible damage. That’s why you want to nip it in the bud at the gingivitis stage. The best way to fight it is to avoid in in the first place.
IMAGE: COURTESY OF MAYO CLINIC
SPECIAL ADVERTISING CONTENT: Blue Cross Blue Shield of Massachusetts
The connection between oral and overall health BLUE CROSS BLUE SHIELD OF MASSACHUSETTS HAS BEEN A LEADER IN PROVIDING HIGH-QUALITY DENTAL INSURANCE TO RESIDENTS OF MASSACHUSETTS FOR 50 YEARS. We are
PHOTO: COURTESY BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
proud of our accomplishments in helping to improve both the oral health and the overall health of our members. BCBSMA gives our members access to qualified dentists who agree to take a discount off their normal fees, offering increased value and helping your dental insurance benefit last longer. More than 90 percent of dentists in Massachusetts partner with Dental Blue to provide our members with quality dental care. At BCBSMA, we know that oral health is vital to overall health. Physicians and dentists have known for years that poor oral health is correlated with the management of many chronic diseases. Inflammation, regardless of whether its source of origin is the mouth or other parts of the body, makes the control of these conditions more difficult. For example, studies have found that individuals with diabetes have better control of their blood sugar level if they have good oral health. Individuals with poor oral health are more likely to have heart disease, and improvement in oral health can help improve some of these heart issues. That is why our coverage offers more frequent cleanings and non-surgical gum treatment to our members with these conditions. Internal studies at BCBSMA have demonstrated lower medical costs to members with diabetes or heart disease when they are receiving dental services to help reduce oral inflammation. Dental Blue has developed dental
insurance plans to help members maintain good oral and overall health. Our dental plans come with standard additional or enhanced benefits for individuals with certain chronic diseases, such as diabetes or heart disease, to better allow them to maintain their overall health. Dental Blue offers four cleanings a year for members with these conditions as well 100 percent coverage for non-surgical gum treatment. This is in addition to the normal benefits that all of our members receive from their dental plan. For instance, if your dental plan gives you $1,000 worth of dental benefits per year, these enhanced benefits do not count against this $1,000 benefit level. There is no additional charge, no co-insurance, co-pay, or out-of-pocket expense necessary for these benefits. Members still have full dental benefits available for all of the other services needed throughout the year. Our commitment to our membersâ€™ health does not end here. We also work with our case management teams to remind members of the importance of dental care. BCBSMA has a team of professionals available to answer questions, encourage participation in our programs to keep members healthy, give members access to our 24/7 nurse hotline and remind members periodically when they might not be doing everything important for their best health practices. Since most of our members also have BCBSMA medical insurance, these additional benefits are already added to your dental benefits when we determine you have one of these conditions. If you do not have medical coverage with BCBSMA, you can simply attest to having one of these conditions and these additional
Robert Lewando, Executive Director, Dental Blue Blue Cross Blue Shield of Massachusetts
dental benefits will be added to your covered services. And again, all of the services are outside your annual dental maximum. As a dentist, I can see the results of these efforts firsthand. Patients who utilize these services are healthier, have less oral inflammation, and are controlling a risk factor in the management of their conditions. They are willing to do what it takes to stay healthy, and are educated in the importance of oral health. I have seen the positive effects of motivating these individuals to maintain their oral health in my practice. I am proud to be part of a profession where I can not only help our members reduce oral inflammation but also improve their overall health. You may already have BCBSMA medical insurance. Why not get dental insurance that will give you great dental benefits too? Partner with a company that cares about your overall health and has taken innovative steps to keep you healthy. Please go to www.bluecrossma. com for further information about all of the dental plans that BCBSMA offers.
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FOCUS: Patient story
Cavities not welcome here A family affair D. COLE’S CHILDREN ARE ANYTHING BUT TYPICAL.
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Cole credits the electric brushes they use. They make it easier and more fun, she reasoned. And of course the “sugar bugs” and “mouth monsters” helped, referring to the bacterial villains described by the American Academy of Pediatric Dentistry. No kid wants monsters in the mouth. Her children are old enough to brush on their own, but Cole maintains a watchful eye. Getting the right food was a bit trickier … and time-consuming. “I would spend hours in the grocery store reading labels,” she explained, scanning the list of contents for sugars and hidden sugars. Armed with good information she developed a plan. Pure 100 percent juice is out. Instead she dilutes it with water. That’s a good thing. The American Academy of Pediatrics recommends that children up to the age of six drink no more
than six ounces of pure orange juice a day. The infrequent sugary beverages are drunk through straws to minimize direct contact between the teeth and sugar. Sweet snacks are allowed only at lunch and on special occasions. The rule is to brush soon afterwards or at least rinse their mouth with water. Her school lunches are healthy. Snacks are actually fruit. When in season, cotton candy grapes serve as a meld of candy and fruit. Lunch beverages are sugar-free juice boxes. But if you ask her what beverage she prefers, she answers in three words — “water, water, water.” There’s a reason Cole has made the extra effort of good oral health for her children. “I believe your smile is an identity to your soul,” she explained. “I want my children to have a great smile.”
They have a penchant for Brussels sprouts. And don’t try to trick eight-yearold Chaz by substituting traditionally-grown strawberries for organic. He can tell the difference. They actually like going to the dentist. So much so that 10-year-old Skylah is ready to submit her application to Boston University Henry M. Goldman School of Dental Medicine. When Skylah was five, she had a couple of cavities. Not anymore — with the help of sealants and good oral care. She has been cavity-free for five years, and her two siblings have not had even one. Cole wants to keep it that way. Their dental check-ups began at one year, and continue every six to 12 months at Boston Children’s Hospital under the watchful eye of Dr. Man Wai Ng. You can trace the children’s somewhat unique behavior directly to Cole herself. As a youngster brushing regularly was drilled into her head, and it paid off. She said she has not had necessary dental treatment since her teens, and she passed this mind-set on to her three kids. But she had to come up with a plan. First the brushing. She got her kids used to having a toothbrush in their mouth even before they had teeth. “Good oral hygiene starts with the gums,” she explained. So when that first incisor made its appearance she had already honed her skills. As her kids got older, brushing became a family affair. She tried to make it fun. Two of the children recited the alphabet while brushing. Shania, her 19-year-old special-needs daughter, preferred to brush to her favorite song.
Dentists recommend brushing teeth with children, not only to supervise, but to encourage making it a daily routine.
FOCUS: Fact or fiction
Fact or Fiction?
THERE ARE SEVERAL MISPERCEPTIONS ABOUT HOW TO KEEP YOUR TEETH AND MOUTH HEALTHY. It’s important to
It is difficult to brush after every meal. Many dentists recommend chewing sugar-free gum for about 10 minutes after you eat. The gum stimulates the production of saliva, and it’s saliva that helps clean the teeth and prevent acid formation. However, gum cannot take the place of daily brushing and flossing. You can chew gum but you still need to brush at least twice a day and floss at least once.
separate fact from fiction. After all, the mouth serves as a window into a person’s overall health.
The harder you brush the better.
Not so. Using a toothbrush with hard bristles or brushing too hard can actually damage or even remove the surface of teeth. Enamel cannot be replaced. Only soft bristles are recommended.
Diet soda is less harmful to teeth because it does not contain sugar.
Diet soda may not contain sugar, but it contains plenty of acid, which can cause permanent damage to your teeth. The average acidity of sodas is 3. Generally, the body, including the mouth, wants to maintain a more neutral pH level of about 7.
It is always best to brush your teeth immediately after eating.
It’s not recommended to have dental work done during pregnancy.
Not always. It depends on what you have eaten. If you eat an orange, for example, which is very acidic, it is best to rinse your mouth with water and wait about 30 minutes before brushing, according to the Mayo Clinic. This reduces acid destruction of tooth enamel.
PHOTO: SHUTTERSTOCK/PIXELHEADPHOTO DIGITALSKILLET
At one time this was a commonly-held notion, but no longer. Some women develop a condition known as “pregnancy gingivitis,” an inflammation of the gums that requires treatment. In addition, it is possible for a mother to spread the bacteria from her mouth to her child, so good oral care is essential.
Chewing sugar-free gum after a meal can take the place of brushing.
8 The American Dental Association, the American Congress of Obstetricians and the American Academy of Pediatrics all encourage women to continue to receive dental care while pregnant.
It’s not necessary to brush a baby’s teeth since they will eventually be replaced.
Fluoride is an artificial substance added to water and is not safe to drink.
Primary teeth have their work cut out for them. They are place holders for permanent teeth and help guide their entry. In addition, cavities at any age can cause pain and discomfort. Tooth decay is one of the leading causes of school absences. Cavities are largely preventable.
Actually, fluoride is a naturally occurring mineral found in several bodies of water including oceans. Fluoride has been found to reduce the risk of cavities. That is why it is an ingredient in many toothpastes as well as water supplies. The U.S. Department of Health and Human Services recommends the level not exceed 0.7 milligrams per liter of water.
Tooth decay is not reversible.
If you catch it early enough it is. Tooth decay begins as a white spot on the enamel. This is a period of “demineralization,” which is caused by direct exposure to acid. At this period the process can be stopped by brushing well with fluoride toothpaste or an application of a topical fluoride by your dentist. Once the decay penetrates the enamel, however, it is not reversible, and requires treatment by a dentist.
Only sugar causes cavities.
There’s a misperception that only sugars, especially candy, cakes and cookies, are the culprits behind tooth decay. Actually, it’s any carbohydrate. That includes starches, like pasta, bread and crackers. Even healthy foods, like milk and whole fruit contain sugar. But they also contain other nutrients that nourish the body, including the teeth.
If you’ve never had cavities as a child, chances are you won’t as an adult.
Not necessarily so. Many changes can occur as you age that can cause cavities. Dry mouth, a change in diet and certain medications can increase the risk of tooth decay.
baystatebanner.com/category/health/be-healthy | Be Healthy 17
Creating opportunities. Building healthier communities.
Your care, your community.
Fenway Health’s Dental Department offers a variety of services for patients of all ages. Services include:
To learn more about Brigham and Women’s Hospital community health and health equity efforts email firstname.lastname@example.org or visit www.brighamandwomens.org/communityprograms
Power Up Your Smile for 2018
The Dental Team at Mattapan Community Health Center is Available to help make Your Smile a Reality . . . All Year. We Provide Services such as: ∞ Oral Exams and Screenings ∞ Pediatric Flouride Treatments ∞ Cleanings ∞ Fillings
∞ Dentures ∞ Anterior Root Canals ∞ Crowns and Bridges ∞ Cosmetic Restorations
Call for an appointment: 617-898-9054.
Mattapan Community Health Center
1575 Blue Hill Avenue, Boston, MA 02126 www.mattapanchc.org
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• Cleanings and check-ups
• Oral cancer screening
• Crowns and bridges
• Non-complicated root canals
• Tooth extractions
ansin building tel
1340 Boylston St., Boston MA 02215
Healthy Steps Eat right, stay active, live well » Nutrition 20 » Exercise 22 » Recipe 23
Nourish your teeth
Good oral health depends on what you eat as well as daily brushing and flossing. The vitamins and minerals in fruits, veggies and proteins help nourish the teeth as well as the gums. baystatebanner.com/category/health/be-healthy | Be Healthy 19
HEALTHY STEPS: Nutrition
Nutrition and a healthy smile What you eat is key WHEN YOU POP THAT BLUEBERRY INTO YOUR MOUTH OR TAKE A BITE OF CANTELOUPE, YOU ARE DELIVERING A HEARTY DOSE OF VITAMINS A AND C AND A HOST OF MINERALS TO YOUR BODY. But those nutrients donâ€™t have to go very far to enhance your health. Your teeth and gums benefit as well. Vitamin A promotes the production of saliva, which helps clean the mouth of bacteria. It is these bacteria that start cavities into motion. Vitamin C strengthens the gums and other soft tissue in the mouth. It helps protect against gingivitis, the early stage of gum disease. Add some leafy greens, almonds or yogurt for calcium and salmon for vitamin D to help strengthen the teeth, and you have a pretty healthy mouth. Good oral health depends on adequate intake of nourishing food. The probFruits, lem is that not many people vegetables and in this country follow the Diproteins are etary Guidelines for Amerrecommendicans that were established ed foods to enhance oral by the U.S. Department of health. Agriculture. For instance, depending on age and gender, the federal guidelines recommend that adults eat at least 1Â˝ to two cups of fruit and two to three cups of vegetables a day. But in its latest report, the Centers for Disease Control and Prevention found that only 12 percent and 9 percent of adults, respectively, met the recommendations for fruit and vegetables. Americans are off the 20 Be Healthy | Summer 2018
AT A GLANCE Foods that increase risk of tooth decay: n Sugar-sweetened beverages, such as sodas, sports drinks and sweetened teas and coffees n Sticky foods, such as raisins, fruit snacks and candy n Sugary starches, such as cakes and cookies n Simple sugars, including honey and table sugar n Alcoholic beverages
Foods associated with decreased risk of tooth decay: n Fresh or frozen fruits and vegetables with no added sugars n Low-fat protein, such as lean meats, eggs, fish, beans and legumes n Low-sugar, whole-grain breads and cereals n Nuts n Dairy products n Fluoridated water or flavored non-caloric seltzers
Source: Academy of Nutrition and Dietetics, Massachusetts Dental Society
HEALTHY STEPS: Nutrition
mark in consumption of whole grains and proteins as well. People might not be eating their fruits and veggies, but they are consuming plenty of sugar. Actually, the body requires sugar. It supplies ammunition to fuel the body and keep it going. But there are two types — one good, one not so good. The natural or “good” sugars are found in fruits and veggies as well as dairy products. They provide energy and other nutrients to promote good health. Added sugars, on the other hand, provide calories and no nutrients. And they are a little sneaky. They often go by other names so consumers are not even aware they are eating them. Here’s a hint. Any ingredient that ends in “ose” is a sugar. Examples are fructose, glucose, maltose and lactose. Sugar is the key ingredient in other foods, but you won’t find it on the list of ingredients. That syrup you pour on your pancakes, that concentrate you mix with water for a tasty beverage, the honey you use to sweeten your tea are all sugars.
They taste good, but do little for your overall health, including your oral health.
Not just sugar Sugars can’t take all the blame for tooth decay. They are part of the broader category of carbohydrates, which also includes fiber and starches. Carbohydrates like bread, pasta and potato chips, are all eventually broken down to sugar by saliva. When you eat carbohydrates the bad bacteria eat as well. They feast on the starch and produce acid, which is the first step of tooth decay. It’s not only what you eat, but how you eat. Some people snack on cookies, candy or crunchy chips throughout the day. Some people sip sugar-sweetened beverages to quench their thirst or wash down food. This perpetual intake of sugar-laden food and drink constantly exposes your teeth to acid.
A better choice Think protein instead. Protein foods are the body’s building blocks and are
work horses. They help fight infection and build and repair tissues, including your teeth. Good sources of protein are lean meat and poultry, seafood, eggs, beans and other legumes. Dairy products, such as milk, yogurt and cheese are rich in calcium as well as protein, which together form a protective barrier on tooth enamel. If none of these suit your fancy, perhaps unsalted nuts and seeds are more to your liking. According to the American Dental Association, nuts and seeds stimulate the production of saliva to reduce the risk for tooth decay. The bottom line is that the mouth, like every part of the body, requires nourishment. That means a well-rounded diet that includes fruits, vegetables, protein and fiber. Combine that with daily brushing and flossing and regular check-ups with the dentist, and you should have a pretty healthy smile. Reviewed by Kathy Cunningham, M.Ed., R.D., L.D.N.
KOHL’S AND BOSTON CHILDREN’S HOSPITAL’S HEALTHY FAMILY FUN PROGRAM
Go shopping. Get chopping. Enjoy cooking together! Find ideas at:
11:48 AM baystatebanner.com/category/health/be-healthy |6/15/18 Be Healthy 21
HEALTHY STEPS: Exercise
Keep on steppin’ Exercise keeps inflammation in check THE LINK BETWEEN EXERCISE AND OVERALL GENERAL HEALTH IS WELL DOCUMENTED. Regular
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AT A GLANCE Exercise and physical activity are essential for overall health, but your oral health need not suffer for it. These are tips to build your biceps and promote healthy gums at the same time. n Keep hydrated, especially during intense activities. Drink water instead of sports drinks. n Breathe through the nose instead of the mouth. n Follow a healthy dental routine: brush teeth twice a day; floss daily; have regular dental cleanings and examinations.
physical activity is essential for cardiovascular, orthopedic, neurological and emotional well-being. But can it impact oral health as well? Apparently so. Scientists from Case Western Reserve University in Cleveland studied the connection between exercise and periodontal disease, or inflammation of the gums. If unchecked, this inflammation can result in tooth loss. What’s worse, however, is that gum disease is closely linked to premature birth, heart disease, diabetes and other chronic conditions, according to Harvard Medical School. The researchers from Case Western discovered that nonsmokers who regularly engaged in moderate to intensive physical activity three or more days a week had a 55 percent lower risk for periodontal problems compared to nonsmokers who did not exercise. Even those who exercised three or fewer days a week reduced their risk of gum inflammation by more than 30 percent. Athletes that participate in rigorous exercise, however, have to use caution. Studies suggest that heavy training might actually have a negative correlation to oral health. In other words, the more hours an athlete trained, and the greater the intensity, the more likely the development of cavities. Two factors appear to contribute to the excess decay. Many athletes prefer to rehydrate with sports or energy drinks instead of water. It is true that sports drinks restore electrolytes lost during rigorous sports, but that comes with a price. Normally, caries, or cavities, is caused by bacteria that produce acids in the presence of sugar, and there’s plenty of sugar in sports drinks — often the second and third ingredients. But sports drinks actually don’t require sugar as the intermediary step for the production of acid. They bring their own. One of the best-known drinks on the market contains both citric and phosphoric acid. Citric acid is known to cause erosion of tooth enamel that can lead to decay. It’s not only what you drink, but how you drink it. Heavy exercisers tend to sip their sports drink throughout the workout, thus exposing their teeth constantly to the sugars and acids. It’s best to guzzle the beverage in one fell swoop, thereby minimizing the unhealthy exposure. Water is the preferred means of hydration. Another habit of exercisers may be even more detrimental to dental health than energy drinks. Particularly during intense activities athletes tend to breathe through open mouths, which can eventually lead to a dry mouth and reduced saliva flow. That’s not a good thing. Saliva protects teeth. Its lack creates a perfect breeding environment for plaque and bacteria and the ultimate development of acid. So keep on steppin’ … but not at the expense of your oral health.
HEALTHY STEPS: Recipe
Berry yogurt popsicles THE POPSICLE DATES BACK TO 1905 AND WAS EVENTUALLY MARKETED AS A “FROZEN DRINK ON A STICK.” It has remained PHOTO: COURTESY AMERICAN INSTITUTE FOR CANCER RESEARCH
a popular summer treat for children as well as adults. This recipe from the American Institute for Cancer Research combines layers of mashed red cherries, blackberries and white Greek yogurt for a healthier, lower sugar version of store-bought treats. Cherries and blackberries are naturally sweet, but do more than satisfy a person’s sweet tooth. Both fruits are rich in vitamins A and C. Vitamin A promotes the production of saliva, which helps clean the mouth of bacteria. Vitamin C strengthens the gums. Yogurt is a good source of calcium that helps strengthen the teeth. These popsicles are refreshing summer treats and a better choice for oral health.
Source: American Institute for Cancer Research (www.aicr.org)
INGREDIENTS n 1½ cups pitted fresh or frozen cherries n ½ cup fresh or frozen blackberries n 1 Tbsp. honey n 24 oz. vanilla Greek yogurt n 12 (3 oz.) paper cups and 12 popsicle sticks
DIRECTIONS n In a small mixing bowl mash cherries and
NUTRITIONAL ANALYSIS (PER SERVING): n Calories: 69 n Total fat: 0 g n Carbohydrate: 12 g n Protein: 5 g n Dietary fiber: 1 g n Sodium: 18 mg
berries. Drizzle on honey and mix together.
n In paper cups, layer alternating spoonfuls of yogurt and fruit until full.
n Place popsicle stick or plastic spoon in each cup. Freeze.
n When ready to serve, tear paper cup off popsicle and enjoy. * Makes 12 paper cup popsicles baystatebanner.com/category/health/be-healthy | Be Healthy 23
With me Through diagnosis Through care To wellness
Some people still whisper the word cancer, but we should speak up. Today, you can survive, even thrive, after cancer. Dana-Farber Cancer Institute can help. They offer mammography screening, right in the community. And should you need it, they provide world-class cancer treatment. They were with me through a diagnosis, through cancer care, and helped me stay well. And they can help you, too. Visit dana-farber.org/community to see how.
Every step of the way.