Smile Healthy mouths, healthy lives
Issue # 1, 2009
Fizzy facts The truth about what ﬁzzy softdrinks do to your teeth
Toothy books for kids Good deeds The Aussie dentist helping Vietnam’s neediest kids
G N I M T I O t A W RO OPe dYovneo CPleasremo
Keeping kids smiling
All smiles W
elcome to Smile. The magazine you’re holding in your hands right now was created to help you get your head around what’s good for your teeth and what isn’t—and why that matters. It’s informed by one basic idea—that everything you put in your body goes via your mouth, so your oral health is a good indicator of your general health. We get bombarded with health information all the time, and it’s hard for anyone to ﬁgure out what’s right and what isn’t. Is orange juice good for you or bad for you this month? Should I be drinking eight glasses of water a day, or do I get enough through the food I eat? Are my toddler’s sippy cups bad for her teeth, and if so, how else do I get her to drink anything? There’s so much information out there, it’s sometimes hard to even know what question you should be asking, let alone what the answer should be. That’s why we created this magazine. There’s a good chance that you’re reading this in your dentist’s waiting room. Our thinking was: if you read about something in this magazine, you can immediately go and ask your dentist about it during your appointment. We’re not setting out to be the last word on everything to do with oral health. That’s your dentist’s job, and he or she will know best. But hopefully, after reading Smile, you’ll know what questions to ask them. Keep smiling, Rob Johnson Editor
EDITOR Rob Johnson firstname.lastname@example.org SUB-EDITOR Michelle Starr CONTRIBUTORS Sharon Aris, Nicol Azzopardi, Lucius Fisk, Danielle Veldre CREATIVE DIRECTOR Tim Donnellan ADVERTISING MANAGER Maxine Guterson COMMERCIAL DIRECTOR Mark Brown
05 06 05. News and views News from around the globe, including clowning around with the Cirque do Soleil, brushing tips, sleep deprivation and dental health, ﬂouride and children’s tooth facts, gag reﬂex suppression, diabetes, genetic risk of cavities, and dental pulp from stem cells. 08. Mouths of babes Despite water ﬂuoridation, school oral health programs and national education campaigns, tooth decay in Australian kids is on the rise. 12. Toothy books for kids Anyone whose tried to get a toddler to brush their teeth knows it’s not something that comes naturally to kids. But dentists recommend you encourage your kids to start brushing their teeth around the age of two.
FOR ALL EDITORIAL OR ADVERTISING ENQUIRIES: PHONE (02) 9660 6995 FAX (02) 9518 5600
13. Busting coke’s myths Don’t believe the soft drink advertisers—despite what their ‘myth busting’ ads say, ﬁzzy drinks really will rot your teeth.
Smile magazine is published 4 times a year by Engage Media, ABN 50 115 977 421. Views expressed in Smile magazine are not necessarily those of publisher, editor or Engage Media. Printing by Superﬁne Printing
16. Reality bites It was a quick-draw response aimed squarely at the polls, but will Labor’s Teen Dental Plan actually deliver?
Suite 408 The Cooperage 56 Bowman Street Pyrmont NSW 2009
19. Good deeds Dr Paul Kotala went from Mosman to Cambodia to help out the needy.
08 12 13 16 19 3 SMILE
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Your dentist is a clown “T Well, not your personal dentist— but Dr Steven Bishop started as a dentist, and is now a clown with Cirque du Soleil.
hroughout my career as a dentist, I was always performing on the side,” says Steven Bishop. “In the beginning, I would keep the two worlds separate and not tell patients about my ‘other life’. But patients like to know you’re human with interests outside the practice.” Bishop and fellow-clown Joanna Holden have, most recently, been opening the Cirque du Soleil show Varekai, which is currently touring around the world. “There are no other dentists, that I know of, with Cirque du Soleil. There are those who have had other occupations in the past, but most have always been performers. You don’t normally ﬁnd a dentist-turnedclown, but I do know a contortionist who is
studying to be a lawyer. “I still occasionally check teeth and make referrals. I have a few instruments and some temporary cement, and I’ve had to bond a bridge on between shows. It can be a bit surreal for me when I see former patients in the audience. I saw a patient in Canberra recently, and I instantly remembered her bite.” Bishop gives a lot of credit to dentistry. “It helped fund my desire to be a performer and allowed me to move forward with my career as a performance artist,” he says. “There are similarities between performing and dentistry. Both involve communication, whether it’s with a patient or with an audience. “Dentists must develop a good one-on-one rapport with their patients. You can’t have a one-on-one with an audience— it’s more like one-on-2600. But you still have to make a connection. That’s the role of the Cirque du Soleil clowns—to engage the audience and allow them to laugh.” ¢
Use a toothbrush with a small head and soft bristles.
Clean the teeth, gums and tongue every morning and night.
You should have your own toothbrush: don’t use anybody else’s.
Store toothbrushes in a clean, dry, airy place so that they can dry out between use.
Store toothbrushes separately so they do not touch other toothbrushes.
After brushing, the toothbrush should be rinsed thoroughly under fast running water to remove toothpaste, bits of food and plaque. Then shake off the water from the toothbrush to help with drying.
Replace toothbrushes regularly and when they become ‘shaggy’ or clogged with toothpaste.
Dr Bishop’s patients always felt there was something a little funny about him ...
Also replace toothbrushes after illness such as colds and ﬂu or after mouth infections.
Sleep your way to better health study in a recent issue of the Journal of Periodontology identiﬁes lifestyle factors that have the most impact on periodontal health. The study followed a group of 219 factory workers in Japan from 1999 to 2003 in an attempt to evaluate the effect of different lifestyle factors on the progression of periodontal diseases. Each worker was
The participants who received seven to eight hours of sleep on average per night exhibited less periodontal disease progression than those who received six hours of sleep or less. High stress levels and daily alcohol consumption also demonstrated a signiﬁcant impact on periodontal disease progression. “From this study, we can speculate that shortage of sleep can impair the body’s immune
evaluated on a list of the following lifestyle factors: physical exercise, alcohol consumption, tobacco use, hours of sleep, nutritional balance, mental stress, hours worked and eating breakfast. The study found that the number one lifestyle factor that independently impacted the progression of periodontal disease was smoking; but hours of sleep closely followed.
response, which may lead to the progression of diseases such as periodontal disease,” said study author Muneo Tanaka, DDS. “This study points out to patients that there are lifestyle factors other than brushing and ﬂossing that may affect their oral health. Simple lifestyle changes, such as getting more sleep, may help patients improve or protect their oral health.”
Who woulda guessed? Sleep deprivation affects other areas of health!
Fluoride Facts Fluoride is found naturally in food and water and is added to most water supplies and many oral care products such as mouth rinse and toothpastes. Using ﬂuoride toothpaste twice a day is a very effective way of reducing tooth decay. Teach children to spit out the toothpaste after using ﬂuoride toothpaste. Don’t swallow. Swallowing toothpaste may cause them to ingest too much ﬂuoride. Don’t rinse. Fluoride can go on protecting the teeth for some time after brushing if the toothpaste is not rinsed out of the mouth. Fluoride toothpaste is not recommended for children under 18 months of age. Young children generally receive sufﬁcient ﬂuoride through food and water.
Did you know...? n Children have 20 teeth in their mouths. n There are 10 teeth each on the top and bottom jaws. n Each jaw consists of speciﬁc teeth, which are incisors (cutting teeth), canines (tearing teeth) and molars (grinding teeth). n From the midline of one side of each jaw consists of two incisors, one canine and two molars.
What is the ADA Seal of Approval? You may have noticed a logo on your toothpaste saying it has the “ADA seal of approval”. Ever wondered what it means? The ADA is the Australian Dental Association. The idea behind the Seal of Approval program is to let people know that any claims you read or hear in ads for approved products is not misleading. The Seal of Approval is not “sold”. So if you want to know what dentists recommend, check this list.
Products with the ADA seal of approval Toothbrushes
Tooth Tunes (by Hasbro Australia Ltd) Reach Access Professional Manual Toothbrush (by Johnson & Johnson Paciﬁc Just Ess – Junior Just Ess – Adult
Advance Power 950TX (Oral B) Professional Care 5000 (Oral B) Professional Care 7000 (Oral B) Professional Care 8500 DLX (Oral B) Professional Care 8500 Centre (Oral B) Sunbeam Plaque Remover model TB 4500 Sunbeam Plaque Remover model TB 6700
Plax Mouth Rinse (Colgate Oral Care) Savacol Mouth and Throat Rinse Mint (Colgate Oral Care) Savacol Mouth and Throat Rinse Freshmint (Colgate Oral Care) Savacol Mouth and Throat Rinse Alcohol-free (Colgate Oral Care) Listerine Mouth Rinse Listerine Citrus Fresh Antiseptic Mouthwash Listerine Coolmint Listerine Freshburst Listerine Tartar Control Antiseptic Mouth Rinse Listerine Teeth Defence Antiseptic Mouthwash with Fluoride
Cedel Medicated Toothpaste YLC Children’s Toothpaste (Coles Group Ltd) YLC Toothpaste Total Care (Coles Group Ltd) YLC Toothpaste Total Care & Whitening (Coles Group Ltd) YLC Toothpaste Whitening (Coles Group Ltd) YLC Sensitive Toothpaste (Coles Group Ltd) Colgate Fluoriguard Anti-cavity Colgate Fluoriguard Anti-cavity Cool Mint Flavour Colgate Fluoriguard Anti-cavity Great Regular Flavour Colgate Fluoriguard Anti-cavity Sparkle Mega Mint Gel Colgate Sensitive Fresh Stripe Colgate Sensitive Multi Protection Colgate Sensitive Whitening Colgate Triple Action Colgate Total Mint Stripe Colgate Total Colgate Total Advanced Fresh Toothpaste Colgate Total Plus Whitening Colgate Whitening Colgate Whitening Plus Tartar Control My First Colgate Macleans Junior Jaws Macleans Milk Teeth Listerine Anti-bacterial Fluoride (maximum defence) Listerine Anti-bacterial Fluoride Tartar Control (maximum defence)
Hand-inmouth Diabetes and periodontal disease often appear together. Uncontrolled diabetes can make periodontal disease worse. Untreated periodontal disease can make it difﬁcult to control a diabetic’s blood sugar. Now, for the ﬁrst time, a study from Columbia University School of Public Health has shown that moderate to severe periodontal disease increases the risk of diabetes later in life. Experts say that diabetics are more likely to get periodontal disease. People with diabetes are more prone to infections. Periodontal disease is a bacterial infection. Medical experts see periodontal disease as a complication of diabetes. This study shows that in some cases, periodontal disease may be a risk factor for diabetes.
Got cavities? Blame your parents Brushing, ﬂossing and eating healthily are important for oral health. But it seems that genes matter, too. Studies of identical twins have shown that cavitiy risk can be inﬂuenced by genes. Now, researchers from the University of Pittsburgh School of Dental Medicine have found several genes that may make people more likely to get cavities. They found other genes that seem to protect against decay. They examined the DNA of people in 46 families in the Philippines. They also collected information on tooth decay in each person. The scans found three genes that appear to protect against decay. They also found two genes that appear to make people more vulnerable to decay. The researchers suggest that these genes might be related to food preferences or the total amount of saliva in a person’s mouth. A study published earlier this year also found that some people with severe tooth decay have a rare form of a certain gene. This gene helps to make a protein that is involved in tooth development. The protein is called amelogenin. One change in this gene can lead to a condition called amelogenesis imperfecta. People with this disease have discolored teeth and are at high risk for cavities.
Dr Tooth Fairy Want to know what the Tooth Fairy does with all of those baby teeth? In the future, she could use them to make new teeth, new nerve cells or even bone. Researchers from the University of Michigan School of Dentistry say they have used stem cells from lost baby teeth to grow dental pulp tissue in mice. Dental pulp is in the center of a tooth. It contains nerves and blood vessels. The Michigan researchers suggest that stem cells could be used to grow dental pulp, or to regrow teeth or parts of teeth.
Kids’ oral health
By Sharon Aris
Despite water ﬂuoridation, school oral health programs and national education campaigns, tooth decay in Australian kids is on the rise.
or three decades, until the mid-1990s, Australian children’s oral heath was steadily improving. Indeed, by 1996, the prevalence of decay in the deciduous teeth of a six-year-old was 39 per cent and each child on average had only 1.4 baby teeth with decay. However, since the mid-1990s, this situation has reversed. Now the prevalence of decay in children’s teeth is increasing. The milliondollar question is why—and, more speciﬁcally, what can dentists do about it? There is little doubt that, worldwide, research supports the notion that repeated exposure to ﬂuoride is the most important factor in reducing dental decay. It is most commonly and successfully 8 SMILE
delivered through water supply, and access to ﬂuoridated water has been the focus of oral health campaigning by professional bodies including the Australian Dental Association (ADA). Victory was apparent in December 2007 when Premier Anna Bligh announced that Queensland— the last hold-out state—was ﬁnally coming to the party and would add ﬂuoride to its water supplies from 2008, ending a 40-year impasse that left Queensland children with the nation’s worst teeth. Six-yearolds in the Sunshine State currently sport 30 per cent more decay in their baby teeth than the national average. But while this Queensland development is a welcome victory, according to Dr Lena Lejmanoski, Chair of the Oral Health Committee at the ADA, the ﬂuoridation battle is far
from won. “There are still areas in Australia without ﬂuoridation,” she says, pointing to the south of Western Australia, which is her home state. “It’s an ongoing issue to get each area ﬂuoridated.” It’s those most vulnerable to dental decay from other factors who are currently missing out. Research suggests that the 30 per cent of Australians who do not have access to ﬂuoridated water, with the exception of Brisbane, are also those with a lower socioeconomic status than average. And Lejmanoski points out other ﬂouride sources are important: “Studies are showing ﬂuoride in toothpaste is very, very beneﬁcial,” she says. Spreading the word The real challenge is getting this message across to the people who need to know—
Helpful hints The good news ∆ The oral health of Australian children is generally of a high standard. Children in Australia have better oral health than children in many other countries, due largely to ﬂuoridated water. Of the 44 countries with comparable data available, Australian 12year-olds have the seventh lowest average number of decayed, missing and ﬁlled permanent teeth.
The bad news
parents and primary caregivers. Lejmanoski says there is still a vast amount of work to be done in this area. “Nationally, we’re ﬁnding a big problem with anyone who deals with babies. There is no information going out on tooth brushing and when to start with toothpaste,” says Lejmanoski. “Information is not getting out to new parents.” She cites children’s expos, where it’s not just parents who inundate the ADA booth in search of oral health information, but also community nurses. “The problem isn’t a lack of interest, it’s ﬁnding the right mechanisms to deliver information,” she says. Lejmanoski also says the ADA has a good track record of campaigning alongside other health professionals, referring to past projects such as hanging posters of in-mouth lesions
in GP surgeries in a bid to boost dentist visits, and running co-operative campaigns against smoking and diabetes. But now the challenge lies in identifying where parents and caregivers ﬁnd their information, she says. What’s happening? Before any campaigning on children’s oral health can start, however, the reason behind why decay rates are increasing needs to be addressed. And it’s not all that straightforward. For a start, even the researchers who initially identiﬁed the rise in children’s tooth decay aren’t sure why it is occurring. Mr Jason Armﬁeld was one of the authors of the report, Water Fluoridation and Children’s Dental Health: The Child Dental Health Survey, Australia 2002, which ﬁrst documented the rising tide of
decay. He says researchers can’t pinpoint the contributing factors, simply because “there hasn’t been the research”. Indeed, he points out that the increased prevalence of decay was only discovered some years after the event, so at the moment the best guesses are associative ones. That is, we know there is an increasing rate of obesity related to increased decay; we know there is high consumption of sugary soft drinks and sports drinks linked to decay; and we also know that more unﬂuoridated bottled water is being consumed than teeth-friendly tap water; but we can’t know for sure which factors are the most signiﬁcant—or if there’s some other contributing factor. This is important, Armﬁeld points out, because if the increasing levels of decay are mostly related to diet,
∆ In 2002, more than 47 per cent of six-yearolds had cavities in their baby teeth. On average, for every six-year-old child in Australia, there were approximately two decayed, missing or ﬁlled baby teeth. At the same time, over 42 per cent of 12-year-olds had cavities in their permanent teeth. For every 12-year-old in Australia, there was approximately one decayed, missing or ﬁlled permanent tooth. ∆ Decay rates of primary teeth across all ages increased from 1996 to 1999. Five-year-old children showed the biggest rise, with a 21.7 per cent increase in decay during this period. ∆ More children are currently hospitalised or require general anaesthetic for dental treatment. Cavities in children aged ﬁve to nine are the second most common reason for hospital admission. There has been a threefold increase in general anaesthetics in children aged up to nine years from 1993-1994 (215.8 per 100,000) to 20032004 (731.4 per 100,000).
K i d ’s o r a l h e a l t h
What other countries are doing Vaccination action
Dr Lena Lejmanoski: the ﬂuoridation battle is far from won.
for example, a big part of the solution should not be driven by dentists, but other health professionals who are already working to reduce childhood obesity—with strategies like zero-tolerance policies for junk food in school canteens. He also points out that worldwide oral health funding is often funnelled into primary healthcare and technology, while preventative care is pushed into the background.
he ADA has already worked on several existing health campaigns, including restrictions on junk food advertising—noting in its submission to the Australian Communications and Media Authority on the Children’s Television Standards Review that “dental decay has been estimated to be Australia’s most expensive diet-related disease. Australian studies show that children view an average 23 hours of television per week, with some four hours of this time spent watching advertisements. It is estimated that food advertisements account for 30 per cent of all advertisements during 10 SMILE
children’s viewing hours—most promoting food products that are high in fat, salt and sugar, but low in ﬁbre.” As for the new government, a spokesman for the Federal Health Minister pointed to recently announced beneﬁts aimed at increasing access to dental care for teenagers (see page 12). A new rebate will provide $150 per person towards an annual dental check-up for about 1.1 million teenagers aged 12 to 17 years in families receiving Family Tax Beneﬁt A, as well as teenagers receiving Youth Allowance or Abstudy. A new Commonwealth Dental Health Program will also provide $290 m over three years to all Australian states and territories in a bid to relieve the 650,000 people currently on public dental waiting lists around the country. These new measures are welcome, of course. But, particularly when it comes to children’s oral health, prevention is always worth more than a lifetime of cure. So rather than another ambulance at the foot of the cliff, better early intervention programs are the real key. ¢
In British Columbia, Canada, when one in 10 children was found to enter kindergarten with dental disease, a variety of programs were introduced to explore strategies that might improve the oral health of children who were at risk of early childhood caries. In one initiative, a simple seven-point questionnaire was used to identify ‘risky’ behaviours in children receiving their 12-month vaccinations. Around 20 per cent of toddlers in the survey were identiﬁed as being high-risk candidates. Dental staff then contacted parents and offered counselling on how to reduce their child’s risk. When families who were contacted after completing the questionnaire were compared with families who received no follow up, the follow up appeared to have had a positive impact. Parents in general were more likely to begin brushing their child’s teeth with a ﬂuoridated toothpaste than they were to change the child’s feeding habits.
Curb the sweet tooth Baby bottle tooth decay (BBTD) was the target of an intervention program with American Indian/Alaskan native children after it was documented that approximately 50 per cent of three- to ﬁve-year-olds from that group suffered the condition—caused by feeding children sweetened liquids (including formula) at bed-time, as well as bottle-feeding past the age of 12 months. The two main components of the intervention were one-to-one counselling with the infant’s caregivers and community-wide campaigning, which included a targeted media presence, participation at health fairs and computerised mail-outs. In three years, the prevalence of BBTD decreased from 57 to 43 per cent.
What do they have in common? In Canada, when one in 10 children was found to enter kindergarten with dental disease, programs were introduced to explore what might improve the oral health of children at risk of early childhood caries. Key common factors found in all of the successful children’s oral health programs included: ∆ Collaboration with existing public health programs such as baby clinics and involving other health providers like general practitioners and pharmacists; ∆ Encouraging community input through mothers’ groups and focus groups before the programs were introduced; ∆ Adapting programs to address key cultural differences. For instance, ensuring that family doctors in regions where Punjabi-speaking families attended clinics for vaccinations were included; ∆ Beginning interventions in infancy; and ∆ Targeting campaigns to children, so that high-risk candidates received treatment, instead of a generic onesize-ﬁts-all program.
Of all the things your kid puts in his mouth, we thought a brush designed for his changing needs should be one of them. We understand the stages kids go through. So we design our toothbrushes for every stage of kids’ oral care development, with features like easy-to-grip handles. Soft bristles for tender gums. Small brush heads for smaller teeth. And fun designs, too. Perhaps that’s why we’re the number-one-recommended toothbrush brand by dentists and hygienists. There’s something special about every stage. 8-Plus Years
5 to 7 Years
4 to 24
2 to 4 Years
©2008 P&G © Disney. Based on the “Winnie the Pooh” works by A.A. Milne and E.H. Shepard.
By Sharon Aris
Anyone whose tried to get a toddler to brush their teeth knows it’s not something that comes naturally to kids. But dentists recommend you encourage your kids to start brushing their teeth around the age of two. 0-2s Whose Teeth? By Jeannette Rowe From the writer who brought you the classic Whose tail? comes Whose teeth?. Children love lifting the ﬂap on each spread to reveal which animals the different sets of teeth belong to.
3-5s The Berenstain Bears Visit The Dentist By Stan and Jan Berenstain Sister Bear wakes up one morning with a loose tooth that makes her talk funny. Sister spends the entire day wiggling her loose tooth until it’s time to take brother to the dentist for his check-up. A great book about a cheerful dentist visit that’s good for getting rid of those little jitters.
Bright and Early Beginner Books: The Tooth Book By Dr Seuss The iconic Dr Seuss takes a look at teeth, where to ﬁnd them, what to do with them 12 SMILE
and how to look after them. Some of what he says is smart. But, of course, some is silly, too. And we wouldn’t have it any other way.
that won’t come out. His dad breaks his pliers trying to pull it out, and his mum can’t yank it out, either. The dentist and the tooth fairy are stumped!
Charlie and Lola: My Wobbly Tooth Must Not Never Ever Fall Out
By Lauren Child Based on the popular ABC TV series, Charlie and Lola are back with an ever-socompletely good story about Lola’s wobbly tooth. It’s her ﬁrst-ever wobbly tooth and Lola is determined to hang on to it—until she ﬁnds out about the tooth fairy.
My Loose Tooth By Stephen Krensky What’s it like to have a wiggly, twisty-turny tooth inside your mouth? With rhyme and colour, you’ll ﬁnd the answers to many tooth questions.
Primary school Andrew’s Loose Tooth By Robert Munsch Andrew has a loose tooth
By Marc Brown Alone among his animal friends, Arthur can’t make his ﬁrst tooth fall out. Nothing he tries works. A visit to the dentist followed by some accidental help from mean Francine solves the problem.
How Many Teeth? By Paul Showers When you were a baby, you didn’t have any teeth at all. Then, as you grew up, your teeth started to come in. First one, then two and ﬁnally, 20 teeth in all! How many teeth do you have in your life?
Nice Try, Tooth Fairy By Mary W Olson In a series of brief letters, Emma thanks the tooth fairy for the money left behind for her ﬁrst tooth, then politely
asks to borrow it back so that she can show grandpa. The tooth fairy obliges, but brings a hippo’s tooth by mistake.
Open Wide: Tooth School Inside By Laurie Keller This fun dental health book uses a class of 32 teeth with bite, teacher Dr Flossman and guest lecturer the tooth fairy to take readers through a factﬁlled and funny journey that includes loads of information on what teeth are made of, what job each tooth does and what you need to do to really take care of them.
The Troublesome Tooth Fairy By Sandi Toksvig When Jessica loses her ﬁrst tooth, granny tells her to watch out for the trainee tooth fairy, because while she might look the part in her outﬁt, she’s not too sure of the job. And granny knows the tooth fairy has whisked away more than just the lost tooth before. ¢
By Salazar Mercedes
Don’t believe the soft drink advertisers—despite what their ‘myth busting’ ads say, ﬁzzy drinks really will rot your teeth.
he managing director of Coca-Cola claimed it just wanted to set the record straight about Coke when it ran an advertisement in newspapers and magazines featuring the actress Kerry Armstrong. Among various claims in the ‘Myth busting’ campaign, the ad stated: “Myth: It rots your teeth”. Almost immediately, the Australian Dental Association
shot back a reply: “Several statements under ‘Myth: It rots your teeth’ are ambiguous or just plain wrong,” said then-ADA Federal President, Dr John Matthews. “The advertisement says ‘Coca-Cola has the same level of acid as many other food and drinks.’ Soft drinks, sports drinks and fruit juices are acidic drinks and all have the potential to erode your teeth. While acid is eventually neutralised by saliva, this is not before it softens your precious tooth enamel,
Can soft drinks ever be safer? Well, as a matter of fact, they can. What’s more, it can be done without affecting the taste of the drinks. It can be done by removing caffeine from the drinks, replacing sucrose with replacements such as Isomalt, and adding calcium, along with a ‘phosphorprotein stabiliser’. All these can help neutralise the negative effect of the drinks. Experiments were conducted proving this in 2005. Have any soft-drink makers done it commercially yet? Not to our knowledge.
At the dentist Coke myths
allowing it to be worn away much more easily. This can cause very serious problems—particularly in people who have dry mouths (caffeine, medications, exercise and certain ailments can cause dry mouth). The problem is then magniﬁed when soft drinks are sipped slowly, as mouths never have a chance to neutralise the acidic effect.” So in the interests of getting some facts out there to the public, we’ve compiled our own list of scientiﬁcally-backed facts which are aimed at dispelling the myths and misinformation being bandied about in the media.
Drinking soft drinks when you have a dry mouth—which is often the case when playing sports—increases the risk of tooth erosion.
FACT: Cola drinks lead to cavities Black cola drinks contain sucrose. One 375 ml can of cola
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a day for a year will mean you’re drinking 15 kg of sucrose a year, which has been directly associated with increased dental caries. Dentists have demonstrated this in several studies since the early 1980s, including an American study of more than 30,000 subjects. The link between a higher sucrose intake and dental caries is undeniable. FACT: Cola drinks soften your tooth enamel Black cola drinks also contain acids. On the can it may be labelled “food acid 338”. It’s also called orthophosphoric acid. Some also contain citric acid (food acid 330) and tartaric acid (food acid 334). The fact that the drinks are bubbly—an effect created by dissolved carbon
dioxide—added to the acids means your saliva can’t neutralise the acids effectively. That’s why enamel and dentine hardness decrease after exposure to these soft drinks. Worst of all, once mineral loss has occurred, it’s very difﬁcult, sometimes impossible, to completely repair. FACT: The caffeine in Cola may weaken your bones Caffeine is one the world’s most popular drugs. It can lower resting salivary ﬂow, pH and buffer capacity, which then affects your oral health. Because it’s addictive, suddenly cutting it out of your diet can lead to withdrawal symptoms—so people who want to do the right thing can soon ﬁnd themselves back in the same bad dietary habits. ¢
Helpful tips What can kids drink? Before the age of six months: Breastmilk or formula After six months: Tap water After one year: Cow’s milk
Don’t give your child: soft drink, fruit juice, ﬂavoured milk, cordial, coffee/tea
Lift your child’s top lip once a month to check for early signs of tooth decay. White lines along the gum line can be the beginning of tooth decay. Please seek dental advice if you notice any changes in your child’s teeth.
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Te e n d e n t a l p l a n
Research by Nicole Azzopardi and Vivienne Reiner
It was a quick-draw response aimed squarely at the polls—so will Labor’s Teen Dental Plan actually deliver?
t’s been lauded as a long-awaited triumph. At the last Federal election, the Rudd Labor Government announced Medicare Teen Dental, possibly the nation’s most ambitious teen dental scheme to date. Originally targetted at the more than one million Australian teenagers between the ages of 12 and 17, six months in it was expanded to include additional
groups of teenagers. But these changes are unlikely to make ufor the problems of the program, critics say. Last December, the government announced that 250,000 teenagers had received a check-up under Teen Dental. As well, 7598 dentists had provided services under the plan, equating to almost 70 per cent of dentists. In addition to teenagers aged 12 to 17 qualifying for the check-up worth $153 in families receiving
Family Tax Beneﬁt Part A, as well as those receiving Youth Allowance or Abstudy, from this year, other teenagers to be incorporated into the program included disadvantaged groups such as those receiving Disability Support Pension or Carer Payment. The cost of a comprehensive dental check-up—comprising oral examination, clean, scale, and x-ray—is around $290. While many dentists welcomed any additional government money
for dentistry, the program still has its critics. From the start the Australian Dental Association was concerned about the haste in which the program had been rolled out. And the potential pitfalls that could lie in wait. Also, they were worried that the teen plan was never discussed at any length with any of the dental community. At the time, they were concerned there was no-one monitoring it. That criticism of Teen Dental will now be answered, with the Director-General of NSW Health giving approval for a wide-reaching NSW survey this year of teenag-
Statistics revealed that in 2001/02, the number of teens using the NZ program dropped to as low as 52 per cent of eligible adolescents.
ers aged 14-15 years old. The ADA president Dr Neil Hewson applauds the move, saying any feedback to help get a better idea of the effect of the free checkup vouchers was a good thing. Hewson says it was not known how many people had been identiﬁed as requiring treatment and whether they were getting the treatment they needed. As well, there was the question of whether some of the eligible teenagers would have gone for a check-up even if there was no voucher. “If you are running a program, there should be some sort of measurability,” he says. Anecdotal evidence suggested there was some confusion among patients as to what they were entitled to under the program. Hewson says he has heard of
patients becoming frustrated when they learned they could not get the necessary treatment free of charge. “I think people don’t understand the system that well and don’t understand it’s just for preventative services,” he says. The ADA’s position was that, if the program would not be expanded to offer coverage for ﬁllings, at least there should be a system whereby special cases, such as people in ﬁnancial difﬁculty requiring serious treatment, could apply to dental advisors to have the work done—similar to the Department of Veterans Affairs program. Hewson says such a program could be applied to varying degrees—because it was essential to treat any decay detected—but supports the main aim to try to minimise gum disease and decay, which are almost entirely preventable. Assessing the achievements so far, NSW Acting Chief Dental Ofﬁcer Dr Peter Hill says the program was well supported by private practices—possibly because of the relative simplicity of the scheme. “The vast majority of eligible teenagers are going private, but it [Teen Dental] is obviously an income stream for the public sector as well,” he said. One of the beneﬁts of the vouchers being available for use in private practices was that waiting times were shorter. And while treatment was not covered, people identiﬁed as needing urgent work could be put on a priority waiting list for public dental work. Hill says for healthy teenagers, regular check-ups, including preventative work, could be enough, “presuming that the teenagers are doing their work at home like cleaning their teeth twice a day, they will be getting through that difﬁcult period where there is a four-fold increase in dental decay”, he says. “But obviously that’s a long term strategy... all of these kids are going to get an an-
Get with the program The Medicare Teen Dental Plan is designed to provide ﬁnancial assistance to families to encourage teenagers to care for their teeth by having annual check-ups and to maintain good oral health habits once they leave home. The program started on 1 July 2008. Around 1.1 million teenagers aged 12-17 years of age in families receiving Family Tax Beneﬁt Part A, and teenagers in the same age group receiving Youth Allowance or Abstudy, will be eligible for the program each year. The Government will provide dental beneﬁts of up to $150 per calendar year for each eligible teenager to receive a preventative dental check from a dentist who is registered with Medicare Australia. Dental therapists and dental hygienists can also provide services under the supervision or oversight of a dentist. Medicare Australia will automatically send eligible families and teenagers a voucher for a preventative dental check each calendar year, using client information provided by Centrelink. Most people received their voucher in July or August this year. Eligible teenagers can receive their preventative check from a private dentist and claim the beneﬁt from Medicare Australia. Alternatively, the dentist can choose to bulk bill the preventative check (ie the dentist claims the beneﬁt directly from Medicare Australia). Teenagers will need to present their voucher when they have a preventative check. Eligible teenagers may also be able to use the voucher at a public dental clinic (including a school-based clinic).
Te e n d e n t a l p l a n
nual check under this scheme so it’s not just a one-off.”
eanwhile, across the Tasman, a similar scheme aiming to provide access to teenage oral health services in New Zealand has been at the brink of collapse, with disgruntled dentists simply opting out. Statistics revealed that in 2001/02, the number of teens using the NZ program dropped to as low as 52 per cent of eligible adolescents. The NZ Ministry of Health’s chief advisor on oral health, Dr Robin Whyman, said the Ministry found that difﬁculties arose when it allowed the focus to get away from pricing. “We went through some difﬁculty early this decade and we are in a phase of building the program back up,” she said. Dr Whyman explained that, before 2001, the system was funded by establishing a standard fee for each service paid to dentists. This agreed amount was updated periodically, but the gap between actual fees and the government-funded amount soon widened. Before long, dentists became disgruntled and started to withdraw from the program. In turn, the proportion of adolescents able to access free dental care was slashed. However, since 2001, the NZ Ministry has changed the fee notice to an individual contract between dentists and local district health boards. “The upside of this is that it has been a much better mechanism for a continuing review of pricing, and of the general program with the dentists providing the care,” Dr Whyman said. By 2006, the proportion of adolescents accessing free dental care increased to 58.3 per cent and each local district health board is now setting an
annual target to increase the proportion of adolescents accessing care. According to the chairman of the Association for the Promotion of Oral Health (APOH), Associate Professor Hans Zoellner, despite a sizeable $490 m being allocated to teen dental, because of the lack of followthrough, “it’s an expensive way to do nothing”. As well, Zoellner says that, although targeting teenagers sounded good as a piece of political spin, the message could be detrimental in practice. Because only teenagers qualiﬁed for the vouchers, it could send the message that looking after dental health beyond this period was not as important, despite the fact that people into
“Vouchers for check-ups should be done in line with national public sector norms. In an area that has been so badly neglected, when there is money spent on dentistry, you want to see it spent properly.” Associate Professor Hans Zoellner, Association for the Promotion of Oral Health (APOH)
their early 20s had shown a signiﬁcant susceptibility to dental decay. Zoellner says the APOH had canvassed dental groups and health ofﬁcials in an attempt to discover who had come up with the idea of Teen Dental. He says politicians and political journalists have suggested to him that it may have been thought up for political, rather than practical, purposes. Assuming Teen Dental was going to remain without major changes, Zoellner suggests providing vouchers for checkups only every two years, in line with national public sector norms,. “In an area that has been so badly neglected, when there is money spent on dentistry, you want to see it spent properly,” Zoellner says.¢
Photography by Matthew Scroope
Dr Paul Kotala went from Mosman to Cambodia to help out the needy. When I was in second year high school, I sat down and worked out the criteria for the job that I would like to do. One of those criteria was that I wanted something where I could educate and help people. Dentistry, along with a few other things, came up,” says Dr Paul Kotala. In 2002, he sold his Sydney-based dental surgery, said goodbye after 13 years of treating the local Mosman residents, and started traveling. Nearing the end of his voyage, the idealistic dentist visited Laos and Cambodia in search of a dental aid program he could join. “I spent a month in each country looking around, and neither had any dental programs. I had thought I could ﬁt in with
the United Nations or the World Health Organisation—that there would be a program like they do in Thailand and Vietnam—but there was nothing. Then I went to Nambak District Hospital with a friend who was with the Swiss Red Cross and the director of the hospital said to me, ‘We have no dentists, can you help?’. That’s how I ended up there, because someone asked. “It is important that we go into these countries and provide the people with treatment, but perhaps more important is to give them education that they wouldn’t otherwise have. However, we have to be aware that they are culturally different to us. A lot of organisations go in under the guise of helping and, in doing so, eliminate cultural heritage. I don’t want to change
them. I just want to provide education to the local people so there is assistance with health matters. I want to help maintain their culture and way of living. “It is totally different [to the surgery in Mosman]. You explain to people what it is like and they really have no idea how it is working under those conditions. I love doing it and the people are so happy, thankful and appreciative. That is a huge part of it for me; it’s because of them that we are doing this. “People say, ‘it is fantastic what you are doing’, but I don’t look at it from that point of view. I have a skill that I can give and educate to people that they can use to enhance their life, and it is something that I love doing. ¢