2014 - Reception Room TFDA

Reception Room Taste Buds Dental Phobia Mouth Cancer

2014 RECEPTION ROOM ISSUE

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contents COVER STORIES Your Oral Health

6-32

columns

features

5 President’s Message

6 What Are Taste Buds?

35 Off the Cusp

10 The Benefits of Seeing an FDA Member Dentist 12 How Can I Get My Children to Let Me Brush Their Teeth?!

16 Dental Phobia ... How to Overcome It. 20 Caution: Obamacare Pediatric Dental/Medical

Embedded Deductible 22 Gum Chewing: Is It Helpful or Harmful?

26 Tobacco Use and Mouth Cancer 30 Generous Dentists Offer Comprehensive Care

to Patients in Need 32 Water Fluoridation

For information on oral health care, visit: www.mouthhealthy.org.

www.floridadental.org

Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.

Reception Room Issue 2014

Today's FDA

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FLORIDA DENTAL ASSOCIATION 2014 RECEPTION ROOM ISSUE VOL. 26, NO. 5

EDITOR Dr. John Paul, Lakeland, editor

STAFF

Boyd Brothers ad coming

Jill Runyan, Director of Communications • Jessica Lauria, publications coordinator Lynne Knight, marketing coordinator

COUNCIL ON COMMUNICATIONS Dr. Thomas Reinhart, Tampa, chairman Dr. Roger Robinson Jr., Jacksonville, vice chairman Dr. Richard Huot, Vero Beach • Dr. Scott Jackson, Ocala Dr. Marc Anthony Limosani, Miami • Dr. Jeff Ottley, Milton Dr. Jeannette Hall, Miami, trustee liaison • Dr. John Paul, editor

BOARD OF TRUSTEES Dr. Terry Buckenheimer, Tampa, president Dr. Richard Stevenson, Jacksonville, president-elect Dr. Ralph Attanasi, Delray Beach, first vice president Dr. William D'Aiuto, Longwood, second vice president Dr. Michael D. Eggnatz, Weston, secretary Dr. Kim Jernigan, Pensacola, immediate past president Drew Eason, Tallahassee, executive director Dr. David Boden, Port St. Lucie • Dr. Jorge Centurion, Miami Dr. Stephen Cochran, Jacksonville • Dr. Richard Huot, Vero Beach Dr. Don Erbes, Gainesville • Dr. Don Ilkka, Leesburg • Dr. Jolene Paramore, Panama City Dr. Rudy Liddell, Brandon • Dr. Beatriz Terry, Miami Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Paul Miller, New Port Richey, treasurer • Dr. Bryan Marshall, Weekiwachee, treasurer-elect Dr. John Paul, Lakeland, editor

PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2014 Florida Dental Association.

All rights reserved. Today’s FDA is a refereed publication.

POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.

EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; email address, fda@floridadental.org; website address, www.floridadental.org.

ADVERTISING INFORMATION For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113 Advertising must be paid in advance.

For classified advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.

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www.floridadental.org

PRESIDENT’S MESSAGE TERRY BUCKENHEIMER, DMD

Your Dentist, the FDA, and You!

“

The FDA and its dentists believe the two most important things are prevention of disease and the value of your doctor patient relationship

”

I’m very proud to be a Florida Dental

preserving the value of the doctor/patient

professional care, your teeth can and will

Association (FDA) member dentist and

relationship. Decisions regarding your

last throughout your life.

I’m sure your dentist is as well. It means

oral health are best done within that

that we, along with more than 6,000

personal relationship rather than one be-

Your dentist is committed to working

dentists in Florida, abide by principles

ing dictated by insurance companies and

with you to help you improve your oral

that promote the ethical practice of den-

governmental agencies.

health. The FDA is committed to work-

tistry. We also are dedicated to attaining

ing with your dentist to allow him or

the continuing education that keeps us

Oral health is essential to maintain your

her to provide that care in the best way

current with the ever-advancing field of

overall health and well-being. Decay and

possible. Working together, our goal is to

dentistry.

periodontal disease are two of the most

achieve your optimal oral health.

common chronic diseases that plague The FDA, as a health professional orga-

people of all ages, yet both are prevent-

nization, advocates on behalf of its mem-

able and can be easily treated. Your den-

bers for legislation that promotes the

tist and his or her team of professionals

oral health of our patients and maintains

are dedicated to help you reach your oral

our ability to provide you with safe and

health goals. Through proper nutrition,

effective care. The FDA is committed to

oral health education, home care and

www.floridadental.org

Dr. Buckenheimer is the FDA president.

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Today's FDA

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Taste Buds

6

Today's FDA

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www.floridadental.org

?

Taste Buds

What are

Taste Buds www.floridadental.org

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Today's FDA

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Taste Buds

“

The average person has about 10,000 taste buds and they’re replaced every two weeks or so.

But as a person ages, some of those taste cells don’t get replaced.

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”

www.floridadental.org

Taste Buds

Reviewed by: Steven Dowshen, MD

Did you ever wonder why your favorite foods taste so good?

Well, you can thank your taste buds for letting you appreciate the saltiness of pretzels and the sweetness of ice cream.

Taste buds are sensory organs that are found on your tongue and allow you to experience tastes that are sweet, salty, sour and bitter. How exactly do your taste buds work? Well, stick out your tongue and look in the mirror.

See all those bumps? Those are called papillae (say: puh-PILLee), and most of them contain taste buds. Taste buds have very sensitive microscopic hairs called microvilli (say: mye-kroVILL-eye). Those tiny hairs send messages to the brain about how something tastes, so you know if it’s sweet, sour, bitter or salty.

The average person has about 10,000 taste buds and they’re replaced every two weeks or so. But as a person ages, some of those taste cells don’t get replaced. An older person may only have 5,000 working taste buds. That’s why certain foods may taste stronger to children than they do to adults. Smoking also can reduce the number of taste buds a person has.

But before you give taste buds all the credit for your favorite

inside the uppermost part of the nose contain special cells that help you smell. They send messages to the brain.

Here’s how it works: While you’re chewing, the food releases chemicals that immediately travel up into your nose. These chemicals trigger the olfactory receptors inside the nose. They work together with your taste buds to create the true flavor of that yummy slice of pizza by telling the brain all about it!

When you have a cold or allergies, and your nose is stuffy, you might notice that your food doesn’t seem to have much flavor.

That’s because the upper part of your nose isn’t clear to receive the chemicals that trigger the olfactory receptors (that inform the brain and create the sensation of flavor).

Try holding your nose the next time you eat something. You’ll notice that your taste buds are able to tell your brain something about what you’re eating — that it’s sweet, for instance — but you won’t be able to pick the exact flavor until you let go of your nose.

So the next time you chomp on an apple or slurp up some soup, thank your tongue — and your nose! Without them, life wouldn’t have any flavor. (c) Nemours/KidsHealth. Reprinted with permission.

flavors, it’s important to thank your nose. Olfactory receptors

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See an FDA Member Dentist

The Benefits of Seeing an FDA Member Dentist

By Dr. Steve Zuknick

“Good morning, <insert your name here>! Welcome to our office. The doctor will be with you very soon! Please have a seat.”

Hopefully, you received a greeting such as this upon arriving today. If this is your first appointment or if your relationship is on the newer side, you may be anxious. What do you really know about the folks behind the counter and the masks? Are they courteous and caring? Are they prompt and pleasant?

These are opinions that you will develop over the course of your treatment.

What caused you to pick up the phone and call this particular office? What drove you to make this very important and

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extremely intimate decision? Was the choice based upon the recommendation of a friend or family member who has had an encounter with these people? Hopefully, this type of referral is not as risky as reading about a business or health care professional online from what @Babycakes241 said in a Google review. Online reviews are better than nothing. At least an acquaintance has some validity, some history, but if you really think about it, can your family and friends really know these people you have entrusted your health and your family’s wellbeing to?

My intent is certainly not to make the queasiness in your stomach worse; it’s actually to alleviate your fear. Regardless of what led you to choose this waiting room, you have actually made your way into an office that is more beneficial to you in a lot

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See an FDA Member Dentist

of ways. What makes this environment better than another? Your dentist is a member of what I like to call a club of like-minded individuals who have taken an ethical oath to put your well-being first. If you picked up this magazine, it is because your dentist decided that it is in her or his best interest (and therefore, yours) to belong to the American Dental Association (ADA), the Florida Dental Association (FDA) and their local dental association.

How does that help you? How could a few words on some paper really change how you are about to be treated? Your dentist has decided to follow a code. This code is an ethical playbook by which he or she has chosen to operate. It’s a guide for situations in which you must trust them regarding your best interest. I hope this fact alone would give you some piece of mind, but let me give you something else to think about, something even more tangible. Your dentist’s membership also ensures that the materials being used on you are safe and effective. The ADA, via its Journal of the American Dental Association, publishes research that your practitioner can read about the latest studies on materials and processes. How is that for important?

Even a patient whose dentist is not a member benefits from the ADA’s research, so how about something specific to you — how about saving you money? That’s right, because your dentist is a member of these dental associations, you will inevitably pay less. This dentist has the ability to keep his or her business overhead lower because, as a member, he or she enjoys the buying power of being part of a larger group. There are life and disability insurance savings. They receive discounted (or free) continuing education to ensure that they stay current in the science and practice of dentistry.

There are many more savings, but suffice it to say that these savings allow your cost of treatment to stay as low as possible.

“Your dentist is a member of what I like to call a club of like-minded individuals who have taken an ethical oath to put your well-being first.”

I realize in this age of electronic immediacy, many of you may not have gotten this far in the article. Kudos to you who have, and I believe it’s just about time for your appointment, but before you go, one last note. I want to say congratulations. Whether it was accidental or not, you can relax knowing your doctor has decided to put you first by maintaining membership in these organizations. If you aren’t too stressed, tell them thank you for putting you first. Best wishes on your appointment!

For more information on the “Principles of Ethics and Code of ADA Professional Conduct,” go to http://www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdf.

Dr. Zuknick has a general dentistry practice in Brandon.

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Brushing Teeth

How Can I Get M to Let Me Brush T 12

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www.floridadental.org

Brushing Teeth

By Dr. Erin Smith Berling

My Children Their Teeth?! www.floridadental.org

Children often have a hard time allowing parents to brush their teeth for the proper amount of time with the desired technique and quality that is needed for proper oral hygiene. Oftentimes, parents tell me that they are just happy to be able to get the toothbrush in the mouth and swipe it across the teeth once or twice before their little one loses interest or just wants to do something else. So that brings up the question: â&#x20AC;&#x153;What is the best way to get my little one to allow me to brush their teeth?â&#x20AC;? My professional opinion (and what I tell my patients) is to use a technique that puts the child in a similar position as when they are sitting in the dentist chair. For example, instead of having the child sit on the counter or stand in front of you, lie them down on the couch with their head in your lap.

If your child is really little or does not like the activity of brushing their teeth, you can always use a second adult to gently hold their hands while brushing.

This position allows for the mouth to be open and the parent to be looking down into the mouth, just like at the dentist's office. Also, you can do this during a commercial break while watching television so that the child knows when their show comes back from commercial you will be finished and they can go back to watching TV!

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Please see BRUSH, 15

Today's FDA

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en you’ll be hospitalized.

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Benefit is paid 2 times per USAble Life is an independent calendar company and operates separately from Blue Cross and Blue Shield of Florida. USAble an American will suffer a year per covered person, except for dependent insurance@fdaservices.com coronary event, and aboutand is solely responsible for the Hospit children. maximum number of visits for all dependent service Blue Cross and Blue Shield ofTheFlorida products.

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10

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Brushing Teeth

“

When do we start using fluoride toothpaste and switch from training toothpaste?

BRUSH from 13

Since we’ve talked about the recommended position for tooth brushing, let’s talk about when tooth brushing and flossing should begin at home. We’ve all heard about the American Academy of Pediatric Dentistry’s recommendation, “First visit by first birthday,” but the average for first tooth development is six months. Should you not brush that tooth for six months before you go to the dentist? Absolutely not! It is recommended to start brushing before that first tooth even arrives. Use an infant finger brush product or simply a wet washcloth to gently massage the gum pads twice a day.

This simple step will allow your child time to adapt to having someone looking in their mouth before the first tooth erupts. Your child may not like you brushing their teeth at this age, but you can always use the positioning technique above to make it easier on them — and you. Another simple trick to assist children in opening their mouths is to run your finger along the inside of their cheek away from the teeth and push slightly on the back gum pad behind the last tooth. Voila! Your child’s mouth should be open just enough to receive a toothbrush. As mentioned above, a common misconception when brushing toddler and infant’s teeth is to only brush the teeth that are currently present. I tell parents every day, during infant oral exams, to brush the gums where teeth will soon be developing. By brushing the areas where teeth will soon be developing, the child becomes familiar with brushing the molar region of the mouth. In addition, often infants will find the gum brushing very soothing, almost like a massage would be for mom and dad!

Flossing can be initiated as soon as brushing; however, when I mention this in my practice most parents give me a wide-eyed look as if to say, “I can barely get a brush in there, and you expect me to keep all my fingers while flossing their teeth?” While we do not encourage losing a digit, make sure you are helping your little one floss as soon as the front or back teeth start to touch or “kiss.” The most common type of cavity that I see in my practice for toddler and preschool-aged children are “kissing cavities” that occur between the teeth. The prevalence of “liquid sugars” in the diet make them a sneaky culprit of dental cavities. Liquid sugars are drinks that contain sugar, such as soda, sports drinks, fruit juices and even milk! Due to the increased levels of sugar (natural or added) in our diets, we highly recommend starting to floss as soon as teeth begin to touch each other and brushes can no longer clean between the teeth. Using kid-oriented floss sticks (dinosaurs, flashy colors, Disney characters, etc.) is a great

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”

way to introduce flossing in a non-intimidating manner. The physical act of flossing will remove any trapped food from between the teeth and gums, but many of the flossers also are coated with fluoride. The fluoride coating helps combat the liquid sugars that we consume and often are trapped on our teeth for days after consuming. While flossing does not mean your child can drink all the liquid sugar they want, it will help with the occasional non-meal sugary drink that is consumed throughout the day.

The final big question that I get in my office from parents of preschool-aged children is, “When do we start using fluoride toothpaste and switch from training toothpaste?” The answer depends on your child’s cavity risk factors. These can be assessed by your pediatric dentist at their first visit. Some children need to switch before the two-year-old mark, so it is important to have their risk status assessed early, when the chance of prevention is still on the table. Using these tips and techniques, as well as a commitment to good oral hygiene, parents can give their children the best opportunity to stay in the cavity-free club.

Dr. Smith Berling is a pediatric dentist in Lakeland.

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Dental Phobia ...

Dental Phobia

Dental Phobia

How to Overcome it

By Sharon Paul

q racing or pounding heart; chest pain or tightness q trembling, shaking

We cringe at the sight of the syringe and sound of the drill.

q feeling dizzy or lightheaded

We make dental appointments, and then cancel them. We get

q churning stomach, physically ill

sweaty palms, feel overwhelming anxiety and have difficulty

q hot or cold flashes, sweating

sleeping the night before a dental appointment. As patients, we have to lie back with our mouths wide open, unable to commu-

Emotional:

nicate – thus rendered passive and unable to see what is going

q feeling overwhelming anxiety or panic while in the waiting room

on – all adding to the feelings of uncertainty and apprehension.

q intense need to escape It is estimated that as many as 75 percent of Americans experi-

q feeling “unreal” or detached from yourself

ence some degree of dental fear . Fear ranges from mild feelings

q fear of losing control of your body or going crazy

of apprehension to high levels of stress, emotional discomfort

q feeling like you are going to pass out

3

and full-blown panic attack.

Ten percent of Americans are considered dental phobic. The significant factor in a phobia is avoidance. These people avoid dentistry at all costs, only seeking treatment for an emergency

q knowing that you are overreacting, but feeling powerless to control your fear

What Causes Dental Phobia?

People are not born fearful; the association with dentistry

or when in extreme pain. Teeth deteriorate to an appalling

develops out of socialization and personal learning experiences.

condition; resulting in low self-esteem, distancing from rela-

Those who suffer from dental anxiety are usually very compe-

tionships, failure to achieve goals in life and a host of physical

tent in all other areas of their lives.

problems. They believe that no one understands their fear; they are embarrassed, ashamed and concerned that they are mentally

Specific Fear:

unstable.

Some people have difficulty tolerating a particular dental

Signs and Symptoms of Dental Phobia

procedure or the associated pain. “I can’t stand needles,” “I

Physical:

through that drill.”

hate dentistry” or “I would rather go with a toothache than go

q difficulty sleeping the night before a dental appointment

Please see PHOBIA, 18

q difficulty breathing or feeling that you are suffocating

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Dental Phobia

It is estimated that as many as 75 percent of Americans experience some degree of dental fear PHOBIA from 17

Distrust:

Relaxation:

Many people feel uncomfortable, helpless and claustrophobic

The relaxed body is more comfortable, has less stress, decreased

during dental treatment. Others feel self-conscious, embar-

blood pressure, a sense of well-being and mastery over fear. We

rassed and fear being scolded about the appearance of their

can learn relaxation and breathing techniques that can be called

teeth or possible mouth odors.

upon when needed, in day-to-day life or in the dental chair.

Uncertainty:

Behavioral and Cognitive Therapy:

We fear the unknown and worry about receiving bad news. We

Therapy can help you uncover the underlying causes of worry

believe that we have a horrible cancer, disease or infection.

and fear, learn how to relax, look at situations in new, less frightening ways and develop better coping and problem-

Vicarious Learning:

solving skills. Therapy gives you the skills to overcome anxiety

We hear horror stories from family, friends and the media of a

and teaches you how to use them to accept dental care without

painful, horrible dental experience â&#x20AC;&#x201D; and believe them!

undue difficulty and fear.

Generalized Anxiety:

Systematic Desensitization:

Many life situations are experienced as stressful or difficult.

A hierarchy of anxiety provoking situations and associated

Dental fear may be predominant, but it is frequently one of

symptoms is established. Anxiety is reduced through gradual

several fears or phobias. This is the most common type of den-

exposure to the identified situations, beginning with least

tal fear in patients .

threatening (sitting in waiting room) and progressing to more

Treatment

threatening (sitting in the chair waiting for the dentist to get

behavioral and pharmacological techniques. As with any illness,

Hypnosis:

3

Treatment of dental anxiety often includes a combination of dental phobic patients must take some initiative in their treatment and recovery.

the drill to begin treatment).

The patient is guided through a sequence of procedures to establish deep relaxation. Anxiety is reduced through suggestions focused on comfortable images of a better life. The patient is cured of dental fear and proud owner of a beautiful smile2.

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Dental Phobia

Pharmacological Techniques:

q Find a dentist who has an office with a calming effect.

Sedation refers to the use of medication to calm and relax pa-

Many dentists offer you headphones to listen to music, a

tients prior to and during dental appointments. The degree of

comedy routine or TV; aromatherapy; virtual reality glasses;

sedation may vary from light calming to general anesthesia .

warm blankets or massage.

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Tips to Get Through Your Next Dental Procedure

THERE IS HOPE! You don’t have to live with dental fear.

q Develop a relationship with a dentist before something

need to be embarrassed. You can accept dental care without un-

Regardless of your own personal experience, understand that your fear may have kept you from the dentist, but there is no

hurts. Talk about your fears and share past experiences,

due difficulty and fear. You can reduce your anxiety level, keep

ask questions about anything that worries you. Once your

appointments and your teeth, and have the confidence that a

dentist knows about your fears, he or she will be better able

beautiful smile can bring.

to work with you to determine the best way to reduce your

References:

anxiety and increase your comfort. If your dentist does not take your fears seriously, find another dentist.

1. Dionne, Pnero, Becker. (2002). Management of Pain and Anxiety in the Dental Office.

q Establish a signal — such as raising your hand — when you

2. Heap, Aravind. (2002). Heartlands Medical and Dental

want the dentist or hygienist to stop treatment. Use this

Hypnosis.

signal whenever you are uncomfortable, need to rinse your

3. Milgrom, Weinstein, Getz. (1980). Treating Fearful Dental

mouth or simply need to catch your breath.

Patients.

q Take a friend or family member along to meet the dentist,

Sharon Paul is a Licensed Mental Health Counselor.

keep you company in the waiting room or for support during treatment.

People are not born fearful; the association with dentistry develops out of socialization and personal learning experiences. www.floridadental.org

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ACA

Caution:

Affordable Care Act Pediatric Dental/Medical Embedded Deductible

â&#x20AC;&#x153; â&#x20AC;?

Some health insurance carriers are including pediatric dental/ vision coverage with the medical coverage and others are using a stand-alone dental plan.

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ACA

By Carrie Millar

FDA SERVICES AGENCY MANAGER

The Affordable Care Act (â&#x20AC;&#x153;Obamacareâ&#x20AC;?) has brought a lot of changes, including every plan sold after January 2014 must include 10 essential health benefits (EHBs). These categories are listed in the figure to the right and include pediatric services.

This means that if you purchase an individual plan or group plan starting this year, it will have to cover all of these services â&#x20AC;&#x201D; including pediatric dental and vision for all children under the age of 19.

However, the guidelines do not state how pediatric dental is to be offered and you need to make sure that you understand your benefits before you go to your pediatric dentist. Some health

Five Tips for Purchasing Health Insurance:

insurance carriers are including pediatric dental/vision coverage

v When purchasing your medical plan, ask if the pediatric

with the medical coverage and others are using a stand-alone

dental/vision deductible is embedded (combined) with the

dental plan.

medical.

Some of the carriers using a combined medical/dental plan are using embedded deductibles. This means your deductible

v Ask for a list of dental or vision providers who are in-network BEFORE you purchase the plan.

is the same for medical and dental coverage, and it must be met before benefits are paid. For example, if your deductible is $2,500, then under the embedded deductible you may not

v Find out the maximum benefit paid in a calendar year before you purchase.

have any dental services covered until that amount has been met. After the deductible is met, there may be cost sharing by patient as well. This can be very alarming if you have a high

v Find out if the plan has coverage for out-of-network providers (PPO).

deductible plan because pediatric dental/vision benefits are not covered until the high deductible is met, in some cases as high as $6,350.

v Make sure the plan is a true dental plan and not a discount card.

Contact your local insurance agent if you have more questions.

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Gum Chewing

Gum

...

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Gum Chewing

?

www.floridadental.org www.floridadental.org

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Gum Chewing

â&#x20AC;&#x153;

Studies have shown that chewing sugar-free gum after meals and snacks can help rinse off and neutralize the acids released by the bacteria in plaque, which are harmful to tooth enamel.

â&#x20AC;?

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Gum Chewing

When it comes to chewing gum, it’s the type of gum you chew that makes a difference in whether it’s helpful or harmful to your teeth. While chewing gum containing sugar may actually increase your chances of developing a cavity, there is clinical evidence that demonstrates just the opposite for sugar-free gum. And there’s even better news when it comes to chewing sugar-free gum that is sweetened with xylitol.

Sugar-free Gum Helps to Clean Teeth Both the act of chewing and the flavor of the artificial sweeteners in the gum stimulate ten times the normal rate of saliva flow. Not only does the increased saliva flow neutralize the acids in your mouth, it also washes away food particles, helping to keep your teeth clean.

Xylitol Reduces Decay-causing Bacteria Sugar-free gum sweetened with xylitol has the added benefit of inhibiting the growth of Streptococcus mutans, one of the oral bacteria that causes cavities. In the presence of xylitol, the bacteria lose the ability to adhere to the tooth, stunting the cavity-causing process. With xylitol use over a period of time, the types of bacteria in the mouth change and fewer decay-causing bacteria survive on tooth surfaces.

To Chew or Not to Chew Although chewing sugar-free gum can be beneficial in most instances, there are some cases in which chewing gum is not recommended. For example, if you are experiencing any type of jaw pain or temporomandibular disorder symptoms (TMD/TMJ), you should refrain from chewing gum and talk to your dentist about what options are available to you.

For most people, chewing sugar-free gum (especially gum sweetened with xylitol) can be a good preventive measure in situations when toothbrushing and flossing aren’t practical, but sugar-free or not, chewing gum should never replace good dental hygiene practices.

Information courtesy of the Academy of General Dentistry and Delta Dental Insurance Company.

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Tobacco and Mouth Cancer

Tobacco Use and

By Drs. Indraneel Bhattacharyya and Nadim Islam

Approximately 30,000-40,000 new cases of mouth (oral) cancer are diagnosed each year in the United States. A large proportion of these cases is related to tobacco use. About 8,000 of these patients die each year. Smoking can increase your risk for developing oral cancer by eight to 10 times. Many studies attribute up to 75 percent of all oral cancer-related deaths to smoking combined with drinking. The best thing you can do to reduce your risk of oral cancer is to not smoke.

Fig 1. A white precancerous patch on the bottom of the tongue that does not rub off and has been present for at least a few months.

Fig.2. Thick white area inside the lower lip associated with chewing tobacco (snuff). Biopsy showed precancer-like changes. Patient chewed tobacco for more than 25 years.

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The International Agency for Research on Cancer (IARC) estimates that smokers have a threefold increase in risk of oral cancer when compared to non-tobacco users. They also have a sevenfold risk of pharyngeal (throat) cancer. Cigarette smoking is a major health risk to vast numbers of smokers. It is the major cause of cancer deaths in developed countries and it is estimated that one in five cancer cases are caused by smoking.

At least 50 percent of current smokers will be killed by their habit if they continue, and 25-40 percent of these will die in middle age. Based on the current trends, it is safe to assume that tobacco will kill about one billion people in the 21st century.

Apart from oral cancers, the habit of smoking also is known to be a major cause/risk factor for cancers of the bladder, cervix, kidney, larynx (voice box), pharynx (upper throat), nose, esophagus (food pipe), pancreas, stomach, liver and some types of leukemia. Therefore, smokers are seven times more likely to die of these than non-smokers. It is important to know that smoking is the most important preventable cause and is associated with increased prevalence of pancreatic cancer, stomach cancer, breast cancer and lymphomas.

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Tobacco and Mouth Cancer

d Mouth Cancer The combined use of tobacco and alcohol increase one’s risk of oral cancer significantly. Tobacco and alcohol have a synergistic effect — their combined effect is greater than each one separately — so people who drink and also smoke heavily have a much higher risk of developing oral cancer compared to others.

A smoker who smokes two packs per day (40 cigarettes) and consumes an average of 30 pints of beer or equivalent alcohol per week is 38 times more likely to develop mouth cancer compared to other people.

It has been proven that tobacco, especially smoking, alters the structure of the DNA (deoxyribonucleic acid), causing a genetic mutation in the tissues of the mouth. Since DNA provides the cells with a basic set of instructions, similar to a computer program, altering the DNA may cause cells to grow in an uncontrollable manner, eventually producing a sore or lump.

As soon as the cancer reaches the blood stream, usually through the lymphatic system (lymph nodes), it can spread anywhere in the body and invade bones, blood and organs. Typically, oral cancer first spreads to nearby parts of the mouth, then the nodes of the head and neck, and eventually to other parts of the body.

Tobacco-related cancers of the mouth usually start in the cells that line the inside of the mouth (squamous epithelium), hence are called squamous cell carcinomas.

The possible signs and symptoms of oral cancer include a nonhealing or persistent sore; area of irritation, or a lump or thick patch in the mouth, lip or throat; a white or red patch in the mouth; a feeling that food or a “barb” is caught in the throat; trouble with swallowing or speaking, or moving the tongue around in general; numbness or alteration of sensation in the tongue or other areas of the mouth; unusual pain from the mouth radiating to the ear or other parts of the face or neck.

Please see TOBACCO, 28

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“ ”

It has been proven that tobacco, especially smoking, alters the structure of the DNA (deoxyribonucleic acid), causing a genetic mutation in the tissues of the mouth.

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Tobacco and Mouth Cancer

TOBACCO from 27

Any person with a history of smoking with any of the above signs or symptoms should see a dentist or health care professional immediately.

“ ”

Like cigarettes, smokeless tobacco also can cause cancer.

At least 28 chemicals in smokeless tobacco have been found to cause cancer.

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Unlike cigarette smoking, smokeless tobacco is tobacco that is not burnt. Smokeless tobacco also is known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew and snuff/snus. Most people chew or suck (dip) the tobacco in their mouth and spit the tobacco juices that build up. Nicotine in the tobacco is absorbed through the lining of the mouth. There are two main types of smokeless tobacco: chewing tobacco and snuff.

Chewing tobacco: A piece of tobacco is placed in the mouth, between the cheek and lower lip. This is available as loose leaves, plugs or a twist of rope. It is held in place or chewed. Saliva is then spit out.

Snuff: Finely cut or powered tobacco is sold in different scents and flavors. It is packed moist or dry. In the U.S., most snuff is the moist variety. It is available loose, in dissolvable lozenges or strips, or in small pouches similar to tea bags. The user places a pinch or pouch of moist snuff between the cheek and gums or behind the upper or lower lip. Some people inhale dry snuff into the nose.

Like cigarettes, smokeless tobacco also can cause cancer. At least 28 chemicals in smokeless tobacco have been found to cause cancer. Nitrosamines are found in smokeless tobacco and scientists have found that the nitrosamine level is directly related to the risk of cancer. Other than nitrosamines, polonium and polynuclear aromatic hydrocarbons in smokeless tobacco also contribute to cancer formation.

Because all tobacco products are harmful and cause cancer, the use of all of these products should be strongly discouraged.

There is no safe level of tobacco use. People who use any type of tobacco product should be urged to quit. As long ago as 1986, the advisory committee to the Surgeon General concluded that the use of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous oral conditions, and can lead to nicotine www.floridadental.org

Tobacco and Mouth Cancer

addiction and dependence.” Furthermore, a panel of experts convened by the National Institutes of Health (NIH) in 2006 stated that the “range of risks, including nicotine addiction, from smokeless tobacco products may vary extensively because of differing levels of nicotine, carcinogens and other toxins in different products.” It is important to remember smokeless tobacco is still tobacco and contains many of the same cancercausing chemicals called nitrosamines. Smokeless tobacco also contains nicotine — an addictive drug. In fact, holding an average-size dip in the mouth for just 30 minutes can deliver as much nicotine as smoking three cigarettes. Nicotine addiction can make quitting difficult.

It is heartening and interesting to know that several studies have shown that stopping smoking or chewing tobacco can greatly reduce the risk of tobacco-related cancers. And the earlier one stops, the better the outlook for future disease prevention. Results from multiple large-scale studies have concluded that stopping smoking by the age of 50 halved the excess risk of cancer overall, while stopping at the age of 30 avoided almost all of the risk! However, it’s never too late to quit!

Fig.3. Typical mouth cancer presenting as a persistent sore on the side of the tongue, present for about one year.

Here are some useful websites about oral cancer and quitting tobacco: v https://www.nidcr.nih.gov/OralHealth/Topics/OralCancer/ AfricanAmericanMen/CausesSymptoms.htm v http://www.tobaccofreeflorida.com/ Drs. Nadim Islam, Indraneel Bhattacharyya and Don Cohen are professors at the University of Florida College of Dentistry, and provide insight and feedback on common, important, new and challenging oral diseases. The dental professors operate a large, multi-state biopsy service. They write a column titled “Diagnostic Discussion” for Today’s FDA that includes case studies that originate from the more than 10,000 specimens the service receives every year from all over the United States.

www.floridadental.org

Fig.4. A large sore with lump formation on the side of the tongue. This mouth cancer had grown to this size in less than six months.

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Florida Donated Dental Services

Generous Dentists Offer Comprehensive Care to Patients in Need

By Dental Lifeline Network ● Florida

Fifty-five-year-old Boyd, a resident of St. Cloud, has suffered vision problems since birth and is legally blind. He is unable to read but enjoys listening to TV, especially the NASCAR races, with Chewy, his three-year-old Chihuahua.

Boyd was in desperate need of dental care, including 10 extractions to eliminate his painful periodontal disease and

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frequent abscesses. As a young adult he was able to work, repairing vehicle transmissions and installing concrete, until his deteriorating vision prevented further employment. Now, he is financially dependent on social security disability insurance, food stamps and Medicaid. Boyd could not afford the extensive dental treatment he needed and Medicaid does not cover dental therapies for adults.

Thankfully, Boyd was rescued by Dental Lifeline Network • Florida’s Donated Dental Services (DDS) program, which often is the last resort for people who have no access to treatment. Due to the overwhelming generosity of Dr. M, a DDS volunteer, Boyd was relieved of his pain. His oral health is restored and Boyd has new dentures and a new smile.

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Florida Donated Dental Services

Boyd (center), a resident of St. Cloud who is legally blind, received comprehensive dental care due to a generous donation from Dr. M (right) and his assistant through Florida Donated Dental Services (DDS), a program of Dental Lifeline Network • Florida.

“My treatment with DDS was excellent,” said Boyd. “They asked me what was the first thing I’d do. I got me a great big apple and ate it — it was delicious! I just keep smiling. It’s nice to walk up to someone and grin!”

Boyd is one of thousands of vulnerable Floridians with disabilities or who are elderly or medically fragile and have no access to dental care that they desperately need.

Dr. M, who treated Boyd, is a one of 396 Florida DDS volunteers. In addition, 196 Florida dental laboratories and several labs from outside the state donate their services.

Through Florida DDS, nearly 1,300 people have received $4.7 million in donated treatment since Dental Lifeline Network • Florida was founded in 1997 in conjunction with the South Florida District Dental Association (SFDDA). This year, the Florida Dental Association Foundation has granted funding that enabled DLN to hire a full-time program coordinator.

To apply for the Florida DDS program, please call Megan Gallagher at 850.577.1466. For more information, visit http://dentallifeline.org/florida/.

Dental Lifeline Network • Florida is part of the national Dental Lifeline Network organization, a charitable affiliate of the American Dental Association. Dental Lifeline Network serves patients in all 50 states and the District of Columbia through more than 15,000 volunteer dentists and 3,600 laboratories.

How to Apply for Treatment Applicants for the DDS program must lack adequate income to pay for treatment and have a permanent disability, or be age 65 or older, or qualify as medically fragile.

Patients who qualify as medically fragile are those who need a clean bill of oral health to receive chemotherapy for cancer or autoimmune diseases, an organ transplant, dialysis, cardiac surgery or those who have crippling arthritis and need a joint replacement.

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Fluoridation

Water

Fluoridation together to prevent even more cavities than by fluoridation alone.

By Johnny Johnson Jr., DMD, MS

What is Water Fluoridation?

Nearly all naturally occurring water sources contain fluoride â&#x20AC;&#x201D; a mineral that has been proven to prevent, and even reverse, cavities. Water fluoridation is the precise adjustment of the natural levels of fluoride in the water to the level that prevents cavities.

This level, called the optimal level of fluoride in water, is 0.7 mg of fluoride per liter (ppm = parts per million).

In Florida, most communities have 0.2 ppm of fluoride in the water. This amount comes from the rock formations in the earthâ&#x20AC;&#x2122;s crust that the water passes through on its way to our aquifers.

At 0.7 ppm, 25 percent of all cavities that children and adults would experience are prevented. Not only are 25 percent of the cavities prevented, but the severity of those cavities is less extensive because of water fluoridation. Put simply, by drinking the water, everyone in a community benefits from water fluoridation without a single change in their daily behaviors.

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Fluoridation is:

Why is Water Fluoridation Important?

Cavities are caused by certain bacteria in the mouth. When a person eats sugar and other refined carbohydrates, these bacteria produce acid that removes minerals from the surface of the tooth.

Fluoride helps to remineralize (re-harden) tooth surfaces and prevents cavities from continuing to form.

Water fluoridation is just one of the tools to fight cavities. Brushing your teeth two times a day with fluoridated toothpaste, flossing, eating a well-balanced diet and the use of topical fluorides like mouth rinses or gels, all work

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q safe. There are no known adverse health effects from water fluoridation at optimal levels. q effective. At optimal levels in the water, at least 25 percent of cavities in children and adults are prevented by simply drinking the water. q cost saving. Fluoridation benefits everyone regardless of socio-economic status, race, age or educational level.

For every $1 spent on fluoridation, $38 is saved per person per year in dental treatment costs.

Fluoridation has been practiced safely and effectively in the U.S. for nearly 70 years. More than 13 million of the 17 million Florida residents who are served by community water systems (or 78 percent) receive optimally fluoridated water.

Opposition to Fluoridation: A small, but vocal group of opponents of fluoridation has been in existence since fluoridation was first introduced in the www.floridadental.org

Fluoridation U.S. in 1945. Today, this group uses the Internet to voice their personal opinions about fluoridation in an attempt to invoke fear in the public that it is evil and harmful. Nothing could be further from the truth. In fact, nearly every major scientific organization in the world supports water fluoridation as safe and effective. No credible scientific group supports a single claim made against fluoridation by those opposed to it.

Sources for Credible Information on Fluoridation: Google and other search engines are very good resources to establish a starting place for a lot of research, but not when it comes to medical science. The Internet has given everyone the ability to promote their own opinions as facts without anyone to filter truth from myth. Trust the resources that we trust the health of our children and families for: the American Academy of Pediatrics, American Dental Association and the Centers for Disease Control and Prevention (CDC). Please see the following links for more information: q American Academy of Pediatrics http://www.ilikemyteeth.org/fluoridation/ q Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/fluoridation/faqs/ q American Dental Association: http://www.ada.org/en/home-ada/ public-programs/ advocating-for-the-public/fluorideand-fluoridation Dr. Johnny Johnson is a pediatric dentist in Palm Harbor.

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When your needs change, we’re here for you.

Sometimes life can take an unexpected turn.

Count on us to help you find your way with a health plan option that fits your needs and budget. Use our free mobile app to easily find the nearest doctor. We can even show you how to get help paying for health insurance. In all of life’s moments, count on us. Contact FDA Services, your local agency for Florida Blue to learn more.

FDA Services 800-877-7597 www.fdaservices.com 1113 E. Tennessee St. Tallahassee, FL 32308 80909-0414/77535-0713 Agt

Florida’s Blue Cross and Blue Shield Plan.

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

OFF THE CUSP JOHN PAUL, DMD, EDITOR

Translations A lot of my patients believe that dentists take a course on how to understand what patients say when their mouth is full of our instruments/fingers. That is pretty close to the truth; after several years of listening to patients, you get to a point when you can make sense of the mumbling.

Even when we are speaking plain English though, some things don’t mean what they seem. The following is a list of things said by patients and dentists that might benefit from a little translation.

Dentist: “You are going to feel some pushing.”

Variation: “You are going to feel a little prick.”

Dentist: “Bite your teeth together and grind around.”

Translation: “I’ve seen three of these and treated one.”

Translation: “Not like a trip hammer, but ever so gently so you don’t bite a hole through your numb tongue or break this crown before I get it adjusted properly.

Ease your teeth together in the way you normally chew, and slide them back and forth to show me where this restoration is too high so I can make it fit properly.”

Variation: “I’ve seen somewhat less than 50 of these …”

Dentist: “The best material for you will be gold.”

Translation: “Your bite is like a hammer on an anvil and your teeth are a kaleidoscope of colors we will never match to your satisfaction. Gold might last and it only comes in one color.”

Translation: “I saw a picture of this on a test in dental school.”

Dentist: “This won’t hurt a bit.”

Translation: “We both know this is an exaggeration, but it’s time for me to go to work and I’ll do my best because I want you to feel comfortable enough to come back.”

Patient: “Money is no object.”

Patient: “I brush and floss twice a day.”

Translation A: “I’m independently wealthy and never leave home without my American Express Centurion card.”

Translation: “I have a hairbrush, and I’ve heard of a toothbrush, but what is this floss you speak of?”

Translation B: “I have no intention of actually paying, so money really is no object.”

Patient: “I can tolerate a lot of pain.”

Variation: “I brushed my teeth real well before I went in for my cleaning.” The doctor can tell.

Translation: If I feel the slightest breeze or tickle I am going to complain. If I actually could tolerate a lot of pain, I would never have brought the subject up.”

Dentist: “I’ve done somewhat less than 100 of these …”

People will forget what you said and they will forget what you did, but they will never forget how you made them feel.

I hope you got a little tickle out of this.

Now go and have a nice chat with the folks in the back!

Translation: “Given that you have multiple tattoos, a pierced eyebrow, lip and tongue — all done without anesthesia — this tiny needle I’m going to use to deliver the numbing should be no problem.”

Dr. Paul is the editor of Today’s FDA.

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THE SIGN OF A PROFESSIONAL!

Member dentists of the American Dental Association and Florida Dental Association are committed to a code of ethics and professional conduct that puts patients first.