Don’t Eat Your Denture Paste
February 24, 2011
The story begins when a healthy 63-year-old Miami man began having trouble walking. Within months, he was paralyzed below the waist and confined to a wheelchair. He was unable to move his limbs and, eventually, unable to get out of bed. His condition worsened and his paralysis extended to his diaphragm, which ultimately led to his death. What led to his symptoms and eventual death? ……his denture adhesive, Poligrip.
Just months after his death, a groundbreaking study published in the medical journal Neurology established a connection between the zinc found in popular denture adhesives brands and serious nerve damage. The study showed that patients who used heavy amounts of denture cream suffered zinc overload, which can purge the body of copper, a mineral needed for healthy brain and nervous system function. Copper deficiency can cause anemia, weakness, numbness in the limbs, difficulty walking and permanent paralysis.
Although the body requires small amounts of zinc to fight illnesses and promote cell growth, some denture-wearers were unknowingly consuming nearly forty-five times or more of the recommended daily dosage. The National Institutes of Health recommend between 8-11 milligrams of zinc per day. Poligrip contains 38 milligrams of zinc per gram of the adhesive. Unbeknownst to him, the man who died had been consuming these dangerously high levels of zinc for over 14 years.
And with no warning on the packaging, he had no way of knowing how much zinc he was ingesting. He was simply trying to keep his dentures secure so he could chew his food and look good.
This all happened back in 2008. At the time, facing over a hundred lawsuits over its failure to warn consumers of the risks associated with its products, GlaxoSmithKline announced in early 2009 that it would voluntarily remove zinc from its adhesives. The company cited “potential health risks associated with long-term excessive use” and announced plans to release reformulated denture creams by April or May of 2009.
This was a promising sign that the company was finally taking responsibility for the safety of its consumers. But for many denture wearers, the damage has already been done. Forty million Americans wear dentures and removing zinc from denture cream will hopefully prevent debilitating, and potentially fatal, medical problems in the future.
Well, this is back in the news again. The reports are that there is an association between the excessive zinc and health concerns which date back to 2006. Documents were written and went to reviewers before they were published. One of the reviewers apparently delayed the publication by saying, “much of the information is irrelevant…..little more than speculation”.
That delayed getting information to doctors and the public. As it turns out, this reviewer was found to be a paid consultant for Proctor & Gamble, makers of the popular denture adhesive Fixodent.
Zinc has been taken out of Poligrip but not out of Fixodent. Proctor & Gamble says that used as directed, there is no evidence of ill-effects from their product.
For most people, if an upper denture is made correctly and is relined when it should be, there is no need for adhesive. Lower dentures are a different story. A couple of implants or mini-implants and the problem is solved – no need for denture adhesive.
There Are No Two Dental Practices Alike
No two dental practices are alike! Each takes on the characteristics of the practitioner who owns it. The personality of the owner is probably the key to how that office “feels” when you walk in the door. Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back. The dentist’s personality is reflected in his or her treatment preferences as well. The fact that different dentists will suggest different plans to treat your condition does not necessarily mean that one plan is better than another.
In my experience, all dentists will suggest what they feel to be the very best plan for any given patient. The differences between the treatment suggested by one dentist and that of another reflects that dentist’s preferences based on his or her experience. Thus, differing treatment plans do not necessarily reflect any deficiency in either dentist’s judgment.
It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances. A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is helpful if the dentist takes the patient’s ability to pay into account.
Think of treatment plans like various models of cars offered by different dealers. All of the models are new, have warranties and will work well out of the lot. The higher end models however have some advantages not found in the less expensive models. Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it.
Dental treatment plans are like that too. Saving a badly damaged tooth with a root canal and a crown will preserve it for a long time, but it is expensive, and the patient may opt for a much less expensive extraction instead. Replacing a missing tooth may be done with a more costly implant or fixed bridge (which remains in the mouth and is not removable), or a much less expensive removable partial denture. A dentist should be able to explain the advantages and disadvantages of the various options, and allow the patient to make the decision.
All dentists who have graduated from an accredited dental school should be technically competent to perform any procedure that they personally feel comfortable performing. But it is important to remember that each one is an individual, and no two dentists can perform exactly the same technical procedure in exactly the same way. As a matter of fact, no single dentist can perform exactly the same procedure exactly the same way twice in a row! How well your filling turns out depends as much on how wide you can open your mouth as it does on the technical qualifications and skills of the dentist himself or herself.
Over the years I have developed a respect for those who practice dentistry. By and large, these are honest people who have the best interest of their patients at heart.
But I Have Insurance
February 11, 2011
I had a reader e-mail me an insurance related question this past week and wanted answer that question as well as a couple of other insurance related issues.
Patients will sometimes balk at treatment not covered by their dental insurance. Dentists will often hear, “Just do what my insurance covers. I don’t want anything extra.” In fact, a recent ADA poll showed that a lack of dental insurance was the No. 1 reason most patients gave for not visiting a dentist. So, here are some frequent questions patients often ask about dental insurance.
Why doesn’t my insurance cover all of the costs for my dental treatment?
Dental insurance isn’t really insurance (defined as a payment to cover the cost of a loss) at all. It is a monetary benefit, typically provided by an employer, to help their employees pay for routine dental treatment. “Dental Insurance” is only designed to cover a portion of the total cost.
But my plan says that my exams and other procedures are covered at 100%.
That 100 percent is usually what the insurance carrier allows as payment towards a procedure, not what your dentist may actually charge. Dentist’s fees are usually a reflection of the level and quality of care in a particular office. Some cost more, some cost less, depending on the costs of running their office, how much they pay their staff, the materials they use, etc. An employer usually selects a plan with a list of payments that corresponds to its desired premium cost per month. Therefore, there usually will be a portion not covered by your benefit plan.
If I always have to pay out-of-pocket, what good is my insurance?
Even a benefit that does not cover a large portion of the cost of what you need pay something. Any amount that reduces your out-of-pocket expense helps.
Why is there an annual maximum on what my plan will pay?
Although most maximum amounts have not changed in 30 years, a maximum limit is your insurance carrier’s way of controlling payments. Dental plans are different from medical plans, in that dentistry is needed frequently. Medical emergencies are rare. It is your dentist’s responsibility to recommend what you need.
If my insurance won’t pay for this treatment, why should I have it done?
It is a mistake to let your benefits be your sole consideration when you make decisions about dental treatment. People who have lost their teeth often say that they would pay any amount of money to get them back. Your smile, facial attractiveness, ability to chew and enjoy food, and general sense of well-being are dependent on your teeth.
Other than complaining to your dental insurance company or your Employee Benefits Coordinator, your best defense is to budget for dental care, or ask your dental office if they have payment plans to spread payment out over time.
If you have any other insurance related questions please e-mail them to me.
The Silent Epidemic
February 8, 2011
With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population, there are a lot of people affected by diabetes. The most up to date research shows the connection between dental health and diabetes has never been more critical.
As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease.
Complications from diabetes cuts years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on.
This isn’t meant to be a scare tactic. These are simply the facts and, yes, they are sobering. But if you have diabetes or are pre-diabetic, you may want to brace yourself. Because we are going to talk straight about oral health and diabetes, two diseases that can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound.
The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few:
Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your uses to fight the infection.
People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums.
People who have diabetes and sever gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease.
Those who have gum disease and diabetes together are more than three time likely to die of combined heart and kidney failure.
In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease.
In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic.
Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease.
