There are five major reasons that people do not get the necessary dental care they need. They are money, time, lack of concern, fear and trust. Let’s take a quick look at each one and see what dentists try to do to overcome these obstacles for patients.

Although you may think that money would be the number one reason people avoid ideal dental treatment, it is not. Even in tougher economic times, money, although a significant barrier for many, is still not the number one issue for most. Yes, dental care in some cases can be a significant investment. With insurance company’s unwillingness to raise the bar, as I have talked about in previous columns, patients often get stuck with large dental bills. Unfortunately, as of now, we have to face these facts but it should not mean avoiding the dentist.

Many dentists offer payment plans through third party carriers so patients can pay for treatment over an extended period of time. Ask your dentist if they have such an option. The point here is to get a plan. Once a plan is established, your dentist can work with you to prioritize and sequence your treatment. This way, if you need to spread your treatment over a period of time to make it affordable, you can pick away at a well thought out plan.

Time is an excuse. We all use time as an excuse for many of the things in our lives we want to avoid or procrastinate on. The reality is, however, if we place something high enough in our value system there is always time for it. In order to move something higher up in our value system, we must be educated and come to realize that this particular thing is of benefit to us. If you want better health/quality of life and to avoid the pitfalls of neglect, make the time.

The most common reason people avoid ideal dental care is lack of concern. Lack of concern about dental health is prevalent in our population for a few reasons. Absence of pain is one. Other than “nerve gone bad” need for a root canal, there few things that actually cause pain. Gum disease is a perfect example. About 75% of the population has some form of this disease but only 50% of the population goes to the dentist. Why? No pain. This doesn’t mean it is healthy and there are not problems down the road like loss of teeth. It is up to the dentist to educate patients on these types of issues, but people have to actually go to the dentist to get this information.

Some people fear going to the dentist….and for good reason, due to bad past experiences or bad information. However, dentistry today should be a comfortable experience most of the time. For those who are still fearful, there are different medications dentists can use to ease the experience. Avoidance cannot make the situation better. Most fearful patients are cured by finding the right dental team.

The last barrier to ideal treatment is trust. For a patient to move forward with treatment, it is essential the patient both like and trust the dentist. Although I am sure that the skills of your dentist are important to you, I am willing to bet that you would not stay with a dentist that you did not like or trust. Find someone you can connect with and build a strong doctor-patient relationship.

Last week we discussed the role and effect that diabetes has on oral health. It is not something that should be taken lightly. If you missed this column, please visit www.thetowncommon.com.

After reading last week’s column, it may seem frightening that there is no way out of the partnership of horrors between diabetes and severe gum disease. There are solutions. Just as poor oral health can compound a diabetic’s plight, proper oral health can come to the rescue.
Clinical studies confirm that treatment of gum disease reduces oral inflammation, which removes the factor that triggers the body’s inflammatory response which, in turn, plays a major role in compounding the effects of diabetes.

Dental treatments that fight gum infections also help improve control of blood sugar levels in diabetics.

If you are pre-diabetic, your dental team may actually be able to help prevent diabetes. If you already have diabetes, your dental team may be able to help you keep it under control, improve your quality of life and reduce the risk of premature death.

There’s even better news. It’s never too late to improve oral health care. Even if you already have severe gum disease or other dental problems, proper treatment can help stop it in its tracks. In many cases, this treatment can even reverse the damage done to your teeth and gums as well as manage the metabolic elements of diabetes. And, if you haven’t yet developed any symptoms of diabetes-related oral health problems, your dental team can start a prevention program that will help you stay in control of your diabetes, maintain better health and enjoy a better quality of life.

This is not something that requires exercise, taking a pill, giving yourself a shot of insulin, or sticking to a special diet, although some or all of these things may be necessary to also help control diabetes. From an oral health perspective, all you need to do is to start seeing your dentist and talking to him or her about your particular situation. Through the guidance of an exceptional dental team, you will be put on a path to better health. It will require you to alter your routine, but change is what is needed.

There may be varying degrees of participation from dental teams, depending on their knowledge or “philosophy” of care, when it comes to partnering with you and your physician to manage the oral health issues in regards to diabetes or pre-diabetes. The best team approach is between the doctor, the patient and the dentist (including the hygienist). If one of these team members does not participate, the battle cannot be won.

Sometimes it is the patient who is not doing the things that he or she needs to do to properly manage the problem. There needs to be open discussion on where things are falling short and follow-up to assess progress. If the dental team doesn’t seem too concerned about your diabetes, and isn’t giving you feedback at every visit on the status of your oral health, it might make sense to find a more progressive dental team.

Diabetes and pre-diabetes is a serious issue. You can take control of it but it needs to start with you wanting the improvement in your life. Your medical and dental teams are there to help make it happen.

With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population has already been affected by this disease. The connections between dental health and diabetes have 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 severe 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 times 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.

We will continue this discussion next week and talk about some things you can do to help this problem.

Dental caries (cavities, decay) is still very prevalent in today’s society. There are many factors that contribute to dental decay. In addition, there are some people who are more susceptible to decay than others. In a recent article in the Journal of the American Dental Association (JADA), sugar-sweetened beverages, one of the main culprits for dental decay, was discussed.

Dental decay is a multifactorial disease characterized as an infectious process during which carbohydrates are fermented by specific oral bacteria at the tooth surface. This results in acid production and enamel breakdown. It should be noted that the beverages described in this column are not the only things that lead to dental decay. Anything rich in carbohydrates or with high acidity can lead to decay. In addition, the right bacteria, genetics, insufficient home care, and salivary flow are all contributing factors.

With regard to beverages specifically, as described in the JADA article, the main carbohydrate additives to note are sugar, lactose, high-fructose corn syrup, sucrose, fructose, glucose, maltodextrin, and honey. The beverages to watch for containing these are milk – yes milk, flavored milk, 100 percent fruit juice and vegetable juice, soda, juice drinks, sports drinks, flavored water, flavored tea and coffee, energy drinks, smoothies, and nutritional supplements.

People usually consume multiple beverages daily. As I have described in past columns, one of the worst things you can do is to drink these kinds of beverages slowly throughout the day. Constant introduction of carbohydrates over a prolonged period feed bacteria and never allow the saliva to neutralize the oral environment. If you have decreased salivary production this makes the situation much worse.

Here is a list of recommendations as stated in the JADA article:

1. Consume these types of beverages at meals only
2. Limit these types of beverages to once per day and to 12 ounces
3. Consume these beverages within a 15-minute time frame
4. Using a straw is preferable
5. Replace these sugary beverages with artificially sweetened or unsweetened beverages. ** I would add to that preferably non-carbonated
6. Brush teeth with fluoridated toothpaste 20 minutes after intake
7. Chew sugar free gum immediately after intake
8. Rinse mouth with water immediately after intake

Dental decay is preventable. Following the guidelines above and practicing good oral hygiene can prevent the most common reasons for decay. It is important to note that most people have plenty of room for improvement with their oral hygiene. Brush your teeth before your next dental appointment and ask your hygienist or dentist to assess how well you are doing at plaque removal. You will be surprised at what you may be missing.

In a recent study published by the American Dental Association (ADA), visits to the emergency room (ER) for dental related issues have doubled nationwide over the last decade. Last year, over 2.1 million people visited the ER for a dental “emergency”, most of which could have been prevented with regular dental visits.

In another recent collaborative study between the Rutgers School of Dental Medicine and the Rutgers Center for State Health Policy, they confirmed that most of these ER visits were for dental pain and infections that were not related to trauma. This is an increasing burden on the taxpayer and the healthcare system. ER visits can be 10 times more costly than if the treatment was performed in a dental office.

Dr. Cecile Feldman, dean of the Rutgers School of Dental Medicine, recently said the following in an ADA publication:

“The most disturbing aspect of the rise in ER dental visits is that treatment is often ineffective. In emergency rooms, there is a lack of diagnostic equipment and tools – such as dental X-ray machines – and ER physicians aren’t trained to identify and treat oral health problems. Often, they prescribe painkillers and antibiotics for infections while the underlying problem remains.”

The increase in dental ER visits supports the fact that many Americans have inadequate knowledge about the consequences of not getting regular dental check-ups. Many view dental care as a luxury and if their teeth don’t hurt and appear visually acceptable, they do not feel the need to visit a dentist.

Dental decay is the underlying cause of most ER dental visits. Dental decay does not hurt until it has affected the nerve of the tooth. Dr. Feldman states, “Tooth decay, which is almost entirely preventable, is the most common chronic illness among school-age children. Left untreated, it can result in infection, unbearable pain, loss of teeth and acute systemic infection, which in some cases can lead to death. Yet nearly one in four American children has untreated tooth decay.”

So, what are some of the underlying reasons for the increase in ER visits?  Dr. Feldman says, “For many, a visit to the dentist is unaffordable and inaccessible. More than 85 million Americans have no form of dental insurance. For those who have Medicaid, finding a dentist who accepts it can be challenging. Many dentists don’t because the reimbursement payments are a fraction of the cost of care and there is a very high administrative burden.”

I have seen many suggestions for helping address this problem. Some push for more community water fluoridation, others for dental coverage for all – such as under the Affordable Care Act (ACA). While children do have coverage under the ACA, it does not extend to adults. I’m not so sure that is the answer anyway, mainly due to the cost.

Dental insurance, in general, is a broken system. Unless there is some major overhaul in the way dental care or dental insurance is delivered in this country, the ER stats will continue to rise. For now, personal responsibility and budgeting for basic preventive dental care is your best defense against future dental problems.