Friday, June 27, 2014

Fluoridation:Public health, not forced medication

The battle against fluoridation is like the battle against vaccinations. It never stops, and it’s a continuing threat to public health.

A skirmish has begun in Fircrest, whose water has been fluoridated since 1957. A group of citizens there has been pressing the City Council to stop the practice, offering the usual “scientific” claims.

We don’t question the sincerity of fluoridation opponents. They obviously believe in their cause and feel genuine concern. Some are quite passionate. The problem is that belief, concern and passion don’t always translate into what’s best for a community.

Let’s be clear: Excessive levels of fluoride can be dangerous. That’s true of any substance on Earth, including salt, water and even oxygen.

But like many minerals, fluoride functions as a micronutrient in the right concentrations. It strengthens teeth and bones. It occurs naturally in water; in some communities, Mother Nature already provides optimal levels of it. Since low-fluoride cities began adding it to their public water supplies in the 1940s and 1950s, it has been spectacularly successful at preventing tooth decay in children.

Cavities are not a minor nuisance: They lead to worse diseases, including severe abscesses. The chronic pain alone can stall a child’s education.

The public health organizations that track fluoride consumption are not operating on autopilot. Their scientists know that Americans are now getting the mineral from other sources, including soft drinks and processed foods.

As a result, they lowered their recommendations for fluoride levels a few years ago. Decisions like that are driven by evidence, unlike sweeping claims that fluoridation at any level is intrinsically harmful.

The claims of fluoridation opponents should be weighed against the credibility of the organizations that reject those claims. Supporters of fluoridation include the U.S. Centers for Disease Control, the American Dental Association, the American Academy of Pediatrics and other scientific groups too numerous to list in this space. These are not sinister or deluded people.

Then there’s the argument that people are being medicated against their will. Not quite. The common definition of a medicine is something that treats disease. Fluoridation — like vaccination, or water chlorination, or the iodization of salt — prevents disease, and does it successfully on a large scale.

That makes it a public health measure. It’s a critically important one, especially for low-income children who have limited access to dentists and fluoride treatments.

More than two-thirds of Americans today drink fluoridated water. Fircrest itself has had more than 55 years of experience with fluoridation. If its population were suffering from it, you’d think we’d know by now.

JOIN THE CONVERSATION

The News Tribune is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service

Read more here: http://www.thenewstribune.com/2014/06/27/3264133/fluoridation-public-health-not.html?sp=/99/447/#storylink=cpy

Monday, March 17, 2014

Dementia and Dental Care:Nurse offers new oral hygiene strategies

Dementia and Dental Care: Nurse Offers New Oral Hygiene Strategies

Amanda Chan, MyHealthNewsDaily Staff Writer | May 03, 2011 12:03pm ET

Submit

When someone has dementia, normal daily activities become difficult. Something as simple as brushing your teeth can become a challenge. And for those caring for people with dementia, helping them brush their teeth can be challenging, too, because dementia increases threat perception and decreases ability to understand things in context, health experts say.
But it's important to care for the teeth of this aging population, especially as more of them are able to retain their natural teeth because of good preventive dental care (regular checkups) and fluoridated water, said Rita Jablonski, an assistant professor of nursing at Pennsylvania State University. A dirty mouth provides a breeding ground for dangerous bacteria, such as Streptococcus pneumoniae that causes pneumonia.
During dementia, there are changes to a region of the brain called the amygdala, Jablonski said. The amygdala holds and moderates memories of fear, which is a good thing for example, getting stung by a bee teaches a person to avoid bees

, she said.

"It's important for the organism to have a recall of adverse events and avoid these things," Jablonski told MyHealthNewsDaily.
But for people with dementia, other parts of the brain are unable to communicate with the amygdala, leaving neurological plaques and tangles that literally obscure pathways in the brain, she said. For a person with dementia, everything is a threat including a nurse who is trying to clean teeth or scrub dentures.
But throughout Jablonski's career as a nurse and then a nurse practitioner, she has used trial and error to compile several tips to help both nurses and family caregivers deal with people suffering from dementia.
"I started accidentally finding ways to interact with people with dementia , whether it was looking into their mouths or listening to their lungs or undressing them," she said. "I was finding things that worked."
Here are a couple of the techniques included in the Managing Oral Hygiene Using Threat Reduction (MOUTh) oral hygiene approach, developed by Jablonski and her colleagues, that are important not only for oral care , but for overall care of a person with dementia:
No 'elderspeak'
When a lot of people talk to older adults, they engage in a type of speech called "elderspeak," Jablonski said.
"Elderspeak is characterized by high-pitch, sing-song voice, use of plural pronouns, and it sounds comical," she said. "It's how I talk to my cat."
A person with dementia may forget the day of the week, the year or even the names of his or her children

or spouse. But a person with dementia never forgets that he or she is an adult, Jablonski said.
So when a person uses elderspeak with an older person -- whether he or she has dementia or not -- it's a direct assault on their personhood, and that person better duck, she said.
"If you do baby talk to an 85-year-old, they're not going to like it," Jablonski said.
This falls in line with a study published in 2008 in the American Journal of Alzheimer's Disease and Other Dementias, which showed that elderly patients exposed to elderspeak were more likely to be aggressive and uncooperative than patients who were spoken to like adults.
Promote independence
Another thing that people do that generates a negative response from an older person is doing things for the person, Jablonski said.
"It's faster, it's easier

, so if I grab a toothbrush and I do it because I have to leave in 10 minutes, I'm rushing the older adult," she said. "I may be rough and I may not realize it. I may be hurting them and not realize it."
Therefore, allowing someone with dementia to do take care of his or her own hygiene -- within reason -- helps to promote their independence, she said.
One strategy is to use the "hand-over-hand" technique, which allows the person to hold the toothbrush. Then, the caregiver puts a hand over the dementia patient's hand, so that he or she is still technically brushing the teeth, Jablonski said.
Another good strategy is to gesture and pantomime, especially because words can get jumbled up and confusing for people with dementia , she said.
"Sometimes with dementia, the ability to process verbal directions is compromised," Jablonski said. "So if I say to you, 'Brush your teeth,' you may hear 'Brush your teeth' but have no idea what I'm talking about. But if I open my mouth and gesture like I'm brushing my own teeth, then you understand."
Pass it on: Don't use elderspeak and help retain independence for people with dementia, especially when it comes to their oral care.

Otzi the Iceman needed to see a dentist

Ötzi the Iceman Needed a Dentist

Tia Ghose, LiveScience Staff Writer | April 11, 2013 11:41am ET

Submit

Otzi the iceman, an astonishingly preserved Neolithic mummy found in the Alps in 1991, shows evidence of severe gum disease and cavities (shown in red).
Credit: UZH

View full size image

Ötzi the Iceman could have used a dentist. The amazingly preserved Neolithic mummy found in the Italian Alps had tooth decay, gum disease and dental trauma, new research suggests.
The new findings, published Tuesday (April 9) in the European Journal of Oral Sciences, suggest that the Iceman mummy's grain-heavy diet took a toll on his dental health.
"It's surprising how bad condition he is in," said study co-author Frank Ruhli, a paleopathologist at the University of Zurich in Switzerland. "We have the whole range of disease pathologies you can imagine." [Album: What Otzi the Iceman Looked Like]

Ötzi is probably the most-studied Neolithic man in history. More than 5,000 years ago, the ancient iceman was hit by an arrow and bled to death on a glacier in the Alps between modern-day Austria and Italy. The glacier preserved his body until it was discovered by hikers in 1991.
Since his discovery in the Ötzal Alps by the hikers, scientists have reconstructed Ötzi's face, analyzed his clothing, scrutinized his body and sequenced his genome.
These extensive studies revealed that Ötzi was a middle-age, well-to-do agriculturalist who lived not far from where he died. He also suffered from heart disease and joint pain, and probably had Lyme disease.
But somehow, scientists had never analyzed his teeth before. So Ruhli and his colleagues used a CT scanner to analyze the condition of Ötzi's teeth. They found that the ancient farmer had several cavities, likely caused by his carbohydrate-rich diet.
Ötzi also showed severe wear of his tooth enamel and severe gum disease. Hard minerals in milled grains abraded the surface of his teeth and gums, exposing the bone below and making the roots loose. Similar wear-and-tear is found in the teeth of Egyptian mummies who ate milled grains, Ruhli said.
"This is like a sandpaper acting on your teeth," Ruhli told LiveScience. "In another five to 10 years, he certainly would have lost some of his teeth."
As a result of his poor dental health, Ötzi would have felt pain when eating hot or tough foods, Ruhli said.
Ötzi also showed evidence of trauma to his front right incisor from being struck, either in a fight or an accident.
Ötzi's dental problems show the results of switching from a strict hunter-gatherer diet to an agricultural one, Ruhli said.
"Hunter-gatherers were depending on meat and berries, whereas [Ötzi] had processed food," Ruhli said. "The processing added a bigger variety of food but also impacted the quality of the teeth."

Wednesday, February 26, 2014

Science from ancient plaque...Huffington Post

Ancient Dental Plaque From 1,000-Year-Old Human Skeletons Sheds New Light On Disease

LiveScience | by Tanya Lewis

Posted: 02/25/2014 9:17 am EST Updated: 02/25/2014 9:59 am EST

Print Article

Microbial PompeiiDaily DiscoveryAnthropologyTooth DecayGum DiseaseAncient Dental PlaqueFossilized Dental PlaqueDental HealthDental Plaque SkeletonsCalculusScience News

A "microbial Pompeii" has been found on the teeth of 1,000-year-old human skeletons. Just as volcanic ash entombed the citizens of the ancient Roman city, dental plaque preserved bacteria and food particles on the skeletons' teeth.

Researchers analyzed dental plaque from skeletons in a medieval cemetery in Germany, and found that the mouths of these aged humans were home to many of the same bacterial invaders that cause gum disease in the mouths of modern humans.

"One thing that is clear about the population we studied is that they didn't brush their teeth very often, if at all," said study leader Christina Warinner, an anthropologist at the University of Zurich in Switzerland and the University of Oklahoma in Norman.

The discovery of these bacteria also revealed clues to the dental hygiene and diets of these centuries-old humans, according to the study detailed today (Feb. 24) in the journal Nature Genetics. [5 Surprising Ways to Banish Bad Breath]

Plaque is a dentist's worst enemy, but it turns out to be a great time capsule for preserving the bacteria (or "microbiome") and bits of food on the teeth of humans long after they die. The sticky bacteria on teeth trapped particles of food and other debris, and over time, the calcium phosphate in saliva — the same mineral found in bones and teeth — caused the plaque to calcify into tartar.

"We knew that calculus preserved microscopic particles of food and other debris but the level of preservation of biomolecules is remarkable — a microbiome entombed and preserved in a mineral matrix, a microbial Pompeii," another study researcher, Matthew Collins from the University of York, in England, said in a statement.

With their new study, Warinner and her colleagues are the first to sequence the DNA in ancient dental tartar, using a rapid method known as "shotgun sequencing." The team reconstructed the genome of a major bacterial pathogen and recovered some of the first evidence of food molecules from ancient dental plaque.

The DNA in food found in the plaque matched pigs, sheep, bread wheat and vegetables such as cabbage. The researchers also found starch granules that matched cereals and the pea/bean family.

"Amazingly, it's much the same thing you would find at a German restaurant today," Warinner said.

The skeletons had many years' or decades' worth of plaque built up on their teeth, and many of them showed signs of gum disease and tooth decay. While a few individuals had surprisingly healthy teeth, most of the older adults had lost most or all of their teeth due to wearing, decay or dental disease.

The microbe species found in the ancient plaque were remarkably similar to ones found in modern mouths, the researchers said. Gum disease is most often caused by the species Porphyromonas gingivalis, Tannerella forsythia,Treponema denticola and Filifactor alocis, and these microbes were all present on the teeth of the skeletons with dental disease.

Gum diseases are usually caused by infections or inflammation of the gums and surrounding bone. About 47 percent of adults ages 30 or older in the United States have some form of gum disease, according to the Centers for Disease Control and Prevention.

Non-human primates and other wild animals rarely get dental diseases, Warinner said, which raises the question, "What is it about humans that allows these pathogens to grow?"Scientists speculate that modern human diets and lifestyles may be to blame, but Warinner's team plans to analyze more ancient populations from other time periods to find out.

Follow Tanya Lewis on Twitter and Google+. Follow us @livescience, Facebook &Google+. Original article on Live Science.

Tuesday, February 18, 2014

Oral Health is more than a Cosmetic Concern

The following is a link to a very good article:
As a primary care doctor, much of my focus is on preventive care. While most patients anticipate my promoting the benefits of a healthy heart, balanced diet and regular exercise, many are surprised when I emphasize the importance of oral health.
Study after study has linked oral health to overall health. Dental problems may affect conditions such as diabetes, heart disease, poor nutrition, systemic infection and even preterm labor.
Studies also have shown correlations between poor dental health and poor school performance for children. Untreated dental disease can have lasting, damaging effects on children’s development by disrupting sleep, and making it harder to learn and communicate.
We also know that prevention is effective, and that untreated dental problems ultimately lead to a lifetime of unhealthy adult teeth and expensive dental treatment. Yet, I have seen firsthand many patients, in particular low-income adults and children, who struggle to get the dental care they need.
When the Washington State Board of Health recently released recommendations aimed at improving the oral health of all Washington residents, it was the first time the state formally recognized that dental diseases impact general health.
The board recommendations urge us all – health care professionals, government, social service agencies and citizens – to support efforts that improve oral health and advocate for collaboration. Doctors, nurses and pharmacists are urged to incorporate oral health into their practices and dentists to partner with social service agencies to help young mothers, seniors, diabetics, and low-income children and adults get the dental care they need.
The Tacoma-Pierce County Health Department has long been a proponent of similar strategies. Its oral health program is based on the guiding principles that it is in everyone’s interest to look after the whole body – including the mouth.
The Health Department has raised doctors’ awareness that they play an important role in the oral health of our children by emphasizing the integration of oral care into well-child checks.
Pierce County’s poorest children also are able to get the dental care they need through ABCD (Access to Baby and Child Dentistry), a nationally recognized program that ensures children age 6 and under see a dentist. ABCD establishes a referral network of doctors, dentists, social service agencies and early childhood development programs to identify and reach out to low-income children and their parents.
In the past, some of my patients with painful mouth problems had to go to the emergency room for care. Some even stood outside a clinic at 6 a.m., hoping an opening might appear that day.
I look forward to the day when patients are no longer turned away due to lack of available services. Even better, we can prevent cavities from happening in the first place.
Community water fluoridation is lauded by the Centers for Disease Control as one of the top 10 public health achievements of the last century. Yet in Pierce County, just 44 percent of county residents have access to fluoridated water, well below the state’s 65 percent and the national average of 74 percent.
Individuals also need to do their part by taking care of their teeth. Brush twice a day and floss daily. Get a regular dental check-up. Every cavity you prevent saves you money and protects you from the risks of infection.
It’s time we rethink oral health as a necessity for healthy living, not a cosmetic luxury. We can do better. We can all be healthier.
Dr. Stephen Cook is a family physician at Paladina Health and member of the Tacoma-Pierce County Board of Health.

Read more here: http://www.thenewstribune.com/2014/02/18/3053406/oral-health-is-much-more-than.html#storylink=cpy

Saturday, February 8, 2014

Oral Hygiene for the Physically or Mentally Impaired Part II

How to proceed
   You have had the patient's teeth cleaned and examined at the dental office. You will now disorganize the bacteria at the gumline once a day.
   The teeth are a four sided object and you want to clean all four sides. The tooth brush will get two sides..the cheek and tongue side. The end tuft brush will clean the other two sides. You will moisten the brush as needed with the mouthwash. Finish by having the patient rinse with the remaining mouthwash.
1. Put on your gloves
2. Have ready the toothbrush, end tuft brush and a cup of mouthwash.
3. Place the patient in comfortable position for them and you ie laying on bed with head on pillow or in chair with a head rest.
4. Picture the mouth having four rows you need to brush 1. Upper cheek and lip side
                                                                                              2. Upper tongue side
                                                                                              3. Lower cheek and lip side
                                                                                              4. Lower tongue side
      Do it methodically....know where you are going and where you have been. I go upper outside, upper inside, lower outside and lower inside. Just so you know where you are going and where you have been.
    5. The end tuft brush is to disturb the bacteria between the teeth. Like with the tooth brush do this methodically. Stick the end tuft brush between the teeth and wiggle. Do this from the cheek side and the tongue side. For example...starting between the upper right last two teeth I stick the end tuft brush at a 45* angle and wiggle the end tuft brush. I work my way around to the other side and come back around on the tongue side. I will repeat this procedure on the bottom arch.
   6. Have patient swish with the rest of the mouthwash.
Note: The tooth is a four sided object..when you brush the teeth you have cleaned 50%.... the end tuft brush(or floss, tooth pick etc) is the other 50%

Oral Hygiene for the Physically or Mentally Impaired...How to get ready to brush someone's elses teeth. Part I

   I'm going to start with some facts you need to know:
1. Bacteria(plaque, tartar, biofilm) form on the teeth constantly and becomes more tenacious and harder with age.
2. Most of the bacteria are harmless but in the mix is the bacteria that causes decay and gum disease.
3. The bad bacteria must work in the absence of oxygen..they are anaerobic.
4. It takes the anaerobic bacteria about 24 hours to get organized..they then begin to eat the sugar that comes into the mouth and poop acid. The acid eats away at the gums and dissolves the tooth structure.
5. The gums fit the tooth like a turtleneck collar....if you disorganize the bacteria at the gumline you can prevent gum disease and decay along the gumline(the most susceptible place for decay in people with poor oral hygiene).
6. Tooth paste does not clean teeth..it's a mouth wash. It makes your mouth taste better and puts some fluoride on teeth. It also makes you salivate when it's in the mouth.
7. The average person finds the mouth scarey...they describe it as dirty or repulsive. They can be, but not if you clean them every day.
8. Fresh plaque or bacteria are are very easy to remove...like talcum powder on a washboard..you can't shake it off but you can just touch it and it comes off. Bacteria in the mouth just needs to be touched.
   What you want to accomplish:
1. Once a day you want to disturb or aerate the organized bacteria all around the base of the teeth.
2. Apply fluoride to teeth to prevent decay.
   How to start:
1. Start with a clean slate. Take the patient to the dentist and have the hygienist clean their teeth, have the dentist do an exam. Have the hygienist or dentist show you potential problem areas. Don't worry....you are like a blind man at this point but your eyes will slowly start focusing. It will take practice.
2. Tools to get: Toothbrush, end tuft brush, fluoride mouthwash and latex gloves for yourself.     a. A very soft tooth brush, preferably with spaces between the bristles. The best one out there is the Lactona S-19. I have found them on Drugstore.com and even on Ebay. They are a tooth brush made in Holland. The bristles are soft and the bristle ends have been rounded to prevent abrasion. You can't hurt any one with this brush.
                          b. An end tuft brush. This is a tooth brush with the back bristles missing.
                          c. Mouthwash for dry mouth like Biotene or Act for dry mouth. They don't use alcohol as a base...very mild. You don't want the patient salivating and wanting to spit.

What they didn't teach me in Dental Hygiene School