Archive for the ‘Oral Health and Vulnerable Populations’ Category

News From Vt. State Dental Society

Thursday, October 11th, 2012

Thanks to member, Toby Kravitz, DDS, Upper Valley Oral Health Coalition is please to post this release from the Vermont State Dental Society on our website.

Subject: The Importance of Oral Health during Pregnancy and Early Childhood
Dear Vermont State Dental Society Members:
Below is the web link to Dr. Steve Arthur’s May 24th Vermont Department of Health’s Public Health Grand Rounds presentation, “Two is Too Late”, which is about the importance of oral health during pregnancy and early childhood.
It does not include an audio recording, but does include a link to the video portion of the presentation.  A link to the presentation is listed under Presentation Recordings and Slides, near the bottom of the page.
The take away message includes that oral health care is safe during pregnancy, and should not be delayed until the baby is born.  Bacteria that cause early childhood caries (ECC) are transferred from mom to infant by things like pretesting food and kissing on the mouth.  If babies are infected before their second birthday, they are set up for a lifetime of more severe decay.  ECC is a real problem in Vermont.  In FY 2009 over 400 Vermont children had to be treated under general anesthesia in a hospital setting, at a total cost of over $2.5 million dollars to treat this preventable disease.  Many of these children will grow up, and pass the decay onto their own children if this cycle is not broken. 
ECC is a complex problem, involving many aspects, and needs to be addressed at all levels of the Vermont Prevention Model.  Ideally, the importance of oral health would be addressed at a woman’s first prenatal visit; she would be given information about how pregnancy may put her at an increased risk for oral disease, how her oral health can affect gestational diabetes and preeclampsia, and how her oral health may affect that of her child.  She would be encouraged to have all needed preventive and restorative dental work done before her baby is born (even if that means needed x-rays and local anesthesia), and to decrease the bacterial count in her mouth by using mouth rinse and xylitol gum.  Appreciating their potential to positively affect this woman’s birth outcomes, and her oral health as well as her child’s, the local dental team would welcome this woman into their practice, and look forward to seeing her child on his or her first birthday.  At the women’s Head Start program and WIC, she would be getting consistent messages about the importance of prioritizing preventive oral health care (showing up for appointments and following through with homecare), limiting sugar sweetened beverages, and establishing a dental home for her child by age one (“Two is Too Late”).   
The California Dental Association Foundation (CDAF) has excellent resources on this topic that are being promoted by VDH:
CDAF’s “Oral Health in Pregnancy and Early Childhood: Evidenced Based Guidelines for Health Professionals” shared with OBGYNs, midwives, pediatricians, WIC, and Vermont dental practices in collaboration with the Dental Society, and patient/parent materials, “Cavity Keep Away.”
I’ve also attached the ADA recommendations outlined in “Baby’s First Tooth”, published in JADA (February 2002).
Please review these materials and share them with your practice team.  It is important that we deliver a consistent message to patients.  We expect to continue working with Dr. Arthur, Robin Miller RDH, and the VDH team on this important topic.

PBS – FRONTLINE June 26, 2012

Monday, June 18th, 2012

On June 26, 2012, Frontline and the Center for Public Integrity investigates the Dental Care Crisis in the US.

“Dental care can be a matter of life or death. Yet more than 100 million Americans either
don’t have dental insurance or simply can’t afford to see a dentist. The result? Severe pain, preventable disease, humiliation, bankruptcy and sometimes even death. In Dollars and Dentists, airing Tuesday, June 26, 2012, at 10 P.M ET on PBS (check local listings) a joint investigation by FRONTLINE and the Center for Public Integrity, correspondent Miles
O’Brien uncovers the shocking consequences of a broken dental care system.”

Dartmouth Students Simple Design for Big Impact – Improving Oral Health during Pregnancy

Friday, June 1st, 2012

This year a group of Dartmouth College undergraduates including Lucas Yamamura, Karl Schutz, Melissa Saphier, Winnie Yoe, Hannah Kim worked with Tom Roberts and Good Beginnings to improve oral health for pregnant mothers.  They are part of the group Design for America (, a national organization from Chicago that has established studios at colleges in the US to use design thinking as a way to solve local social issues.  Lucas and his colleagues learned that gum disease is a common problem for pregnant women, and poor dental health is usually correlated to negative birth outcomes.  Brushing teeth twice a day is the recommendation of most dentists – a simple strategy for healthy teeth and gum.  In order to tackle this issue, the group asked the following question: How to encourage pregnant moms to promote their own oral health?  The group’s answer is a tooth brush holder in the form of a simple, low cost cup and lid that holds the brush.  The cup is decorated in honor of the coming baby and and can include a copy of the baby’s ultrasound or any other picture or drawing the mom and family apply. That way, they intend to elicit a personal connection between the parents and the upcoming child, reminding future mothers that brushing teeth is part of the  Not yet in production, but the group will be suggesting this idea to a group of pregnant moms for their input.  Great work and let’s hope it works.

A Personal Story: Cost Overshadows Everything – Anne and Evan, Lebanon

Monday, March 19th, 2012

Anne is 60 and has an 18 year old adopted son, Evan, with Downs Syndrome. Anne explains that people with Downs Syndrome have short, spindly fragile teeth that break a lot. She’s determined that her son be able to keep his teeth in the best condition possible: “His smile is his passport to the world.” Evan’s local dentist retired and that dentist’s replacement left, so Anne now has to drive from Lebanon, New Hampshire, to Burlington for dental care for Evan. Because of Evan’s Downs Syndrome, he needs to have all dental work done under anesthesia, and even routine care is complicated. He recently had an x-ray, fillings, extractions and sealants, and Anne just got the bill for $4,000. Usually Evan’s maintenance work costs $1,700, and is not covered by insurance. “It should be done every six months, but I don’t have $1,700 every six months.” Anne put the dental work on her Visa card. “On one card alone I have a $22,500 balance and almost all of it’s this.”

Anne needs to have a knee replaced. She has trouble walking, falls a lot, and she says, “the pain is excruciating.” Anne says that the cost of Evan’s dental care prevents her from having the money to get her knee replaced. “The ripple effect of this is so huge, I can hardly talk about this without crying. I can’t walk. Sometimes I order groceries in. There was no handicapped parking space tonight … I don’t know how much longer I can go on.”

A Personal Story: No Help for Young Mom – Elane, Lebanon

Thursday, March 15th, 2012

Elane lives in Lebanon, New Hampshire, and has worked for 36 years as a nurse at an Upper Valley hospital. She often sees patients with dental health needs who cannot find or afford care. One case has stayed with her for a long time: that of a 34-year old pregnant woman with recurring infections in her mouth. This woman went to the emergency room multiple times but could not get lasting treatment. Finally, someone got grant money so the woman could get dental work done, and all of her teeth were pulled. Elane remembers, “…and then what happened was even worse, because after she had all of her teeth pulled, they mandated her to go to work, or she would lose her grant…. She was so humiliated with no teeth that she couldn’t go apply for jobs that way. She ended up losing her grant, and … ended up on the street trying to find a place for her and her baby.”

Elane will remember this story for a long time, “We turned over every leaf we could to get this mom help–it just wasn’t coming.”

Elane sees real gaps in the system in the area of dental health–she feels it should all be regarded as medical help, since it all comes down to that sooner or later. She also feels accessible and affordable care would be more possible here if Vermont and New Hampshire had a dental school. “If you have a dental school, you have dentists that need training under the supervision of dentists that are trained … that’s our only hope…. Wherever I’ve seen a program that works where they can get help … [it] is because it’s in affiliation with dental schools.”

Illustration by Dennis Pacheco.

A Personal Story: Broken Teeth & Unemployed – Zack, Claremont

Friday, March 9th, 2012

Zach is 23 and lives in Claremont, New Hampshire. He is currently unemployed and without dental insurance. “I have some of the older style fillings that are in my mouth that have fallen out. I have broken teeth… I have tried to get help for them. I’ve been to the ER a couple of times because of the pain… I’ve tried calling different dental places and they either want cash up front or they need insurance. A lot of them don’t do sliding scale or anything like that, it’s like a flat rate and you need to have that money when you walk in. I just don’t have that money, I’m unemployed.”

Zach says that the initial visit for a broken tooth costs over $300 just for the x-rays and an exam. Then, to have the tooth extracted it costs over $400. “That’s just one tooth and I have three that need to be taken out right not, and that’s not even counting the fillings.”

Zach had a tooth break three months ago. The pain got worse and worse. “I was losing my hearing, I couldn’t smell or breathe through one of my nostrils because the infection had gone up in my face…. You explain this to the dentist’s office and they’re like, sorry, we can’t help you out, you’d better try going to the ER.” He went to the emergency room but, “they basically just gave me pain medication and antibiotics and sent me on my way.”

Zach was able to get his one tooth pulled through some grant money, but he still has two more broken teeth that need to be addressed. He has tried going to the local dental clinic, but the dentist who was volunteering there was sick the day of his appointment, and now Zach has to wait another three months for an appointment. He’s worried he doesn’t have that long–his dental needs are so acute that they need to be addressed now. “I just think it’s crazy how hard it is to get into a dentist’s office and have them help you out. If I broke my arm or something they’d fix it right away, but if I break a tooth, you sit and suffer with it… it’s one of the most painful things to go through.”

March 7th Presentation – Pediatric Oral Health Disparities

Sunday, March 4th, 2012

View Video Presentation: Pediatric Oral Health Disparities

COHI member Dr. Steven Chapman (Assistant Professor, Department of Pediatrics at Dartmouth Medical School, Medical Director, General Pediatrics Clinic Medical Director, Boyle Community Pediatrics Program, Children’s Hospital at Dartmouth, Dartmouth Hitchcock Medical Center) will be presenting “Pediatric Oral Health Disparities” at Pediatric Grand Rounds on Wednesday, March 7th from 8-9 a.m. in Auditorium E, Dartmouth-Hitchcock, Lebanon, New Hampshire. Dr. Chapman’s presentation will highlight both the unmet needs and role of pediatricians in addressing the oral health of children and families. The public is invited.

A Personal Story: A Tooth Would Help! – Cathy, Enfield

Friday, September 23rd, 2011

Cathy lives in Enfield, New Hampshire. This is her story:

I had a dentist ask me once, “you’ve had good times and bad, haven’t you?”

True, I have a couple of beautiful caps, some ugly ole’ black fillings, and many emergency extractions. I’m 63 and even with insurance it is NEVER enough to get a nice smile. :)

I have also worked with homeless people for 40 years (including running Shelter, Inc homeless shelter in Cambridge, Massachusetts for 7 years). When families call to ask what can they do [to help homeless people], I would say: “Help someone get to a dentist.” They can’t work without teeth. They don’t need pie at Thanksgiving or any more socks or hats – a tooth would help!

A Personal Story: What Value 4 Teeth? – Nurse Nancy’s Clients, West Topsham

Tuesday, September 13th, 2011

Nancy is a nurse who has been working with pregnant women, babies, and children in the Upper Valley for the past eighteen years. She, herself, lives in West Topsham, Vermont. Many of her clients do not have access to the dental care they need. She remembers one client of hers, a twenty two year old mother of three, who had advanced decay and had to have all of her teeth pulled. This was paid for by Medicaid, but the dentures she needed were not, “which is a rather sad commentary on looking at a twenty two year old woman who we’re now going to ask to go out and get a job, and she had no teeth.” Fortunately, Nancy was able to find a private donor so the woman could get dentures made.

Another woman Nancy works with had an abscessed tooth. She went to a dentist who extracted the tooth and in the process did a large amount of nerve damage. In trying to help this woman get follow-up care, Nancy found that that care was non-existent. “It has now been eight months. She’s still in horrible pain. She has altered movement in her jaw.” Trying to find care for this woman has been like, “calling in circles.” The woman has Vermont Medicaid but one clinic wouldn’t see her because they only accepted Medicaid from Chittenden county. Another clinic in New Hampshire wouldn’t see her because she had Vermont Medicaid. The one doctor that did see her referred her to a nerve specialist in Boston. When she did finally see him it was too late for him to do anything about the nerve damage. Nancy describes Medicaid and dental services for adults as “pathetic…basically, they will pull your teeth out.”

Another of Nancy’s clients, a young woman who just had her second baby, went to the dentist during her pregnancy. She found out that she had cavities and needed work on nearly all of her teeth. She was told if she didn’t get the work done right away she could wind up losing her teeth. She’d used up her year’s cap (on her insurance) and so she had to decide whether to have teeth pulled out, which would be covered by Medicaid, or to wait until January, hoping that at that time she could have more work done, and that her teeth would last that long.

“It’s really really frustrating and I always end up feeling like we don’t value people’s teeth, which are such a huge part of who they are. The impact of dental infection and gum disease on health is huge – I don’t even think we have a clue about the impact.” According to Nancy it not only affects cardiac health but also prenatal health. “But nobody acknowledges or is willing to take that on.”

Illustration by Dennis Pacheco.

Prison: Better Access to Oral Health Care?

Thursday, August 25th, 2011

The August 29th edition of The New Yorker includes an intriguing cartoon by Emily Flake. In it, a man sits in a jail cell with his arms folded and speaks to his cell mate who is standing nearby. They both look upset. The caption reads: “I’m just here for the dental.”

View the cartoon.