New CDC Report Offers Fluoride Use Tips

Dentistry has been touting the benefits of fluoride on dental health for years, and a well-referenced new report from the Centers for Disease Control and Prevention backs those claims.

The CDC in August published a series of fluoride-related findings in Morbidity and Mortality Weekly Report: Recommendations and Reports. With the release of "Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States," the CDC broke some new ground; and its fluoride work group weighed in on the quality of evidence for each fluoride modality’s effectiveness, association with enamel fluorosis, and cost.

Marjorie Stocks, MPH, project director for the Dental Health Foundation’s Fluoridation Implementation Project, greeted the report with enthusiasm. "We’re glad to see that once again water fluoridation is promoted as one of the best measures for individual prevention of tooth decay."

"This report is particularly helpful because it provides a comprehensive review of fluoride modalities from community water fluoridation to professional application to self-administration of fluorides, classified according to grade of evidence, strength of recommendation, and appropriate target population," says Stanley B. Heifetz, DDS, MPH.

Heifetz, a diplomate of the American Board of Dental Public Health and a clinical professor in the Department of Dental Medicine and Public Health at USC School of Dentistry, also cited the report with its 270 references as a "source document for the state of the science of fluoride use."

For those in clinical practice, the report offers five recommendations:

* Continuing efforts to fluoridate community drinking water;

* Counseling parents and caregivers on the use of fluoride toothpaste for children younger than 6, particularly those younger than 2;

* Limiting fluoride mouthrinse recommendations to patients at high risk for caries;

* Limiting high-concentration fluoride products to people at high risk for caries; and

* Judicious prescribing to and use of fluoride supplements for those at high risk for caries and whose primary drinking water has a low fluoride concentration. This should include informing parents and caregivers of the benefits of fluoride and risks of fluorosis.

Dentists and others may offer tips to the patient. Such recommendations include:

* Knowing the fluoride concentration in their primary source of drinking water;

* Using an alternate source of drinking water for children younger than 8 if the primary source of drinking water is more than 2 ppm fluoride;

* Frequently using small amounts of fluoride (easily accomplished via drinking optimally fluoridated water and brushing twice daily with fluoridated toothpaste); and

* Supervising the use of fluoride toothpaste by children younger than 6.

Dental product manufacturers and public health agencies are advised to take actions to ensure optimal dental health such as:

* Labeling the fluoride concentration of bottled water;

* Promoting supervised use of pea-sized amounts of fluoride among children younger than 6; and

* Developing a low-fluoride toothpaste for children younger than 6.

"Because an appreciable percentage of the population, particularly in Southern California, drink bottled water rather than tap water, the recommendation for labeling fluoride content of bottled water -- whether naturally present or added -- is long overdue," Heifetz says.

According to Heifetz, some larger bottled water companies voluntarily offer their customers fluoride-free or optimally fluoridated water at the same cost.

"I recently had our water distributor switch the bottled water that they supply to the USC School of Dentistry to fluoridated water," Heifetz says.

The CDC report recommends several areas for research in the years ahead, including identifying biomarkers of fluoride, which will estimate a person’s total fluoride intake and amount of fluoride in the body, and re-evaluating the existing method of determining optimal fluoride concentration of community drinking water to determine if fluoride consumption patterns and environmental changes necessitate improvements.

To obtain CDC’s MMWR Recommendations and Reports Publication: "Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States" visit http://www.cdc.gov/mmwr/mmwr.html; call (202) 512-1800; or write Superintendent of Documents, U.S. Government Printing Office, Washington, D.C., 20402.

UCSF Finds Shortage of Dentists in Rural, Poor, Minority Areas

A shortage of dentists in many communities may contribute to poor access to dental care for many California rural, low-income, and minority residents, according to a new study by UCSF researchers at the Center for the Health Professions.

"We have a crisis in access to care in our state. The numbers of children with untreated dental decay is alarming, particularly in underserved communities," says lead author Elizabeth Mertz, MPA, project director at the center. Even more disturbing are the findings that the communities most in need of services are the same communities least likely to have them, according to the study published in the summer issue of the Journal of Public Health Dentistry.

Access to dental services in California is a public health issue gaining increasing attention. Recent research on the extent of oral health problems has highlighted significant disparities by race and income, both in California and across the nation, Mertz says. The racial and ethnic composition of the health care workforce is also a public health issue, as minority health care providers are more likely to practice in undeserved communities.

The study found that two-thirds of communities without dentists are rural, at least 20 percent of California communities may have a shortage of dentists, and many of the same communities do not enjoy the benefits of fluoridated water.

The study also found that minority dentists are more likely to practice in minority communities, but are a small portion of the dental workforce.

"Although this pattern has been previously demonstrated for doctors and nurses, the new study demonstrates this is also true for the dental profession," Mertz says.

Study objectives were to estimate the supply and geographic distribution of dentists in California and to examine the community characteristics associated with the supply of dentists. There were 19,801 dentists in the survey provided by a computerized file from the American Dental Association.

"The plight of rural communities in recruiting and retaining health professionals is not new," Mertz says. "Our research indicated that the undersupply of dentists in rural areas of California is extensive and is not adequately addressed by existing policies to recruit dentists to rural practice."

The report recommends that the issues of access to dentists and oral health care services should be addressed by public policy through programs such as expanded educational opportunities in dentistry for minority students, recruitment of students from rural backgrounds, and targeted dental service programs for the underserved.

"Policies to promote greater participation of underrepresented minorities in dentistry are essential for producing a dental workforce that is responsive to the needs of underserved populations," Mertz adds.

Protein Links Perio and Heart Disease

Elevated levels of C-reactive protein explain one reason periodontal disease could be a risk factor for cardiovascular disease, according to a new study in the Journal of Periodontology.

Periodontal disease may cause oral bacteria to enter the bloodstream and trigger the liver to make proteins such as C-reactive that inflame arteries and clot blood, which can lead to heart attacks. C-reactive protein levels identify those patients whose inflammations systems respond most actively to stimuli.

"Until intervention studies are completed, we will not know with certainty whether periodontal disease really can cause heart disease. In the meantime, this study provides one more explanation for why it is very plausible that an infection in the mouth could lead to problems with the heart," says Ernesto De Nardin, PhD, one of the study's researchers.

The study carried out at the University at Buffalo compared C-reactive protein levels in 59 people with moderate and 50 people with advanced periodontal disease to 65 periodontally healthy patients. Adjustments were made for other factors that are known to be associated with elevated levels of C-reactive protein such as age, body mass index, smoking, and blood lipids. Researchers found that 25 percent of the 174 total subjects had C-reactive protein concentrations that have been associated with a higher risk of cardiovascular problems. However, among the 50 people with advanced periodontal disease, the percentage increased to 38. Furthermore, they found that those patients infected with bacteria that cause periodontal disease had the highest levels of C-reactive protein.

Tooth Tattoo May Encourage Kids to Brush

KidGenics, a children’s oral hygiene company, has launched Tooth Tat 2s, a new dental care product disguised as decorative tooth art for kids.

Tooth Tat 2s are temporary, decorative appliques that are placed on tooth surfaces. They come in a variety of theme packages such as the Love Pac and Friendship Pac.

"Research shows that 5-year-olds, on average, reach about 25 percent of their tooth surfaces while brushing, while 11-year-olds reach 50 percent," said Loren Krok, executive vice president of KidGenics and its parent company, Oralgiene USA. "Tooth Tat 2s require a clean dental surface to adhere, therefore kids need to do a thorough job of cleaning their teeth to wear them."

Krok said the dental tattoos have tested well. "Kids loving making a ‘statement’ with designs on their teeth."

Time in Space Puts Astronauts’ Teeth at Risk

It is well-documented that astronauts who spend weeks in orbit rapidly lose bone density and mass. What has not been recognized is the effect the lack of gravity has on teeth, Cmdr. William Stenberg recently told a meeting of the MARS Society.

Astronauts in space lose bone density and mass at rates up to 10 times that of the earth-bound, Stenberg says. This form of osteoporosis experienced in the zero-gravity environment of space during long missions -- such as a journey to Mars -- could also lead to tooth loss.

Stenberg, a periodontist with the U.S. Public Health Service, presented the difficulties of maintaining oral health in space during the annual meeting of the Mars Society recently at Stanford University. The Mars Society is dedicated to furthering the goals of exploration and settlement of the planet Mars.

As the bone repair mechanisms in the body shut down in space, bone density rapidly degrades and the body is depleted of calcium. While bones can regain strength once the astronaut returns to earth, the tooth loss would, of course, be permanent, Stenberg emphasizes.

Stenberg says the problem is not without possible solutions. Exercise and hormone treatments have shown promise in maintaining some bone density during long space missions.

British Authorities Target Children’s Dental Health

One million British children are to receive free toothbrushes and toothpaste during the next three years thanks to the Brushing for Life campaign.

The project aims to significantly reduce tooth decay in children. By 2003, 5-year-olds are to have no more than one decayed, missing or filled tooth, and seven out of 10 should have no tooth decay at all.

In addition to giving out free toothpaste and toothbrushes, "health visitors" will demonstrate correct brushing techniques and give oral health talks in day care facilities and to playgroups.

Health minister Hazel Blears says, "The government is determined to tackle oral health inequalities. Most recent figures show that over 60 percent of 5-year-olds now experience no tooth decay at all. This is excellent news, but research also shows that in some deprived areas, children can experience three times the amount of dental decay compared to children from more affluent areas.

"This is unacceptable when both dental decay and gum disease are avoidable simply by encouraging young children to develop the habit of brushing their teeth twice a day with fluoride toothpaste. Regular brushing not only helps people maintain stronger and whiter teeth but also improves the number of years people spend free from illness.

"Good oral health early on in life, is essential to prevent difficulties later on in life -- this is precisely what the Brushing for Life project aims to encourage."

Science abuzz over decay-fighting bee substance

The potent Brazilian variety of a substance excreted by honeybees to protect their hives could prove to be a powerful agent against tooth decay, scientists at the University of Rochester Medical Center have discovered.

In laboratory tests, the substance propolis, taken from beehives in southern Brazil, cut the caries rate in laboratory animals by about 50 percent, according to the scientists. Bees produce propolis from the digested secretions of trees and other plants and use the material to hold their hives together.

Key to the utility of propolis is its action against glucosyltransferase enzymes, which play an important role in the buildup of dental plaque. According to the scientists, the Brazilian propolis blocked up to 95 percent of the action of glucosyltransferase in a test tube and about 60 to 70 percent on tooth-like surfaces.

Human use of propolis dates back to at least 300 B.C. Today there are creams, lotions and even chewing gum that contain the substance and tout its antibacterial, anti-inflammatory and anti-oxidant properties, an August 31, 2001, URMC news release said.

Honors

Harold C. Slavkin, DDS, has been given the Callahan Award by the Ohio Dental Association for his compelling history of scientific research. Dr. Slavkin is dean of the University of Southern California School of Dentistry.

Jack F. Conley, DDS, has been named 2001 Alumnus of the Year for the USC School of Dentistry. Dr. Conley is an associate professor in the Division of Health Promotion, Disease Prevention and Epidemiology at USC and the long-time editor of the Journal of the California Dental Association.

Upcoming Meetings

2001

Nov. 3 Association of Managed Care Dentists Annual Meeting, Los Angeles, (310) 453-3439. www.amcd.org

Nov. 4-10 U.S. Dental Tennis Association Annual Meeting, Palm Desert, Calif., (800) 445-2524

Nov. 28-30 California Department of Health Services, Children’s Dental Disease Prevention Program, 2001 Annual Conference, San Diego, (916) 324-3270

2002

Jan. 31-Feb. 3 Yankee Dental Congress, Boston, (508) 480-9797, www.yankeedental.com

March 13-16 Academy of Laser Dentistry Annual Conference & Exhibition, San Diego, (954) 346-3776, www.laserdentistry.org

April 4-7 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470

April 12-14 International Dental Exhibition and Meeting, Singapore, 212 -974-8835, www.idem2002.com

May 7-12 American Academy of Cosmetic Dentistry Annual Session, Honolulu, (800) 543-9220, www.aacdhawaii.com

Sept. 27-29 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470.

Oct. 19-23 ADA Annual Session, New Orleans, (312) 440-2500.

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.