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New National Poll Finds Lack Of Guidance May Delay A Child’s First Dentist Trip



Less than half of parents received guidance about starting dental visits from a doctor or dentist, worse among low-income parents.

Without a doctor or dentist’s guidance, some parents don’t follow national recommendations for early dental care for their children, a new national poll finds.

One in 6 parents who did not receive advice from a health care provider believed children should delay dentist visits until age 4 or older – years later than what experts recommend – according to this month’s C.S. Mott Children’s Hospital National Poll on Children’s Health. (link is external)

The American Academy of Pediatrics and the American Dental Association both recommend starting dental visits around age one when baby teeth emerge.

“Visiting the dentist at an early age is an essential part of children’s health care,” says Mott poll co-director Sarah Clark.

“These visits are important for the detection and treatment of early childhood tooth decay and also a valuable opportunity to educate parents on key aspects of oral health.”

“Our poll finds that when parents get clear guidance from their child’s doctor or dentist, they understand the first dental visit should take place at an early age. Without such guidance, some parents turn to family or friends for advice. As recommendations change, they may be hearing outdated information and not getting their kids to the dentist early enough.”

The nationally representative poll is based on responses from 790 parents with at least one child aged 0-5

More than half of parents did not receive guidance from their child’s doctor or a dentist about when to start dentist visits. Among parents who were not prompted by a doctor or dentist, only 35 percent believed dentist visits should start when children are a year or younger as is recommended.

Over half of parents (60 percent) reported their child has had a dental visit with most parents (79 percent) believing the dentist visit was worthwhile.

Among the 40 percent of parents whose child has not had a dental visit, common reasons for not going were that the child is not old enough (42 percent), the child’s teeth are healthy (25 percent), and the child would be scared of the dentist (15 percent).

Experts say starting dental visits early helps set children up for healthy oral hygiene, with parents learning about correct brushing techniques, the importance of limiting sugary drinks, and the need to avoid putting children to bed with a bottle.

Early childhood caries (dental decay in baby teeth) may also be detected at young ages, allowing for treatment of decay to avoid more serious problems. In young children with healthy teeth, dentists may apply fluoride varnish to prevent future decay.

A quarter of parents who had delayed dental visits said their child’s teeth are healthy but Clark notes it is unlikely that a parent could detect early tooth decay.

“Parents may not notice decay until there’s discolouration, and by then the problem has likely become significant,” she says.

“Immediate dental treatment at the first sign of decay can prevent more significant dental problems down the road, which is why having regular dentist visits throughout early childhood is so important.”

Another factor that may delay dental care is that health care recommendations for early childhood are often focused on well-child visits with medical providers, Clark notes.

“Parents hear clear guidelines on when they should begin well-child visits for their child’s health and often schedule the first visit before they even bring their baby home from the hospital. Doctors typically prompt parents to stick to a standard schedule for immunizations and other preventive care,” she says.

“Parents get much less guidance, however, on when to start taking their child to the dentist, with less than half saying they have received professional advice. This lack of guidance may mean many parents delay the start of dental visits past the recommended age.”

Parents with higher income and education and those with private dental insurance were more likely to report that a doctor or dentist provided guidance on when to start dental visits.

“Our poll suggests that families who are low-income, less educated, and on Medicaid are less likely to receive professional guidance on dental care. This is particularly problematic because low-income children have higher rates of early childhood tooth decay and would benefit from early dental care,” Clark says.

“Providers who care for at-risk populations should dedicate time to focus on the importance of dental visits. Parents should also ask their child’s doctor or their own dentist about when to start dentist visits and how to keep their child’s teeth healthy.”

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Losing Teeth During Middle Age Linked To An Increased Risk Of Cardiovascular Disease



Losing two or more teeth in middle age is associated with increased cardiovascular disease risk, according to preliminary research presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population-based cardiovascular science for researchers and clinicians.

Studies have shown that dental health problems, such as periodontal disease and tooth loss, are related to inflammation, diabetes, smoking and consuming less healthy diets, according to study author Lu Qi, M.D., Ph.D., professor of epidemiology at Tulane University in New Orleans.

“Previous research has also found that dental health issues are associated with elevated risk of cardiovascular disease,” Qi said.

“However, most of that research looked at cumulative tooth loss over a lifetime, which often includes teeth lost in childhood due to cavities, trauma and orthodontics. Tooth loss in middle age is more likely related to inflammation, but it hasn’t been clear how this later-in-life tooth loss might influence cardiovascular disease risk.”

In a collaborative research effort between Tulane University School of Public Health and Tropical Medicine and Harvard T.H. Chan School of Public Health, Qi and colleagues analyzed the impact of tooth loss in large studies of adults, aged 45 to 69 years, in which participants had reported on the numbers of natural teeth they had, then in a follow-up questionnaire, reported recent tooth loss. Adults in this analysis didn’t have cardiovascular disease when the studies began. The researchers prospectively studied the occurrence of tooth loss during an eight-year period and followed an incidence of cardiovascular disease among people with no tooth loss, one tooth lost and two or more teeth lost over 12-18 years.

They found:

  • Among the adults with 25 to 32 natural teeth at the study’s start, those who lost two or more teeth had a 23 percent increased risk of cardiovascular disease, compared to those with no tooth loss.
  • The increased risk occurred regardless of reported diet quality, physical activity, body weight and other cardiovascular risk factors, such as high blood pressure, high cholesterol and diabetes.
  • There wasn’t a notable increase in cardiovascular disease risk among those who reported losing one tooth during the study period.
  • Cardiovascular disease risk among all the participants (regardless of the number of natural teeth at the study’s start) increased 16 percent among those losing two or more teeth during the study period, compared to those who didn’t lose any teeth.
  • Adults with less than 17 natural teeth, versus 25 to 32, at the study’s start, were 25 percent more likely to have cardiovascular disease.

“In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in recent past could be at increased risk for cardiovascular disease,” Qi said.

“That’s regardless of the number of natural teeth a person has as a middle-aged adult, or whether they have traditional risk factors for cardiovascular disease, such as poor diet or high blood pressure.”

Armed with the knowledge that tooth loss in middle age can signal elevated cardiovascular disease risk, adults can take steps to reduce the increased risk early on, he said.

A limitation of the study was that participants self-reported tooth loss, which could lead to misclassification in the study, according to Qi.

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Children’s Use of Non-Dental Services for Oral Pain Costing The NHS £2.3m a year



The study of more than half of all of the pharmacies in London and nearly 7,000 parents finds that most pharmacy visits for children’s pain medications in London are to treat oral pain.

Lead researcher Dr Vanessa Muirhead from Queen Mary’s Institute of Dentistry said: “The fact that only 30 per cent of children with oral pain had seen a dentist before going to a pharmacy highlights a concerning underuse of dental services.

“Children with oral pain need to see a dentist for a definitive diagnosis and to treat any tooth decay. Not treating a decayed tooth can result in more pain, abscesses and possible damage to children’s permanent teeth.

“These children had not only failed to see a dentist before their pharmacy visit; they had seen GPs and a range of other health professionals outside dentistry. This inappropriate and overuse of multiple health services including A&E is costing the NHS a substantial amount of money at a time when reducing waste is a government priority.”

Nearly one in ten children had signs of a dental emergency
Previous research has found that the main cause of planned hospital admissions for children aged 5-9 years is to have their decayed teeth extracted under general anaesthesia. Meanwhile, a quarter of five-year-olds in England still have tooth decay in their baby teeth and approximately one in five 12-year-olds have tooth decay in their adult teeth.

Only 58 per cent of children in England and 49 per cent of children in London had visited a dentist in 2016, even though dental care is free in the UK for under 18s and national guidelines recommend dental visits at least every year for children.

  • In this latest study, published in BMJ Open and jointly funded by Healthy London Partnership and NHS England London Region, 951 pharmacies collected information from 6,915 parents seeking pain medications for their children in November 2016 – January 2017, and found that:Nearly two-thirds (65 per cent) of parents seeking pain medications for their children were doing so to relieve their children’s oral pain.
  • Only 30 per cent of children with oral pain had seen a dentist before the pharmacy visit while 28 per cent had seen between one and four different health professionals (including GPs, health visitors, school nurses and A&E departments – GPs being the most common).
  • Nearly one in ten children had signs and symptoms indicating a dental emergency and community pharmacy staff signposted them to emergency services.
  • The cost to the NHS of children contacting health professionals outside dentistry over the period was £36,573 (an annual cost of £373,288). Replicating these findings across all pharmacies in England could mean that the NHS spends an estimated £2.3 million annually when children with oral pain inappropriately use multiple health services.
  • 41 per cent of the children had toothache; 20 per cent had pain from a newly erupting tooth and 15 per cent had a painful mouth ulcer.
  • Saturdays and Sundays were the peak days for parents to visit pharmacies for pain medication for children’s oral pain. This could partly explain why some parents had not seen a dentist due to limited urgent dental care services over the weekend.

GPs, pharmacists and dentists need to talk to each other
Dr Muirhead added:

“We need to develop integrated systems and referral processes where GPs, community pharmacists and dentists talk to each other to make sure that children with toothache see a dentist as soon as possible for treatment. We also need better training for community pharmacy staff giving parents advice and look at how dentists manage children who have toothache.”

The researchers also highlight the need to work towards preventing tooth decay from occurring in the first place. This includes rolling out Scotland’s Childsmile programme more widely, where fluoride toothpaste is distributed to all pre-school children, all nurseries have supervised toothbrushing every day and early years’ settings have healthy low sugar meals and snacks.

The study limitations include the extrapolation of cost estimations which contained several assumptions. The researchers also possibly underestimated the number of children with oral pain in London because only community pharmacies were used as a means of identifying children and parents.

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Our Ancestors Had The Same Dental Problems Like Us – Even Without The Sweets!



Dental erosion is one of the most common tooth problems in the world today. Fizzy drinks, fruit juice, wine, and other acidic food and drink are usually to blame, although perhaps surprisingly the way we clean our teeth also plays a role. This all makes it sound like a rather modern issue. But research suggests actually humans have been suffering dental erosion for millions of years.

My colleagues and I have discovered dental lesions remarkably similar to those caused by modern erosion on two 2.5m-year-old front teeth from one of our extinct ancestors. This adds to the evidence that prehistoric humans and their predecessors suffered surprisingly similar dental problems to ourselves, despite our very different diets.

Dental erosion can affect all dental tissue and typically leaves shallow, shiny, lesions in the enamel and root surface. If you brush your teeth too vigorously you can weaken dental tissue, which over time allows acidic foods and drinks to create deep holes known as non-carious cervical lesions (NCCLs).

We found such lesions on the fossilised teeth from a human ancestor species Australopithecus africanus. Given the lesions’ size and position, this individual would likely have had toothache or sensitivity. So why did this prehistoric hominin have tooth problems that look indistinguishable from that caused by drinking large volumes of fizzy drinks today?

The answer may come back to another unlikely parallel. Erosive wear today is often also associated with aggressive tooth brushing. Australopithecus africanus probably experienced similar dental abrasion from eating tough and fibrous foods. For lesions to form, they would still have needed a diet high in acidic foods. Instead of fizzy drinks, this probably came in the form of citrus fruits and acidic vegetables. For example, tubers (potatoes and the like) are tough to eat and some can be surprisingly acidic, so they could have been a cause of the lesions.

Dental erosion is extremely rare in the fossil record, although this might be because researchers haven’t thought to look for evidence of it until now. But another type of problem, carious lesions or cavities, has been found more often in fossilised teeth.

Cavities are the most common cause of toothache today and are caused by consuming starchy or sugary food and drink including grains. They are often considered a relatively modern problem linked to the fact that the invention of farming introduced large amounts of carbohydrates, and more recently refined sugar, to our diets.

But recent research suggests this is not the case. In fact, cavities have now been found in tooth fossils from nearly every prehistoric hominin species studied. They were probably caused by eating certain fruits and vegetation as well as honey. These lesions were often severe, as in the case of cavities found on the teeth of the newly discovered species, Homo naledi. In fact, these cavities were so deep they probably took years to form and would almost certainly have caused serious toothache.

Dental Abrasion
Another striking type of dental wear is also more common in the fossil record, and again we can guess how and why it was created by looking at the teeth of people alive today. This process, called dental abrasion, is caused by repeatedly rubbing or holding a hard item against a tooth. It could come from biting your nails, smoking a pipe or holding a sewing needle between your teeth. These activities usually take years to form noticeable notches and grooves, so when we find such holes in fossilised teeth they offer fascinating insights into behaviour and culture.

The best examples of this type of prehistoric dental wear are “toothpick grooves”, thought to be caused by repeatedly placing an object in the mouth, usually in the gaps between the back teeth. The presence of microscopic scratches around these grooves suggests they are examples of prehistoric dental hygiene, where the individual has used stick or other implements used to dislodge food. Some of these grooves are found on the same teeth as cavities and other dental problems, suggesting they may also be evidence of people trying to relieve their toothache.

These lesions have been found in a variety of hominin species, including prehistoric humans and Neanderthals, but only in the species most closely related to us, not our older ancestors. This might mean this tooth wear is the result of more complex behaviour from species with larger brains. But more likely it’s a consequence of different diets and cultural habits.

What we do know for sure is that the complex and severe dental problems we often associate with a modern diet of processed foods and refined sugars actually existed far back into our ancestry, although less frequently. Further research will likely show that lesions were more common than previously thought in our ancestors, and ultimately will provide more information into the diet and cultural practices of our distant fossil relatives.

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