Empire Hygeniuses

Researchers wanted to find out which is best in treating moderate-severe periodontal disease:

SRP over weeks+placebo

SRP+systemic antibiotics

same day full mouth disinfection + systemic antibiotics

same day full mouth disinfection+ systemic antibiotics

They conducted a double-masked clinical trial with 184 participants and guess what? There’s no difference. 

“If extraction or retention of teeth is regarded as a measure of failure or success 5 years after completion of periodontal therapy, none of the four strategies produced an end result better than the other.”

Interestingly, those who had SRP+antibiotics had significantly more teeth extracted than participants in the full mouth disinfection or SRP plus placebo groups.

  There have been many studies done testing different treatment regimens, technology, providers, chemicals, drugs, etc, etc. and they all continually show the same results which is why SRP is still the standard of care and the golden rule of periodontal disease treatment.

Highlights:

Oral sex can transfer the HPV virus.

The leading cause of oropharyngeal cancer is HPV.

HPV causes 30,700 occurrences of cancer annually in the United States, including cancer of the vagina, vulva, penis, anus, rectum and oropharynx.

Center for Health Workforce Studies now has an Oral Health Workforce Research Center (OHWRC) which is doing a great job conducting policy-relevant research on the impact of the oral health workforce on oral health outcomes. 

Perusing through their website I came across this policy brief,  Utilization of Oral Health Services by Medicaid-Insured Adults in New York, 2012-2013 which is an analysis of Medicaid enrollment and dental claims data for adult New Yorkers in from January 1, 2012, to December 31, 2013.  

The dental benefit for Medicaid beneficiaries in New York includes preventive services, restorative services, periodontal services, dentures, and oral surgery. However, in 2012-2013, while 21.9% of the adult population in New York were insured by Medicaid only one third received at least one oral health service in a dental office or clinic. Why?

Only a small percentage of dentists (24.4%) provided services to Medicaid enrollees in rural and mixed urban-rural counties.

Conclusions drawn by the researchers:

Regarding dental hygiene, New York is a collaborative practice state. This means that dental hygienists can enter into agreements with dentists to provide dental hygiene services in Article 28 facilities such as nursing homes, schools, clinics, etc. Additionally, New York has general supervision requirements which means that dentists DO NOT have to be physically present in order for dental hygienists to provide dental hygiene treatment. 

So..... these numbers are disappointing and disheartening. Legislators have made it legally possible for oral health professionals who are serious about improving oral health in their communities to get it done. 

In the August issue of the Journal of the American Dental Association, appears an article regarding the dental caries trend in children aged 2-19 according to poverty status.

I have written about the effects of poverty on oral health before, believing it be a crucial point of focus for all of us interested in improving the health (not just oral health!) of those we care for. After reading the article in JADA, “Trends in dental caries in children and adolescents according to poverty status in the United States from 1999 through 2004 and from 2011 through 2014″ (which most of you cannot access because JADA is super stingy about their scholarship which is not cool but I can access it because I’m relentless) I was disappointed that we have not made greater strides in reducing the caries rate amongst those most vulnerable- children.

Here are the findings:

Among children aged 2 to 5 years, caries experience was lower from 2011 through 2014 compared with 1999 through 2004 (24% versus 28%, respectively)

For boys aged 6 to 8 years in families with incomes from 100% through 199% of the FPG (the category “near poor”), dental caries significantly increased (P < .05) from 61% to 72% 

For Hispanic children aged 6 to 8 years, caries prevalence in primary teeth significantly increased (P < .05) from 60% to 69%  

Overall, there was little change in the prevalence of caries in older children and adolescents. 

Metabolic Syndrome and Oral Health

Nice article here from DentistryIQ regarding metabolic syndrome and its effects on oral health. Obesity, malnutrition and metabolic syndrome will increasingly become the focus for dental hygienists looking to improve their patient’s oral health. Back in my day we OBSESSED about how long to brush and floss your teeth and fluoride. In my experience that’s not the key-the key is what people eat and how well they take care of themselves.

There are 204, 990 practicing dental hygienists in the USA. The average wage? $25/hour which translates to a yearly salary of just about $73, 000. The state with the highest wages for dental hygienists is Alaska where the average per hour wage is $49.47. In Alaska, dental hygienists may opt to practice under collaborative agreements with dentists. These agreements free up the dental hygienist and no direct supervision by a dentist is necessary. 

The state with the second highest dental hygiene salaries is California. Dental hygienists there make an average of $45/hour. (This is not surprising considering that California is the only state in which dental hygienists are self-regulated. Recently California dental hygienists opted to terminate their charter relationship with the American Dental Hygienists’ Association and create their own professional organization, the California Dental Hygienists’ Association. California has long led the way in expanding scopes of practice for dental hygienists.)

California, Texas, New York, Florida and Michigan lead the way with the most employment opportunities for dental hygienists.

A study published in one of my favorite journals (PLOS anything, but this one was published in PLOS Medicine) delivers evidence to support taxing soda drinks.

It is no surprise to any oral health care provider that sugary drinks contribute heftily to the deplorable incidence of tooth decay in the US:

About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth.

1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth.

The percentage of children and adolescents aged 5 to 19 years with untreated tooth decay is twice as high for those from low-income families (25%) compared with children from higher-income households (11%)

Among adults aged 20–64, 91% had dental caries and 27% had untreated tooth decay.

These statistics are pathetic considering dental decay is completely avoidable.

The effects of sugar on this epidemic have also been extensively studied by researchers and are unequivocal: 

“ Dental caries is a disease that requires, above all, a single specific cause: free sugars. There is extensive scientific evidence that free sugars are the primary necessary factor in the development of dental caries. Acid-producing bacteria and other factors facilitate the development of dental caries, but free sugars are the necessary dietary cause of caries, with consistent evidence for a markedly sensitive log-linear dose-response increase in caries from 0.1% sugars intake to 1346 Journal of Dental Research 94(10) 2% to 3%. A 10% sugars intake was noted by the WHO (2015) as inducing high caries rates despite fluoride use in drinking water and toothpaste.”

One of the worst culprits in the American diet are sugary drinks. Their contribution to dental decay cannot be understated as their consumption by children and adults alike is considerable:

In order to limit the amount of soda Americans drink California has implemented a tax which cost any Berkeley resident who buys a 12-ounce soda each day an additional $40. Soda consumption in Berkeley is now down 9.6%. Additionally, the tax generated $1.4  $1.4 million for child nutrition and community health programs.

You can access the study, which details the first such tax in the US, by clicking HERE.

Sources:

Dye BA, Xianfen L, Beltrán-Aguilar ED. Selected Oral Health Indicators in the United States 2005–2008. NCHS Data Brief, no. 96. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention; 2012.

Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and tooth loss in adults in the United States, 2011–2012. NCHS data brief, no 197. Hyattsville, MD: National Center for Health Statistics. 2015. 

CE licensure requirements for dental hygienists in the USA. Nice resource here from ADHA