tag:theconversation.com,2011:/ca/topics/oral-health-1123/articlesOral health – The Conversation2024-03-28T05:45:33Ztag:theconversation.com,2011:article/2247402024-03-28T05:45:33Z2024-03-28T05:45:33ZCurious Kids: what did people use before toothpaste was invented?<figure><img src="https://images.theconversation.com/files/583065/original/file-20240320-28-zza8cd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-asian-cute-girl-brush-teeth-612960914">Casezy idea/Shutterstock</a></span></figcaption></figure><blockquote>
<p>How does toothpaste work? What did people use before toothpaste was invented? – Amelia, age 7, Meanjin (Brisbane)</p>
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<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>Thanks for your great questions, Amelia. </p>
<p>I’m a dentist, so I know a bit about how toothpaste works and what we used before it was invented.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-do-cats-and-dogs-lose-baby-teeth-like-people-do-98380">Curious Kids: Do cats and dogs lose baby teeth like people do?</a>
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<h2>How does toothpaste work?</h2>
<p>Toothpaste makes your mouth smell fresh and feel clean. If you brush your teeth two times a day, toothpaste also helps protect your teeth from forming holes or cavities. Let’s look at these benefits one at a time.</p>
<p><strong>That fresh feeling</strong></p>
<p>Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245492/">toothpaste ingredients</a> mix with your spit (or saliva) to make a soapy sudsy foam. The sudsy foam turns into slimy slop that you spit out.</p>
<p>Many toothpastes also have a slight sandy feeling to scrub stains off your teeth. This also helps remove the sticky, soft, white globs that grow on your teeth called plaque (pronounced plark). </p>
<p>Plaque is made from sticky bits of food and bacteria (tiny bugs). The bacteria in your plaque live, grow and multiply in your mouth. Some bacteria – such as <a href="https://www.ingentaconnect.com/content/aapd/pd/2021/00000043/00000001/art00002"><em>Streptococcus mutans</em></a> (pronounced strep-toe-cock-us mew-tans) – love to digest the sugary food you eat. Other bacteria in your plaque burp rotten-egg gases that make your breath smell. </p>
<p>No wonder we want to get rid of plaque with gassy bacteria.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/iAQUCF9n3HU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What is plaque?</span></figcaption>
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<p><strong>Prevents cavities</strong></p>
<p>Even worse, plaque bacteria poo out diarrhoea (pronounced die-ree-a). That diarrhoea is “acidic”, meaning it can dissolve your teeth to form holes. So we brush our teeth twice a day to get rid of as much bacteria and their diarrhoea as we can.</p>
<p>There are lots of special ingredients in toothpastes to prevent holes from forming that include:</p>
<ul>
<li><p><a href="https://www.tandfonline.com/doi/abs/10.1080/19424396.2003.12224154">xylitol</a> (pronounced zy-lee-toll). When bacteria in your plaque eat this, they get constipated and poo less acid</p></li>
<li><p><a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007868.pub3/full">fluoride</a> (pronounced floor-ride). Your teeth have tiny gaps on the surface that are so small you can only see them with a microscope. Fluoride fills these gaps to make your teeth strong. This is how fluoride protects against nasty bacteria poo from dissolving your teeth.</p></li>
</ul>
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Read more:
<a href="https://theconversation.com/curious-kids-what-is-inside-teeth-187258">Curious Kids: what is inside teeth?</a>
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<h2>What did people use in the olden days?</h2>
<p>People who lived a long time ago didn’t know much about <em>Streptococcus mutans</em> and bacteria poo. They thought getting holes in teeth was part of growing up. They were wrong. But they tried to make their teeth look whiter by using tooth powders.</p>
<p>People in ancient Egypt, China and India used their fingers to rub <a href="https://mansapublishers.com/index.php/jofr/article/view/1834/1444">tooth powders</a> on their teeth.</p>
<p>The first tooth powders were made of crushed animal bones, ox hooves, and egg, snail and oyster shells. Later, people added crushed charcoal (the black stuff you get when you burn bones or wood), powdered tree bark and flavouring herbs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Snail on green leaves" src="https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583315/original/file-20240321-16-u9l7da.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People used to crush snail shells and rub the powder on their teeth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/snail-muller-gliding-on-wet-leaves-1341770150">Zebra-Studio/Shutterstock</a></span>
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<p>The ancient Romans cleaned their teeth with toothpaste made with <a href="https://mansapublishers.com/index.php/jofr/article/view/1834/1444">pee</a>. </p>
<p>Thank goodness things have changed.</p>
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<em>
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Read more:
<a href="https://theconversation.com/how-did-people-clean-their-teeth-in-the-olden-days-119588">How did people clean their teeth in the olden days?</a>
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<h2>Thank your lucky stars</h2>
<p>The next time you brush your teeth, think of all those people in the olden days. They made tooth powders with bones and shells, and toothpaste with pee. </p>
<p>Luckily, we now have toothpastes that leave a better taste in your mouth and stop holes forming in your teeth. </p>
<p>But when you brush your teeth, remember to spit out the toothpaste. Don’t rinse it away with water. We want to keep a bit in your mouth to protect your teeth from that nasty bacteria poo. </p>
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<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/224740/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon's PhD research on the effect of ageing on mineral and collagen in teeth was funded by Colgate. She is also an Advocate for Oral Health with Colgate. Arosha is a practice owner and works as a general dentist.. </span></em></p>People once used tooth powders made from crushed bone or shells to whiten their teeth. Others rinsed their mouth out with pee. Yuck!Arosha Weerakoon, Senior Lecturer and General Dentist, School of Dentistry, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2250402024-03-12T12:36:08Z2024-03-12T12:36:08ZTikTok claims ‘tongue scrapers’ can cure bad breath – here’s what the evidence actually says<figure><img src="https://images.theconversation.com/files/580951/original/file-20240311-24-oankia.jpg?ixlib=rb-1.1.0&rect=57%2C9%2C6438%2C4269&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people use tongue scrapers to remove the 'biofilm' from their tongue.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-girl-cleaning-her-tongue-scraper-666254164">Andrey_Popov/ Shutterstock</a></span></figcaption></figure><p>Most of us know how important it is to brush and floss if we want a healthy smile. But some people on TikTok are suggesting that this isn’t enough – and that if you really want good oral health, you need to use a “tongue scraper”.</p>
<p>Tongue scraping has long been part of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002817716304536">daily hygiene routines</a> in many parts of the world. It involves running a hard instrument across the tongue to remove bacterial build-up and debris. Tongue scrapers come in all shapes and sizes – with some people even using their toothbrush. They remove the white coating (which contains bacteria) that builds up on the back of some people’s tongues.</p>
<p>Videos on social media of people advocating for the use of tongue scrapers have amassed millions of views. Many proponents claim the practice banishes bad breath. But while there’s some evidence to back these claims, the practise could also come with risks.</p>
<p>Everyone has communities of bacteria, fungi and even viruses living inside their mouth. This is known as your <a href="https://www.sciencedirect.com/science/article/abs/pii/S019643991300041X?casa_token=59XPqoC2RXIAAAAA:Go0cyqIFg99BAsdgZCuvOfd2P5D2xLEQpHYe5SBHk5tfSgLN4R0ji1oOWpk80PcYo5oTmowhGGA">oral microbiome</a>. These bacteria can stick to the surface of your tongue and teeth and build up in layers (known as a biofilm). Plaque is one example of a biofilm. </p>
<p>Poor oral health can lead to a build-up of biofilms containing certain bacterial species which cause dental decay (cavities), gum disease and bad breath. For example, a build-up of the bacteria <em>Streptococcus mutans</em> is associated with cavities, while a build-up of <a href="https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1016/j.otohns.2005.09.036">volatile sulphur compound producing bacteria</a> (VSCs) on the tongue and gums can cause bad breath. <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155592">Diets high in sugar</a> and low in fibre can also contribute to the build-up of VSCs.</p>
<p>For most, brushing your teeth twice daily (for two minutes each time) and using floss or interdental brushes to clean between teeth will be enough to remove the build-up of these biofilms. These techniques are also <a href="https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-8-oral-hygiene#oral-hygiene-principles-for-oral-health">very effective</a> for preventing tooth decay and gum disease. </p>
<p>But there’s less evidence showing whether these techniques are also effective for preventing tongue biofilms and bad breath.</p>
<h2>Tongue scraping</h2>
<p>A couple of reviews have shown that <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005519.pub2/full">tongue scrapers</a> can reduce the release of VSCs produced by the bacterial species found in the tongue’s biofilm. Tongue scrapers are also shown to be superior to a toothbrush for <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1601-5037.2010.00479.x">reducing bad breath</a>.</p>
<p>So, based on the limited evidence out there, it does seem that regularly using a tongue scraper may help remove biofilms and improve bad breath. However, these reviews did find that the benefits of tongue scraping were shortlived and needed to be done using a specific technique to be effective.</p>
<p>Scraping your tongue once or twice a day for around <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1601-5037.2010.00479.x">15-30 seconds is adequate</a>. You also need to ensure you get far enough back on the tongue (where VSC-producing bacteria live), <a href="https://www.mdpi.com/1660-4601/19/1/108">scrape back to front</a> and keep up your regular tooth-brushing routine for the practise to be effective.</p>
<p>There are other caveats when it comes to tongue scraping. Bad breath isn’t only caused by VSCs. It can also be caused by cavities, <a href="https://www.nhs.uk/conditions/tonsillitis/">tonsillitis</a> and even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948765/">stomach problems</a> (such as acid reflux). In these instances, tongue scraping will do little to solve bad breath. </p>
<figure class="align-center ">
<img alt="A father and his young son brush their teeth." src="https://images.theconversation.com/files/580954/original/file-20240311-30-169fj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580954/original/file-20240311-30-169fj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580954/original/file-20240311-30-169fj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580954/original/file-20240311-30-169fj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580954/original/file-20240311-30-169fj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580954/original/file-20240311-30-169fj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580954/original/file-20240311-30-169fj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Brushing and flossing are still the best ways to look after your oral health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-son-brushing-teeth-bathroom-50754166">sirtravelalot/ Shutterstock</a></span>
</figcaption>
</figure>
<p>And despite their bad press, we actually need certain bacteria for good health. For example, <a href="https://journals.sagepub.com/doi/10.1177/00220345221080982">nitrate-reducing bacterial species</a> living on the tongue <a href="https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-023-01413-y">convert nitrate</a> from the foods we eat (such as green leafy vegetables) to nitrite. This mechanism is important, since we swallow the nitrite that’s produced. The nitrite is then converted in the gut to nitric oxide, which <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147587/">relaxes our blood vessels</a> and keeps blood pressure lower.</p>
<p><a href="https://www.frontiersin.org/articles/10.3389/fcimb.2019.00039/full">One study</a> has suggested that tongue scraping may actually enrich the amount of nitrate-reducing bacteria on the tongue. However, this study was only conducted using a sample of 27 people, the majority of whom were dental hygiene students. It will be important for further research to be done with more participants to better determine both the potential benefits and harms of tongue scraping.</p>
<h2>Should I use a tongue scraper?</h2>
<p>A qualified dentist would find it difficult to strongly advocate the use of tongue scrapers, due to the limited evidence supporting their use. It’s also likely that the benefits and downsides of using a tongue scraper would differ for each person. A check-up would probably be necessary before a dentist could advise – especially so they can ensure a white tongue coating isn’t due to another more serious condition, such as oral thrush or oral cancer.</p>
<p>Not everyone gets a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004167/">tongue biofilm</a>, either. Only <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004167">around 10% of the people</a> develop a thick tongue coating. For these people, removing this thick layer can help counter bad breath. </p>
<p>For others, a thick tongue biofilm may only happen at certain times – for example, during <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417575/">periods of illness</a>, stress, with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004167/">hormone changes</a>, or if they change their diet. So for them, a tongue scraper may only be occasionally beneficial. </p>
<p>If there’s no white coating present at all, there doesn’t seem to be much point using a tongue scraper. <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005519.pub3/full">Good oral hygiene</a> will probably be enough to fix bad breath – and aggressive tongue scraping may actually risk making your tongue bleed. We also don’t yet fully know how tongue scraping will affect good bacteria on you tongue. </p>
<p>Anecdotal TikTok videos should not drive your healthcare decisions (especially if those videos haven’t been fact-checked). But in this case, TikTok may be highlighting an area where we need to do more research to better help peoples’ oral health. Producing strong evidence that tongue scrapers really do work (or don’t work), through good quality clinical studies, could lead to a change in UK guidelines in the future. </p>
<p>But until we know more, keep brushing your teeth twice daily for two minutes with a fluoride toothpaste and clean between your teeth with floss. Scrape your tongue, or clean your tongue with a toothbrush, with care, if you must.</p><img src="https://counter.theconversation.com/content/225040/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zoe Brookes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Tongue scraping’ has long been a part of daily hygiene routines in parts of Europe, India, South America and Africa.Zoe Brookes, Associate Professor of Dental Education and Research, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2211812024-01-30T12:31:07Z2024-01-30T12:31:07ZEating leafy greens could be better for oral health than using mouthwash<figure><img src="https://images.theconversation.com/files/571870/original/file-20240129-15-n8j7zg.jpeg?ixlib=rb-1.1.0&rect=6%2C0%2C2039%2C1634&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eating nitrate rich vegetables like lettuce and spinach could hold the key to better oral health</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/young-woman-with-a-lettuce-news-photo/930122070?adppopup=true">BSIP/Universal Images Group via Getty Images</a></span></figcaption></figure><p>Over half the adult population in the <a href="https://pubmed.ncbi.nlm.nih.gov/26052472">UK and US</a> have gum disease. Typical treatments include <a href="https://www.nature.com/articles/s41598-020-61912-4">mouthwash</a> and in severe cases, <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/vetn.2017.8.10.542">antibiotics</a>. These treatments have side effects, such as dry mouth, the development of <a href="https://pubmed.ncbi.nlm.nih.gov/30967854/">antimicrobial resistance</a> and increased <a href="https://www.nature.com/articles/s41598-020-61912-4">blood pressure</a>. </p>
<p>But research has indicated that a molecule called <a href="https://www.nature.com/articles/s41598-020-69931-x">nitrate</a>, which is found in leafy green vegetables, has fewer side effects and offers greater benefits for oral health. And it could be used as a natural alternative for treating oral disease. </p>
<p>Inadequate brushing and flossing leads to the build up of <a href="https://www.nature.com/articles/s41598-020-69931-x">dental plaque</a>, a sticky layer of bacteria, on the surface of teeth and gums. Plaque causes tooth decay and gum disease. Sugary and acidic foods, dry mouth, and smoking can also contribute to bad breath, tooth decay, and gum infections. </p>
<p>The two main types of gum disease are gingivitis and periodontitis. <a href="https://www.spandidos-publications.com/10.3892/etm.2019.8381">Gingivitis</a> causes redness, swelling and bleeding of the gums. <a href="https://www.spandidos-publications.com/10.3892/etm.2019.8381">Periodontitis</a> is a more advanced form of gum disease, causing damage to the soft tissues and bones supporting the teeth.</p>
<p>Periodontal disease can therefore, lead to tooth loss and, when bacteria from the mouth enter the bloodstream, can also contribute to the development of <a href="https://www.nature.com/articles/bdjteam2015163">systemic disorders</a> such as cardiovascular disease, dementia, diabetes and rheumatoid arthritis.</p>
<h2>Leafy greens may be the secret</h2>
<p>Leafy greens and root vegetables are bursting with <a href="https://www.sciencedirect.com/science/article/pii/S2666149723000312">vitamins, minerals, and antioxidants</a> – and it’s no secret that a diet consisting of these vegetables is crucial for maintaining a healthy weight, boosting the immune system, and preventing <a href="https://journals.sagepub.com/doi/10.1177/2048004016661435">heart disease, cancer and diabetes.</a> The multiple health benefits of leafy greens are partly because spinach, lettuce and beetroots are brimming with <a href="https://www.nature.com/articles/s41598-020-69931-x">nitrate</a>, which can be reduced to nitric oxide by nitrate-reducing bacteria inside the mouth. </p>
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<figcaption><span class="caption">Popeye knew a thing or two about the health benefits of eating leafy greens. Boomerang Official, 2017.</span></figcaption>
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<p>Nitric oxide is known to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0006295222004191">lower blood pressure</a> and improve <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243755#:%7E:text=Nitrate%2Drich%20beetroot%20juice%20offsets,healthy%20male%20runners%20%7C%20PLOS%20ONE">exercise performance</a>. However, in the mouth, it helps to prevent the overgrowth of bad bacteria and reduces <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243755#:%7E:text=Nitrate%2Drich%20beetroot%20juice%20offsets,healthy%20male%20runners%20%7C%20PLOS%20ONE">oral acidity</a>, both of which can cause gum disease and tooth decay. </p>
<p>As part of our research on nitrate and oral health, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243755#:%7E:text=Nitrate%2Drich%20beetroot%20juice%20offsets,healthy%20male%20runners%20%7C%20PLOS%20ONE">we studied competitive athletes</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9839431/">Athletes are prone to gum disease</a> due to high intake of carbohydrates – which can cause inflammation of the gum tissues – stress, and dry mouth from breathing hard during training. </p>
<p>Our study showed that beetroot juice (containing approximately 12 <a href="https://www.nursingtimes.net/students/an-easy-guide-to-mmols-09-02-2012/">millimole</a> of nitrate) protected their teeth from acidic sports drinks and carbohydrate gels during exercise – suggesting that nitrate could be used as a prebiotic by athletes to reduce the risk of tooth decay. </p>
<p>Nitrate offers a lot of promise as an oral health <a href="https://www.nature.com/articles/s41598-020-69931-x">prebiotic</a>. Good oral hygiene and a nitrate rich diet could be the key to a healthier body, a vibrant smile and disease-free gums. This is good news for those most at risk of oral health deterioration such as <a href="https://www.news-medical.net/health/Periodontitis-and-Pregnancy.aspx">pregnant women</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771712/">the elderly</a>. </p>
<p>In the UK, antiseptic mouthwashes containing <a href="https://www.nature.com/articles/s41598-020-61912-4">chlorhexidine</a> are commonly used to treat dental plaque and gum disease. Unfortunately, these mouthwashes are a blunderbuss approach to oral health, as they indiscriminately remove both good and bad bacteria and increase oral acidity, which can cause disease. </p>
<p>Worryingly, early research also indicates that chlorhexidine may contribute to <a href="https://pubmed.ncbi.nlm.nih.gov/30967854/">antimicrobial resistance</a>. Resistance occurs when bacteria and fungi survive the effects of one or more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768623/">antimicrobial drugs</a> due to repeated exposure to these treatments. Antimicrobial resistance is a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext">global health concern</a>, predicted to cause 10 million deaths yearly by the year 2050. </p>
<figure class="align-center ">
<img alt="Two clear bottles with white screw tops, and illegible labels. One of the bottles is half full of red liquid and the other is full of a light blue liquid. A blue toothbrush is between the bottles, with a clear mouthwash cup containing red fluid." src="https://images.theconversation.com/files/571610/original/file-20240126-25-giuwd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571610/original/file-20240126-25-giuwd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571610/original/file-20240126-25-giuwd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571610/original/file-20240126-25-giuwd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571610/original/file-20240126-25-giuwd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571610/original/file-20240126-25-giuwd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571610/original/file-20240126-25-giuwd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Mouthwash may not be the best option for a healthy mouth.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/mouthwash-alodont-and-eludril-news-photo/151060141?adppopup=true">BSIP/UIG Via Getty Images</a></span>
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<p>In contrast, dietary nitrate is more targeted. Nitrate eliminates disease-associated bacteria, reduces oral acidity and creates a balanced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2944498/">oral microbiome</a>. The oral microbiome refers to all the microorganisms in the mouth. Nitrate offers exciting potential as an <a href="https://www.nature.com/articles/s41598-020-69931-x">oral health prebiotic</a>, which can be used to prevent disease onset or limit disease progression. </p>
<h2>How many leafy greens for pearly whites?</h2>
<p>So how much should we consume daily? As a rule of thumb, a generous helping of spinach, kale or beetroot at mealtimes contains about 6-10 mmol of nitrate and offers immediate health benefits.</p>
<p>Work we have done with our collaborators has shown that treating <a href="https://www.nature.com/articles/s41598-020-69931-x">plaque samples</a> from periodontal disease patients with 6.5 mmol of nitrate increased healthy bacteria levels and reduced acidity. </p>
<p>For example, consuming <a href="https://aap.onlinelibrary.wiley.com/doi/full/10.1002/JPER.20-0778">lettuce juice</a> for two weeks reduced gum inflammation and increased healthy bacteria levels in patients with gum disease. </p>
<p>Growing evidence suggests that nitrate is a cornerstone of oral health. Crunching on a portion of vegetables at mealtimes can help to prevent or treat oral disease and keeps the mouth fresh and healthy.</p><img src="https://counter.theconversation.com/content/221181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mia Cousins Burleigh has previously received funding from The Royal Society of Edinburgh. </span></em></p><p class="fine-print"><em><span>Siobhan Paula Moran does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Want to improve oral health? Channel your inner Popeye and eat plenty of leafy greens – a nitrate rich diet could help prevent dental issues before they begin.Mia Cousins Burleigh, Lecturer, School of Health and Life Sciences, University of the West of ScotlandSiobhan Paula Moran, PhD candidate, School of Health and Life Sciences, University of the West of ScotlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2198782023-12-19T23:42:53Z2023-12-19T23:42:53ZOral health is health: Better access to dental care may have potential benefits beyond Canadians’ mouths<figure><img src="https://images.theconversation.com/files/566686/original/file-20231219-15-3hv10x.jpg?ixlib=rb-1.1.0&rect=688%2C22%2C4303%2C2964&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because oral health is linked to overall health, dental care needs to be viewed as an integral part of health care. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/oral-health-is-health-better-access-to-dental-care-may-have-potential-benefits-beyond-canadians-mouths" width="100%" height="400"></iframe>
<p>Oral diseases, particularly dental decay and periodontal (gum) diseases, are largely preventable, yet are some of the <a href="https://www.who.int/data/gho/data/themes/oral-health-data-portal">most common non-communicable diseases around the world</a>. Pain due to untreated dental decay impacts eating and sleep quality, among other essential functions. Indeed, the agonizing nature of dental pain earned it the title of “<a href="https://doi.org/10.1038/sj.bdj.4809302">the hell of all diseases</a>” more than 200 years ago.</p>
<p>But pain is only the most obvious of the many ways oral health is linked to overall health.</p>
<h2>Access to dental care</h2>
<p>The federal government recently launched the long-anticipated <a href="https://www.canada.ca/en/services/benefits/dental/dental-care-plan.html">Canada Dental Care Plan</a> (CDCP) to improve access to dental care for the almost <a href="https://www.canada.ca/en/health-canada/news/2023/12/the-canadian-dental-care-plan.html">nine million Canadians</a> who lack dental insurance.</p>
<p>The program comes in light of the increasing barriers to dental care with the most recent data from Statistics Canada showing that <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/231106/dq231106a-eng.htm">one in four Canadians avoid seeing a dental professional due to costs</a>. While this burden affects mostly low-income families, seniors and people living with disabilities, it also places a huge toll on the population as a whole.</p>
<p>On top of the time lost from school or work due to dental problems, many without the means to access dental care end up seeking care in hospital emergency departments, unnecessarily costing the health-care system billions of dollars.</p>
<p>The CDCP is an important milestone that could eventually get many Canadians the dental care they need and deserve. Meanwhile, this investment in oral health is a reminder of the importance of a healthy mouth, what makes it fundamental to overall health, and notably, how the potential impact of improving access to dental care for those who need it most may extend beyond the mouth.</p>
<h2>Oral health is integral for overall health</h2>
<p>The <a href="https://www.who.int/health-topics/oral-health#tab=tab_1">World Health Organization</a> (WHO) defines oral health as “the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompassing psychosocial dimensions such as self-confidence, well-being, and the ability to socialize and work without pain, discomfort and embarrassment.”</p>
<p>A healthy, disease-free mouth is key to quality of life and well-being. Being fundamental to various essential functions, the lack of oral health connects it to a number of chronic diseases in several ways.</p>
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<strong>
Read more:
<a href="https://theconversation.com/filling-the-gaps-why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare-181306">Filling the gaps: Why Canada still needs a public dental health plan despite decades of medicare</a>
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<p>The most <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">recent WHO report</a> shows that dental decay and gum diseases affect almost 25 per cent of Canadian adults — a higher figure than that observed in the United States. Importantly, both conditions are among the most common causes of tooth loss in adults globally, thereby impacting the ability to eat, the quality of nutrition and, in seniors, <a href="https://doi.org/10.1111/jgs.16377">contributing to frailty</a> and <a href="https://doi.org/10.1111/jgs.13190">declining cognitive health</a>.</p>
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<figcaption><span class="caption">Prime Minister Justin Trudeau making an announcement about applying for the federal dental benefit, at one of Western University’s dental clinics in December 2022.</span></figcaption>
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<p>Severe gum disease in particular is an inflammatory condition that is linked to several other chronic conditions through <a href="https://doi.org/10.1038/s41577-020-00488-6">exacerbating inflammatory reactions</a> in other organs and body systems and that may arguably contribute to some <a href="https://doi.org/10.1016/j.amjcard.2016.05.036">heart</a> and <a href="https://doi.org/10.1111/nep.13225">kidney diseases</a>, among others.</p>
<p>Importantly, there is <a href="https://doi.org/10.1038/sj.bdj.2017.544">a bidirectional relationship between gum diseases and diabetes</a>, where severe inflammation of the gums and supporting bone can aggravate the risk and complications of diabetes, and vice versa.</p>
<p>The consequences of an unhealthy mouth also extend to an individual’s social interactions. For example, those experiencing poor esthetics due to crooked, broken or stained teeth are more likely to be <a href="https://doi.org/10.1016/j.ssmph.2015.11.001">stigmatized and blamed for their dental appearance</a>. In severe cases, they may potentially have <a href="https://www.thestar.com/news/why-is-he-out-of-work/article_711c362f-333c-5580-97ae-7f4646eb092d.html">fewer opportunities for employment</a>.</p>
<p>Observations such as these bring to mind the 19th century’s French naturalist and father of paleontology, Georges Cuvier who famously said, “<a href="https://wellcomecollection.org/articles/W3LpDykAACgAEVFi">Show me your teeth and I will tell you who you are</a>.” </p>
<p>Cuvier’s statement at the time intended to describe how teeth where distinctive of populations according to diets and environmental impacts. Nevertheless, it is not hard to see its relevance to the appearance and health of the mouth and teeth and their impact on how one is perceived in today’s society.</p>
<h2>Children’s health and dental care</h2>
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<img alt="A boy being examined. by a dental care worker out of shot" src="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Canadian kindergarteners in need of dental treatment are found to score lower on physical, cognitive, social and emotional development scales than those without dental problems.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Certainly, oral diseases affect all age groups and children are no exception. Recent reports show that almost <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">39 per cent of Canadian children</a> under nine years old have dental decay. Just like in adults, the impact of dental decay on children extends to poor nutrition, and affects sleep and development.</p>
<p>For example, Canadian kindergarteners in need of dental treatment were found to <a href="https://doi.org/10.1186/s12887-019-1868-x">score lower on physical, cognitive, social and emotional development scales</a> than those without dental problems. On top of this, researchers found the treatment of severely decayed teeth to be by far <a href="https://publications.gc.ca/collections/collection_2014/icis-cihi/H118-94-2013-eng.pdf">the most common reason for children aged one to five years old to receive general anesthesia to undergo surgery</a>.</p>
<h2>Dental care and chronic conditions</h2>
<p>The connection between oral health and overall health is evident in myriad ways, and so is the need to improve oral health and access to dental care in Canada. It also raises the question of whether dental care can help alleviate chronic conditions beyond the mouth. </p>
<p>The <a href="https://doi.org/10.1038/s41467-022-35337-8">scientific evidence on that varies</a>, and largely depends on the chronic condition in question. For example, patients with diabetes are among those who can benefit the most from having better access to dental care. Treating gum diseases can help subside body inflammation and <a href="https://doi.org/10.1002%2F14651858.CD004714.pub4">reduce the risk and complications of diabetes by helping the body regulate blood glucose levels</a>. </p>
<p>Notably, Canada ranks <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf">fourth out of 29 countries</a> in the Region of the Americas in its rate of lip and oral cavity cancer. Many dentists are trained to spot the signs of oral cancer and can help in its early detection, which can be lifesaving.</p>
<p>As we learn more on the impact of dental treatment on chronic disease management, we know that facilitating access to dental care can have promising results on several fronts. In addition to saving costs for individuals and our health-care system, it would enhance the population’s oral health and potentially help in the management of some chronic diseases, such as diabetes. </p>
<p>Importantly, it can reduce the pervasive and inequitable burden of oral diseases. </p>
<p>Indeed, investing in better access to dental care may bring us closer to a healthy smile and beyond, for every Canadian.</p><img src="https://counter.theconversation.com/content/219878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Noha Aziz-Ezzat Gomaa receives or has received funding from the Canadian Institutes of Health Research, the Schulich School of Medicine & Dentistry at Western University, and the Children's Health Foundation. She is affiliated with various national and provincial dental professional associations.</span></em></p>In addition to saving costs for individuals and our health-care system, facilitating access to dental care would enhance the population’s oral health and potentially help in managing chronic diseases.Noha A. Gomaa, Assistant Professor, Dental Public Health and Oral Medicine, Schulich School of Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2181222023-11-24T00:11:40Z2023-11-24T00:11:40ZLess than 75% of Queenslanders have access to fluoridated water – and it’s putting oral health at risk<figure><img src="https://images.theconversation.com/files/561235/original/file-20231123-25-usixfe.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5792%2C3864&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/6-year-old-boy-drinking-water-1805710462">Yulia Raneva/Shutterstock</a></span></figcaption></figure><p>Health-care professionals have recently called on the Queensland government to mandate <a href="https://www.abc.net.au/news/2023-11-20/qld-fluoride-access-issues-tooth-decay-dental-care-oral-health/103099734">fluoride in drinking water</a> across the state, where water fluoridation coverage lags behind other Australian states and territories. </p>
<p>But what are the benefits of adding fluoride to our drinking water supplies? And why do more than one-quarter of Queenslanders not have access to a fluoridated drinking water supply, while most other Australians do?</p>
<h2>First, what is water fluoridation?</h2>
<p>Fluoride is a naturally occurring mineral best known for its role in strengthening our teeth. When our teeth come into regular contact with fluoride, this makes them more resistant <a href="https://pubmed.ncbi.nlm.nih.gov/10916327/">to dental caries</a>, or decay.</p>
<p>Water fluoridation is a public health program which works to reduce dental decay at the population level. It involves adding a very small amount of fluoride to public water systems which supply tap water. In Australia, the recommended levels of fluoride in public water supplies range from <a href="https://pubmed.ncbi.nlm.nih.gov/31868926/">0.6 to 1.1 mg per litre</a>. </p>
<p>The idea of water fluoridation was pioneered in the United States. In 1945, Grand Rapids, Michigan became the first city in the world to <a href="https://www.cdc.gov/fluoridation/basics/anniversary.htm">fluoridate its water supply</a>. Water fluoridation was cited by the US Centers for Disease Control and Prevention as <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm">one of ten great public health achievements</a> of the 20th century.</p>
<p>Fluoride has been added to water supplies in Australia for seven decades, starting in Beaconsfield, Tasmania, in 1953. Today, <a href="https://www.abc.net.au/news/2023-11-24/fluoride-dental-care-dentistry-water-queensland-government/103128018">over 90% of Australians</a> have access to fluoridated water. </p>
<p>The majority of <a href="https://legislation.nsw.gov.au/view/html/inforce/current/sl-2017-0419">Australian states</a> and territories <a href="https://www.health.vic.gov.au/publications/code-of-practice-for-fluoridation-of-drinking-water-supplies-health-fluoridation-act">have laws</a> requiring the fluoridation of public water supplies, with the exception of Queensland, which has left the decision up to <a href="https://www.abc.net.au/news/2023-11-20/qld-fluoride-access-issues-tooth-decay-dental-care-oral-health/103099734">individual local governments</a>.</p>
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Read more:
<a href="https://theconversation.com/four-myths-about-water-fluoridation-and-why-theyre-wrong-80669">Four myths about water fluoridation and why they're wrong</a>
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<h2>The evidence</h2>
<p>The scientific consensus is that water fluoridation is a safe and effective way to improve oral health. The <a href="https://ada.org.au/policy-statement-2-2-1-fluoride-use">Australian Dental Association</a>, the <a href="https://www.who.int/publications/i/item/9241563192">World Health Organization</a> and the <a href="https://www.iadr.org/science-policy/position-statement-community-water-fluoridation">International Association for Dental Research</a> are among the bodies which endorse water fluoridation as a public health measure. </p>
<p>To support and maintain a program like water fluoridation on such a large scale, we need to routinely collect evidence it works.</p>
<p>The <a href="https://www.adelaide.edu.au/press/titles/ncohs">National Child Oral Health Study 2012-14</a>, which I was involved in, gathered data on more than 24,000 children across Australia. The evidence demonstrated <a href="https://pubmed.ncbi.nlm.nih.gov/29869803/">water fluoridation was effective</a> in preventing dental caries. Another analysis I worked on of more than <a href="https://pubmed.ncbi.nlm.nih.gov/25558897/">5,000 children in Queensland</a>, published in 2015, showed water fluoridation reduced dental decay by 40%.</p>
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<img alt="A girl smiles and points at her teeth." src="https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Water fluoridation protects against tooth decay.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-happy-little-patient-sitting-on-1855461733">AnnaStills/Shutterstock</a></span>
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<p>Studies reviewed by the <a href="https://www.nhmrc.gov.au/about-us/publications/2017-public-statement-water-fluoridation-and-human-health">National Health and Medical Research Council</a> (NHMRC) in 2017 showed water fluoridation can reduce the incidence of dental caries by 26% to 44% in children and adolescents, and by 27% in adults. Earlier evidence has similarly shown fluoridation is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/28092105/">fewer caries in adults</a>. </p>
<p>Water fluoridation has also been found to be <a href="https://pubmed.ncbi.nlm.nih.gov/22452320/">highly cost-effective</a> – investment in these programs can result in significant savings through improved population oral health.</p>
<h2>Can fluoridation reduce inequalities in oral health?</h2>
<p>Social factors such as background and income are associated with oral health. For example, <a href="https://pubmed.ncbi.nlm.nih.gov/25394849/">people who are poorer</a>, from culturally and linguistically diverse backgrounds, or from <a href="https://theconversation.com/collaborating-with-communities-delivers-better-oral-health-for-indigenous-kids-in-rural-australia-141038">First Nations communities</a> will often have poorer oral health compared with the overall population.</p>
<p>My research shows exposure to fluoridated water is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/30931771/">reduced inequality in child oral health</a> related to household income and Indigenous status. We would expect to see this because of the passive mechanism of fluoride delivery. That is, people can benefit just by drinking fluoridated tap water, regardless of their socioeconomic circumstances. </p>
<h2>Potential side effects</h2>
<p>Dental <a href="https://pubmed.ncbi.nlm.nih.gov/17652199/">fluorosis</a> (changes in the colour of tooth enamel) is a known side effect of water fluoridation. But dental fluorosis can also result from intake of fluoride from other sources, such as fluoridated toothpaste and fluoride applications during procedures at the dentist when children are young. Dental fluorosis in Australia is mostly very mild to mild and not associated with long-term <a href="https://pubmed.ncbi.nlm.nih.gov/26763813/">oral health consequences</a>.</p>
<p>The NHMRC’s <a href="https://www.nhmrc.gov.au/about-us/publications/2017-public-statement-water-fluoridation-and-human-health">2017 review</a> concluded water fluoridation poses no other risks which should be cause for concern. </p>
<figure class="align-center ">
<img alt="A hand holds a glass under the tap, filling it with water." src="https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The majority of Australia’s drinking water supplies are fluoridated.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-pouring-water-into-glass-kitchen-1928623259">New Africa/Shutterstock</a></span>
</figcaption>
</figure>
<p>However, fluoridation has historically been somewhat controversial. One of the reasons so many local councils in Queensland have opted out is vocal opposition from small groups.</p>
<p>An argument recently raised against fluoridation suggests early life intake of fluoride is associated with childhood development, particularly <a href="https://pubmed.ncbi.nlm.nih.gov/31856837/">lower IQ scores in children</a>. Much of evidence for these arguments has come from poorly designed research or from areas with <a href="https://theconversation.com/fluoride-very-high-levels-in-water-associated-with-cognitive-impairment-in-children-216840">very high levels</a> of natural fluoride and other heavy metals.</p>
<p>But child development is an important issue, so it’s understandable this has caused concern.</p>
<p>Several large reviews have recently investigated this potential link. The reviews published in <a href="https://pubmed.ncbi.nlm.nih.gov/32382957/">2020</a>, <a href="https://www.journals.uchicago.edu/doi/10.1086/711915">2021</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/37120936/">2023</a> all concluded fluoride exposure in the context of water fluoridation is not associated with lower cognitive abilities in children.</p>
<p>My colleagues and I also ran <a href="https://pubmed.ncbi.nlm.nih.gov/36214232/">an Australian study</a> to investigate this issue. We collected data from a nation-wide sample of more 2,600 children. We found exposure to fluoridated water in early childhood was not associated with any impact on child development. </p>
<p>This again shows us water fluoridation as practised in Australia and internationally is safe for children.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/collaborating-with-communities-delivers-better-oral-health-for-indigenous-kids-in-rural-australia-141038">Collaborating with communities delivers better oral health for Indigenous kids in rural Australia</a>
</strong>
</em>
</p>
<hr>
<h2>Where to from here?</h2>
<p>While the most significant gaps in Australia are in Queensland, some other parts of the country are missing out on fluoridated water too, including many <a href="https://pubmed.ncbi.nlm.nih.gov/36825829/">rural towns in Victoria</a>.</p>
<p>Water fluoridation has been a cornerstone of population prevention of <a href="https://www.healthdirect.gov.au/tooth-decay">dental decay</a>, which can lead to other oral and general health issues. </p>
<p>It’s important water fluoridation programs are supported, maintained and expanded where possible by all levels of government and health organisations.</p><img src="https://counter.theconversation.com/content/218122/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Loc Do receives funding from the National Health and Medical Research Council.</span></em></p>Fluoride is a naturally occurring mineral best known for its role in strengthening our teeth and making them more resistant to decay.Loc Do, Professor of Dental Public Health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2141692023-10-02T14:37:35Z2023-10-02T14:37:35ZBrush your teeth! Bad oral hygiene linked to cancer, heart attacks and renal failure<p><em>It’s normal to have bacteria in your mouth. But harmful bacteria have been linked to a host of health problems. Medical scientist Glenda Davison and microbiologist Yvonne Prince, who have <a href="https://www.mdpi.com/2227-9059/11/1/3">researched</a> the oral cavity, explain why it’s so important to practise good oral hygiene.</em></p>
<h2>Can poor oral hygiene lead to serious diseases? Why and how?</h2>
<p>Abnormal bacterial communities in the oral cavity have been linked to <a href="https://www.niddk.nih.gov/health-information/liver-disease#:%7E:text=There%20are%20many%20kinds%20of,one%20sign%20of%20liver%20disease.">liver disease</a>, <a href="https://www.ncbi.nlm.nih.gov/books/NBK519012/#:%7E:text=The%20term%20renal%20failure%20denotes,two%20kinds%20of%20kidney%20failure.">renal failure</a>, <a href="https://www.who.int/health-topics/cancer#tab=tab_1">cancers</a>, <a href="https://www.webmd.com/heart-disease/heart-disease-types-causes-symptoms">heart disease</a> and <a href="https://www.cdc.gov/bloodpressure/about.htm">hypertension</a>.</p>
<p>The <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/oral-cavity">oral cavity</a> is the door to the <a href="https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works">gastrointestinal tract</a> and the rest of the body. </p>
<p>Like the gut, the mouth is home to several diverse colonies of bacteria, fungi, viruses and <a href="https://www.cdc.gov/parasites/about.html">protozoa</a>. It’s the second largest microbial community in humans, after the gut.</p>
<p>More than 700 species of microorganisms reside in the mouth. New technologies, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC523561/">16S rRNA analysis</a>, have allowed researchers to study their genetic makeup and family trees. </p>
<p>These <a href="https://askthedentist.com/oral-microbiome/">microbes</a> are found all over the mouth: in and around the teeth, the gums, tongue, palate and saliva. They usually remain stable during our lifetime but if the balance in the bacterial community is disrupted, harmful bacteria may become dominant. This can lead to bleeding gums and oral diseases such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK279593/">gingivitis and periodontitis</a>.</p>
<h2>How do problems in the mouth lead to other illnesses?</h2>
<p>Changes in the <a href="https://www.news-medical.net/health/pH-in-the-Human-Body.aspx">pH</a> (acidity or alkalinity), temperature and oxygen in the oral cavity are known to lead to abnormal growth of groups of bacteria which are usually harmless. When they become dominant, they can cause disease. </p>
<p>This disruption in the oral <a href="https://www.hsph.harvard.edu/nutritionsource/microbiome/#:%7E:text=The%20microbiome%20consists%20of%20microbes,symbiotic%20microbiota%20coexist%20without%20probleguitms.">biota</a> causes inflammation and the slow development of periodontitis, bleeding gums and tooth decay. As the gum disease destroys the gum and begins to erode the bone, inflammatory molecules called <a href="https://www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy/cytokines.html#:%7E:text=Cytokines%20are%20small%20proteins%20that,body's%20immune%20and%20inflammation%20responses.">cytokines</a> can enter the blood stream. </p>
<p>These chemicals activate immune cells and can result in low grade chronic inflammation with the development of diseases such as <a href="https://diabetes.org/diabetes/type-2">type II diabetes</a>, <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/atherosclerosis#:%7E:text=Atherosclerosis%20thickening%20or%20hardening%20of,walls%20become%20thickened%20and%20stiff.">atherosclerosis</a> or thickening of the arteries and many others, even obesity. The bacteria themselves can also move from the gums into the surrounding tissue and <a href="https://www.sciencedirect.com/science/article/pii/S2213453018301642">release toxins</a> which can move throughout the body. </p>
<p>Similarly, the gut hosts more than 1,000 species of bacteria which reside in the <a href="https://www.ncbi.nlm.nih.gov/books/NBK507857/#:%7E:text=The%20large%20intestine%20is%20responsible,descending%20colon%2C%20and%20sigmoid%20colon.">large intestine</a> and play a vital role in digestion, absorption, immunity and protection against toxins and harmful bacteria. </p>
<p>Human beings cannot live without a healthy, diverse gut biota. If this well-balanced community of microbes is disturbed and not restored, gastrointestinal disorders can be experienced. </p>
<p>Recent research has linked an abnormal gut biome to diseases as diverse as <a href="https://www.immunology.org/public-information/bitesized-immunology/immune-dysfunction/autoimmunity-introduction">autoimmunity</a>, obesity, cardiovascular disease and even <a href="https://www.healthline.com/nutrition/gut-microbiome-and-health">Alzheimer’s</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/microbiome-certain-gut-microbes-may-warn-of-alzheimers-disease-long-before-the-first-symptoms-begin-207999">Microbiome: certain gut microbes may warn of Alzheimer's disease long before the first symptoms begin</a>
</strong>
</em>
</p>
<hr>
<h2>Where do bacteria in the body come from?</h2>
<p>It all starts with our microbes, tiny organisms which share our bodies and are vital to the health of human beings. There are <a href="https://www.voanews.com/a/research-estimates-we-are-only-about-43-percent-human/4932876.html">39 trillion microbes</a> in the human body, outnumbering the estimated 30 trillion human cells, and they inhabit almost every organ and crevice in the human body. They can be found in the gut, skin, lung, seminal and vaginal fluid, eyes, scalp and mouth. </p>
<p>Each of these habitats has its own environment, attracting different organisms which adapt to their surroundings and make it their home. They live in synergy with each other and the surrounding tissue. If this relationship is disrupted it can result in disease.</p>
<p>Most of these microbes come from our mothers and enter our bodies when we are born. The womb is sterile but as the baby moves down the birth canal and enters the outside world, bacteria and other microbes occupy the newborn infant and create a unique ecosystem called the <a href="https://www.sciencefocus.com/the-human-body/human-microbiome">human microbiome</a>.</p>
<p>As we grow and begin to explore the world, these microorganisms become more diverse and varied and are influenced by our diets, lifestyles, interactions with animals and the environment. It is important to maintain this balance to reduce the risk of developing disease. </p>
<h2>What should people do to avoid these risks?</h2>
<p>Good dental hygiene includes regular dental check-ups, preventing the build-up of <a href="https://www.webmd.com/oral-health/plaque-and-your-teeth">plaque</a> by brushing your teeth regularly, and avoiding foods high in carbohydrates and sugar, which can lead to increased tooth decay and cavities. </p>
<p>To further support the balance of the bacteria in the mouth it is recommended that foods rich in <a href="https://www.medicalnewstoday.com/articles/301506">antioxidants</a>, such as fresh fruit and vegetables, are included in our diet. </p>
<p>Dentists also recommend avoiding the use of <a href="https://pubmed.ncbi.nlm.nih.gov/31709856/">antibacterial mouth washes</a>, which have been shown to disrupt the balance of microbes. Overuse can lead to disturbances and stimulate species of bacteria that could cause disease. </p>
<p>Elevated <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9678961/">levels of stress</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182722/">lack of exercise</a> have also been linked to disruptions in the balance of the oral biota. So a well balanced diet with enough rest, accompanied by<a href="https://www.medicalnewstoday.com/articles/324708#_noHeaderPrefixedContent"> good dental hygiene</a>, is recommended. </p>
<p>The mouth is the door to the gut and the rest of the body. Ensuring the harmony of the microbes that live there is important to reduce the risk of disease.</p><img src="https://counter.theconversation.com/content/214169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glenda Mary Davison receives funding from the South African Medical Research Foundation and serves as the Interim DSI-NRF SARChI chair in cardiometabolic health which is funded by Nedbank.</span></em></p><p class="fine-print"><em><span>Yvonne Prince does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Oral hygiene is often neglected but research has shown that abnormal bacterial communities in the mouth can cause serious disease.Glenda Mary Davison, Associate Professor, Cape Peninsula University of TechnologyYvonne Prince, PhD in Biomedical Science (Microbiology), Cape Peninsula University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2009482023-03-10T18:01:56Z2023-03-10T18:01:56ZPregnancy nose isn’t the only weird change your body may go through when you’re expecting<figure><img src="https://images.theconversation.com/files/514688/original/file-20230310-28-a6l0xr.jpg?ixlib=rb-1.1.0&rect=28%2C14%2C9461%2C6302&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nosebleeds and a runny or stuffy nose are also common during pregnancy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-teenager-girl-pregnant-expecting-1809169852">Krakenimages.com/ Shutterstock</a></span></figcaption></figure><p>There are certain changes people expect to experience when they get pregnant. Whether that’s unconventional food cravings, a “glowing” complexion or morning sickness.</p>
<p>But some of the changes the body goes through during pregnancy can be a tad more unconventional. </p>
<p>Recently, many women have <a href="https://www.tiktok.com/@kaylyn.hill/video/7180415277476171051?embed_source=121331973%2C120811592%2C120810756%3Bnull%3Bembed_fullscreen&refer=embed&referer_url=www.parents.com%2Fpregnancy-nose-is-trending-on-tiktok-what-is-it-7092471&referer_video_id=7180415277476171051">taken to social media</a> to share photos and videos of their noses before and during pregnancy. The trend, being termed “pregnancy nose”, has highlighted how some women’s noses swell and change shape during pregnancy. It’s not known how common this is as everyone’s hormone levels are different and everyone responds differently to changes in them. The change may also be more noticeable for some women.</p>
<p>This change is nothing to worry about and is only temporary, typically resolving six weeks after birth. </p>
<p>The reason it happens is due to the significant increases in <a href="https://www.frontiersin.org/articles/10.3389/fphys.2018.01091/full">hormone levels</a> that happens during pregnancy – particularly because of the increase in oestrogen, which relaxes the blood vessels in all the body’s tissues. This allows more blood into the nose’s tissues, causing it to expand and change shape – looking larger and puffier. These hormonal changes can also cause a <a href="https://pubmed.ncbi.nlm.nih.gov/14719986/">runny and stuffy nose</a> (pregnancy rhinitis) and nosebleeds, which affects <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360570/">one in five pregnant women</a>.</p>
<p>But pregnancy nose isn’t the only peculiar change your body may go through when you’re expecting. Here are a few others: </p>
<h2>Bigger heart</h2>
<p>The heart undergoes a number of changes during pregnancy in order to accommodate the baby’s growth.</p>
<p>Just as the abdominal organs are squished and moved to make room for the growing foetus, the heart is pushed higher up in the chest as a result. </p>
<p>Not only that, the heart also develops thicker muscles and changes size during pregnancy. This is because the heart has to work a lot harder at this time – beating <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1399-1">up to eight times</a> more per minute compared to pre-pregnancy – in order to pump the additional volume of blood around the body and to the baby. In some cases, the amount of blood a woman circulates throughout her body <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.114.009029">doubles during pregnancy</a>. This helps ensure there’s enough oxygen getting to the baby to support its development.</p>
<h2>Changes in skin colour</h2>
<p>Most of us have heard of the pregnancy “glow”, which causes some women’s skin complexion to appear brighter. But some women experience a condition known as melasma, which causes the skin around the eyes, nose, chin and upper lip to darken. </p>
<p>It’s actually an extremely common condition, affecting around <a href="https://www.jaad.org/article/S0190-9622(84)80305-9/pdf">75% of pregnant women</a> – but is more typical in women with <a href="https://www.ncbi.nlm.nih.gov/books/NBK459271/">darker complexions</a>. These changes will vary between women, and will typically disappear shortly after birth or when they stop breastfeeding.</p>
<p>The exact cause of melasma in pregnancy is unknown, but increases in oestrogen and progesterone are thought to be involved.</p>
<p>The skin surrounding the nipple (called the areola) can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183040/">become darker</a> during pregnancy. Again, it’s not entirely certain why this happens, but it could be to help new born babies identify the nipple for feeding. </p>
<p>Newborns aren’t able to fully distinguish colour – only things that are very <a href="https://www.sciencedirect.com/science/article/abs/pii/0042698994901279?via%3Dihub">saturated and red</a> – and they can’t see much more than a foot from their face. They actually distinguish light and dark much better, so the contrast of the dark areola compared the light surrounding skin may help them. For most women, their areola may remain slightly darker permanently after pregnancy.</p>
<h2>Hair growth (and loss)</h2>
<p>For many women, their hair <a href="https://pubmed.ncbi.nlm.nih.gov/23682615/">grows and looks healthier</a> during pregnancy thanks to the increase in oestrogen in the body, which causes the hair follicles to remain in growth mode.</p>
<p>Unfortunately, these hormone changes affect <a href="https://www.mdpi.com/1422-0067/21/15/5342">all hair follicles</a> – not just those on the head. This means that hair growth can also happen in less desirable place during pregnancy – including the upper lip, upper thighs, abdomen and back, this disappears after pregnancy. </p>
<figure class="align-center ">
<img alt="A worried-looking pregnant woman brushes her hair while sitting on her bed." src="https://images.theconversation.com/files/514690/original/file-20230310-318-rozpfn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514690/original/file-20230310-318-rozpfn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514690/original/file-20230310-318-rozpfn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514690/original/file-20230310-318-rozpfn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514690/original/file-20230310-318-rozpfn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514690/original/file-20230310-318-rozpfn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514690/original/file-20230310-318-rozpfn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Hair loss can happen during and after pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-mixed-caucasian-pregnant-woman-suffering-1663932307">Twinsterphoto/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Some women also find that they lose their hair instead during pregnancy. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715231/">This process</a> is typically caused by the shock of pregnancy on the body, causing the hairs to go into “resting” phase then shed. This usually subsides as the pregnancy progresses. </p>
<p>Hair loss can also happen after giving birth, due to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/">drop in oestrogen</a> levels as hormones return to normal. Hair loss usually peaks around four months after birth. In most cases, hair grows back and returns to normal.</p>
<h2>Oral health changes</h2>
<p>Pregnancy can cause many changes in oral health.</p>
<p>Increases in oestrogen and progesterone can make the gums more susceptible to bleeding, infection and damage. In fact, approximately <a href="https://pubmed.ncbi.nlm.nih.gov/18481562/">70% of pregnant women</a> experience gingivitis. Teeth are also at an increased risk of damage and cavities during pregnancy, especially if a woman has experienced morning sickness. This is because stomach acid can dissolve the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312266/">protective lining</a> on teeth. </p>
<p>Teeth may also feel wobbly during pregnancy. This is due to both oestrogen levels, alongside increases in a hormone called relaxin. It causes all ligaments in the body to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341375/">become more flexible</a> during pregnancy in order to aid in childbirth. But while this is useful in some parts of the body (such as the pelvis), relaxin also <a href="https://onlinelibrary.wiley.com/doi/10.1111/prd.12394?af=R">affects the ligament</a> anchoring each individual tooth in place, causing teeth to feel loose.</p>
<p>In some rare cases, tooth loss can happen. It isn’t clear exactly how many pregnant women experience tooth loss. What is clear is that it’s more likely to happen to women who have been <a href="https://pubmed.ncbi.nlm.nih.gov/2720476/">pregnant multiple times</a>, and women who come from lower socioeconomic backgrounds. Typically, if a woman loses any teeth during pregnancy it’s due to years of poor oral health – not just the changes that happen to oral health during pregnancy. </p>
<p>While some of the changes you’ll experience during pregnancy are less than ideal, they’re all designed to ensure the baby develops properly in the womb. And luckily, most of these changes are only temporary – disappearing shortly after birth.</p><img src="https://counter.theconversation.com/content/200948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fortunately, most of these changes are only temporary.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1711892022-10-03T12:06:13Z2022-10-03T12:06:13ZNo, it’s not just sugary food that’s responsible for poor oral health in America’s children, especially in Appalachia<figure><img src="https://images.theconversation.com/files/453131/original/file-20220319-27-1rh8vob.jpg?ixlib=rb-1.1.0&rect=34%2C25%2C5716%2C3802&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tooth decay can cause pain, embarrassment, missed school and more.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-girl-with-a-sad-and-frightened-face-holds-royalty-free-image/1307147643?adppopup=true">Olga Simonova/EyeEm via Getty Images</a></span></figcaption></figure><p>Brushing your teeth is essential for maintaining optimal oral health, but like most aspects of health, the full story is more complicated.</p>
<p>As directors of the <a href="https://www.dental.pitt.edu/research/center-oral-health-research-appalachia">Center for Oral Health Research in Appalachia</a>, <a href="https://www.upmc.com/media/experts/mary-l-marazita">we</a> <a href="https://psychology.wvu.edu/faculty-and-staff/faculty-directory/daniel-mcneil">know</a> firsthand that inequalities exist when it comes to oral health, including in children. Some people or groups have considerably more oral health problems than others because of a combination of factors beyond personal dental hygiene.</p>
<p>For example, Appalachia – which stretches from the northern part of Mississippi, Alabama and Georgia up through the southern part of New York, and includes all of West Virginia – has one of the <a href="https://www.arc.gov/report/an-analysis-of-oral-health-disparities-and-access-to-services-in-the-appalachian-region/">greatest burdens of oral health problems per person</a> in the U.S.</p>
<p>October is <a href="https://www.adha.org/national-dental-hygiene-month">National Dental Hygiene Month</a>, which provides an opportunity to draw more attention to this chronic but often preventable problem.</p>
<h2>Oral health defined</h2>
<p>While the terms dental hygiene and dental health are largely focused on the teeth and gums, <a href="https://doi.org/10.1038/sj.bdj.2016.953">oral health</a> is more comprehensive. According to the <a href="https://doi.org/10.1038/sj.bdj.2016.953">FDI World Dental Federation</a>, oral health encompasses the <a href="https://www.cdc.gov/oralhealth/conditions/index.html">proper functioning of the mouth</a>, including one’s “ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions” without pain or discomfort. Oral health affects not only a person’s teeth but <a href="https://doi.org/10.1016/j.adaj.2016.10.001">also overall well-being and quality of life</a>.</p>
<p><a href="https://www.nidcr.nih.gov/research/oralhealthinamerica">Tooth decay</a> affects children all across the U.S., but far too little attention is paid to how preventable and treatable it is. Cavities, or caries, are the most common <a href="https://doi.org/10.1016/j.yapd.2007.03.012">chronic disease in kids</a> – five times <a href="https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000095.v4.p2">more common than asthma and seven times more common</a> than environmental allergies, despite being preventable. More than <a href="https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000095.v4.p2">40% of children have tooth decay</a> when they start kindergarten.</p>
<p>However, people who have less formal education or lower incomes, <a href="https://doi.org/10.1542/peds.2021-051481">marginalized ethnic and racial groups</a> and those living in more rural areas, such as Appalachia, tend to have <a href="https://doi.org/10.1111/j.1600-0528.2012.00716.x">more oral health problems than others</a>, and <a href="https://doi.org/10.1542/peds.2021-051481">at younger ages</a>. The <a href="https://doi.org/10.1177/00220345211068033">greater prevalence of childhood tooth decay</a> in specific populations is not only an inequity but also a serious public health problem. Oral health problems early in life extend into adulthood and can be lifelong.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A map of Appalachian states indicating economic status of all counties." src="https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=657&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=657&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=657&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=826&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=826&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483778/original/file-20220909-7447-temt35.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=826&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">County economic status in Appalachia, fiscal 2023.</span>
<span class="attribution"><a class="source" href="https://www.arc.gov/wp-content/uploads/2022/06/County-Economic-Status_FY2023_Map.png">Appalachian Regional Commission</a></span>
</figcaption>
</figure>
<h2>Beyond personal dental hygiene</h2>
<p>It’s a common misconception that consuming sugary foods and beverages is the only cause of tooth decay. While that is undoubtedly a problem, there’s much more to good oral health. It includes <a href="https://doi.org/10.1177/00220345211068033">consistent brushing and flossing</a>; eating healthy foods, like fresh fruits and vegetables; avoiding tobacco products; and wearing mouth guards while playing certain sports. <a href="https://doi.org/10.1177/0022034509356779">Regular visits for dental care</a> are also critical, as they provide an opportunity for cleanings and preventive care.</p>
<p>Oral health in kids is a <a href="https://www.kentuckypress.com/9780813135861/appalachian-health-and-well-being/">reflection of their overall health</a> and that of their families; however, in addition to behavioral and social influences, genetic and other biological factors are also at play. For example, <a href="https://doi.org/10.1177/0022034510381502">genes influencing taste preferences</a> – such as those for sweet foods – are associated with cavities on certain teeth and surfaces of teeth. It’s possible that our taste genes predispose some of us to prefer consuming sweet foods and drinks, which is a risk factor for developing cavities. </p>
<p><a href="https://dx.doi.org/10.1038%2Fs41598-020-71495-9">Bacteria and other microorganisms in the mouth</a>, known as the oral microbiome, also play a role. Some parts of the <a href="https://doi.org/10.3920/BM2011.0002">oral microbiome are beneficial</a> and even required for good oral health. Other <a href="https://doi.org/10.1111/odi.12509">bacteria</a> are invaders that can lead to oral diseases.</p>
<p>Just as important are <a href="https://doi.org/10.17796/1053-4628-40.2.152">environmental factors</a>, including air quality, access to healthy foods, the cost of dental care, access to transportation to and from the dentist, and school-based programs that encourage good oral hygiene among children. Whether one lives in a community with fluoridated water or otherwise has access to fluoride treatments is also important, as <a href="https://doi.org/10.1542/peds.2014-1699">fluoride helps to prevent tooth decay</a>. <a href="https://www.degruyter.com/document/doi/10.1515/reveh-2017-0012/html?lang=en">Water quality</a> in communities is another factor. If the only available water is toxic or unappealing, people may turn to soda and other sugar-sweetened beverages.</p>
<p>Additionally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624082/">mothers’ perceived social support</a> and <a href="https://doi.org/10.1001/jamanetworkopen.2022.6414">parents’ social networks</a> can influence their children’s oral health too. Among mothers with a high number of cavities, the availability of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624082/">someone to talk to about problems</a> has been shown to be associated with fewer cavities in their children. </p>
<figure class="align-center ">
<img alt="Little girl and dad brushing their teeth together." src="https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453132/original/file-20220319-10592-qsrcfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents can help improve their kids’ oral health by modeling good oral hygiene themselves.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-adorable-kindergarten-age-girls-and-father-royalty-free-image/1263412992?adppopup=true">Nitat Termmee/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>Role modeling good oral health</h2>
<p><a href="https://doi.org/10.1177/2380084417698103">Parents’ and caregivers’ own oral health</a> greatly influences that of their children. Kids and their parents typically drink the same water and many of the same beverages and eat a lot of the same foods. Children often follow the dental hygiene habits of their parents as well. Children typically take on their parents’ and caregivers’ <a href="https://doi.org/10.1111/ipd.12564">feelings about dental visits</a> too – whether it’s comfort, stress, anxiety or fear. </p>
<p>Parents’ thoughts about dental care influence their decisions about preventive care. Dental fear and anxiety can lead to delay or avoidance of dental appointments for themselves and their children. “<a href="https://doi.org/10.1111/cdoe.12621">Oral health values</a>” – the importance one places on maintaining natural and good-looking teeth – affect decision-making about dental hygiene and professional dental care. <a href="https://doi.org/10.1177/0145445515615353">Depression in parents</a> can even influence their own dental hygiene and oral health and that of their children.</p>
<p>Dental problems in kids <a href="http://dx.doi.org/10.15585/mmwr.mm6541e1">can lead to missed school</a>, pain and embarrassment about visible decay, and missing or crooked teeth. Teeth and gums are critical for speaking, eating, development and appearance. They affect social functioning and one’s enjoyment of food. Kids’ dental problems affect their parents, too, as they can result in parents’ unexpectedly missing work to bring their child to the dentist.</p>
<h2>What can be done to improve oral health?</h2>
<p>To a great extent, <a href="https://doi.org/10.1177/0022034514547273">dental problems in kids can be prevented</a>. Some preventive steps are affected by <a href="https://www.nidcr.nih.gov/research/oralhealthinamerica">economic, educational and health care factors</a>. One of the best things parents or caregivers can do is to establish a relationship for their child with a dental practitioner, practice, office or clinic to promote prevention but also to provide emergency care if needed. Within the oral health world, this relationship is called a “<a href="https://digitaleditions.walsworth.com/publication/?i=728372&article_id=4156968&view=articleBrowser&ver=html5">dental home</a>.” The <a href="https://www.mychildrensteeth.org/globalassets/media/policy-center/year1visit.pdf">American Academy of Pediatric Dentistry</a> and other professional health organizations recommend that children see an oral health care provider before age 1 or at the emergence of the first tooth. Access to dental treatment, especially preventive care, has been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/29085793/">improve oral health in families</a> and their communities. </p>
<p><a href="https://media.news.health.ufl.edu/misc/cod-oralhealth/docs/posts_frontpage/SocialInequalities.pdf">System-level changes</a> are surely needed too. Since cost affects whether parents can provide their children with routine dental care, greater access to dental insurance is an important step to ensuring equal access and reducing oral health inequities. Integrating oral health practices into <a href="https://www.cdc.gov/healthyschools/npao/oralhealth.htm">schools and educational programs</a> is another system-level change that would benefit all children regardless of their family’s socioeconomic status. </p>
<p>Oral health is a critical factor in a person’s overall health. Teaching kids this early can help them develop a healthy smile and care for their pearly whites throughout their lives.</p><img src="https://counter.theconversation.com/content/171189/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel W. McNeil receives funding from the National Institutes of Health, including the National Institute of Dental and Craniofacial Research.</span></em></p><p class="fine-print"><em><span>Mary L. Marazita receives funding from the National Institutions of Health, specifically the National Institute of Dental and Craniofacial Research (NIDCR).</span></em></p>Appalachia has one of the highest rates of oral health problems per person in the US.Daniel W. McNeil, Eberly Distiniguished Professor Emeritus, Clinical Professor Emeritus of Dental Public Health & Professional Practice, West Virginia UniversityMary L. Marazita, Director, Center for Craniofacial and Dental Genetics; Professor of Oral Biology and of Human Genetics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1900932022-09-26T16:31:50Z2022-09-26T16:31:50ZFour health conditions linked to gum disease<figure><img src="https://images.theconversation.com/files/484022/original/file-20220912-22-h1m0ag.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3666%2C2436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early symptoms of gum disease include red, swollen gums, and bleeding when you brush or floss your teeth.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-bleeding-gums-periodontal-disease-avitaminosis-1897304893">Creative Cat Studio/ Shutterstock</a></span></figcaption></figure><p>Gum diseases are among the most common chronic <a href="https://bmjopen.bmj.com/content/11/12/e048296">human diseases</a>, affecting between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/">20 to 50% of people worldwide</a>. They happen when plaque, a sticky film of bacteria, builds up on teeth. The earliest stages of gum disease are treatable and reversible (gingivitis). But some people
develop a chronic destructive form of gum disease, <a href="https://www.ncbi.nlm.nih.gov/books/NBK554590/">which is irreversible</a>. This disease progresses to tooth loss. A <a href="https://pubmed.ncbi.nlm.nih.gov/34463994/">growing body of evidence</a> shows that gum disease can also make people more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/">develop other serious health conditions</a>. </p>
<hr>
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<hr>
<p>Here are a few of the common health conditions linked to gum disease and how they are connected.</p>
<h2>1. Alzheimer’s disease</h2>
<p>Several large studies and meta-analyses agree that moderate or severe gum disease is significantly associated with dementia. For example, one study showed suffering from chronic gum disease for ten years or more was associated with a <a href="https://alzres.biomedcentral.com/articles/10.1186/s13195-017-0282-6">70% higher risk</a> of developing Alzheimer’s than those without. Research has also shown a link between gum disease and a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786266/">sixfold decline</a> in cognitive ability.</p>
<p>Initially, it was thought bacteria were directly responsible for this link. <em>P. gingivalis</em>, bacteria common in chronic gum disease, was <a href="https://pubmed.ncbi.nlm.nih.gov/30746447/">found in the brains</a> of people who had died of Alzheimer’s disease. Toxic bacterial enzymes called gingipains were also found, which are thought to worsen gum disease by preventing the immune response from <a href="https://www.nature.com/articles/cddis2016481">turning off</a> and hence prolonging inflammation. </p>
<p>However, it’s not certain whether bacteria in the brain, a modified <a href="https://www.nature.com/articles/bdjteam201662">immune response</a> or other factors – such as damage from <a href="https://pubmed.ncbi.nlm.nih.gov/32701930/">systemic inflammation</a> – explain the link. But taking care of your oral health could be one way to <a href="https://journals.lww.com/co-neurology/Fulltext/2020/04000/Linking_mechanisms_of_periodontitis_to_Alzheimer_s.13.aspx">reduce the risk of</a> Alzheimer’s disease.</p>
<h2>2. Cardiovascular disease</h2>
<p>Cardiovascular disease is also firmly associated with gum disease. </p>
<p>In a large study of over 1,600 people aged over 60, gum disease was linked with an almost 30% higher risk of <a href="https://pubmed.ncbi.nlm.nih.gov/26762521/">first heart attack</a>. This link even persisted after researchers adjusted for other conditions (such as diabetes and asthma), or lifestyle habits (such as smoking status, education and marriage) that are known to increase a person’s risk of a heart attack.</p>
<figure class="align-center ">
<img alt="A digital illustration showing yellow plaque sticking to the walls of the arteries." src="https://images.theconversation.com/files/484023/original/file-20220912-22-tbna33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484023/original/file-20220912-22-tbna33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=320&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484023/original/file-20220912-22-tbna33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=320&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484023/original/file-20220912-22-tbna33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=320&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484023/original/file-20220912-22-tbna33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=402&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484023/original/file-20220912-22-tbna33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=402&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484023/original/file-20220912-22-tbna33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=402&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bacteria common in gum disease can also cause plaque to form in the arteries.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/artery-blocked-bad-cholesterol-clogged-arteries-1137490856">xplode/ Shutterstock</a></span>
</figcaption>
</figure>
<p>More recently, studies have also shown that systemic inflammation caused by chronic gum disease causes the body’s stem cells to produce a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300828">hyper-responsive</a> group of neutrophils (a type of early defence white blood cell). These cells may damage the lining of arteries by damaging the cells that line the arteries – triggering the <a href="https://jnm.snmjournals.org/content/48/11/1800/">build-up of plaques</a>.</p>
<h2>3. Type 2 diabetes</h2>
<p>Gum disease is a known complication of type 2 diabetes, and chronic gum disease increases the risk of <a href="https://onlinelibrary.wiley.com/doi/10.1111/jcpe.12837">developing type 2 diabetes</a>. </p>
<p>The processes that link the two diseases are the focus of much research, and it’s likely that inflammation caused by each condition affects the other. For instance, type 2 diabetes raises the risk of gum disease by <a href="https://www.nature.com/articles/s41415-019-0794-5">increasing inflammation</a> in the gums. Gum disease has also been shown to contribute to impaired insulin signalling and <a href="https://www.nature.com/articles/s41415-019-0794-5">insulin resistance</a> – which can both exacerbate type 2 diabetes. </p>
<p>Several <a href="https://pubmed.ncbi.nlm.nih.gov/29265454/">clinical trials</a> have shown an intensive dental cleaning can improve blood sugar control in diabetic patients for several months, further showing the links between the two diseases. </p>
<h2>4. Cancers</h2>
<p>Gum disease is also linked to a greater risk of developing many types of cancer. For instance, patients who reported having a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855151/">history of gum disease</a> were shown to have a 43% greater risk of oesophagal cancer, and a 52% greater risk of stomach cancer. Other research has also reported people with chronic gum disease had a between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868279">14-20% higher risk</a> of developing any type of cancer. The same study also showed a 54% higher risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868279/">pancreatic cancer</a>.</p>
<p>It’s not clear why this relationship exists. Some think it has to do with inflammation, which is a factor in both <a href="https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html#:%7E:text=Periodontal%20diseases%20are%20mainly%20the,red%2C%20and%20they%20may%20bleed.">gum disease</a> and <a href="https://www.sciencedirect.com/science/article/pii/S107476131930295X#:%7E:text=Inflammation%20predisposes%20to%20the%20development,inflammatory%20tumor%20microenvironment%20(TME).">cancer</a>. Inflammation disrupts the environment that cells need to stay healthy and function properly and is a factor in the progression of both gum disease and <a href="https://www.spandidos-publications.com/10.3892/ol.2018.8716#:%7E:text=The%20inflammatory%20microenvironment%20is%20an,tumors%2C%20as%20well%20as%20metastasis.">tumour growth</a>.</p>
<h2>Improving gum health</h2>
<p>Gum disease is preventable and reversible in the early stages. </p>
<p>While some risk factors for gum disease can’t be changed (such as your genetics), you can change your lifestyle to reduce your overall risk. For example, eating less sugar, avoiding tobacco and alcohol and reducing stress can all help. It’s also important to know that certain medications (such as some antidepressants and hypertension drugs) may lower saliva production, which can increase your risk of gum disease. People taking these medicines need to take extra precautions, such as using special gels or sprays to increase saliva production, or making sure to take extra care while brushing their teeth.</p>
<p>Of course, the most important things you can do to protect yourself from gum disease (and subsequently your overall health) are brushing twice daily with fluoride toothpaste and avoiding using mouthwash after brushing – and taking care not to rinse after brushing to allow the fluoride to remain on your teeth. Interdental cleaning at home (such as flossing) and regular dental visits will also help you keep your oral health in check.</p><img src="https://counter.theconversation.com/content/190093/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Bryson works part time for Floe Oral Care.</span></em></p>Here’s why it’s so important to look after your oral health.Christine Bryson, Senior Lecturer Medical Science, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1840822022-06-29T14:34:56Z2022-06-29T14:34:56Z‘Gain a child, lose a tooth’: old saying holds true for women in northern Nigeria<figure><img src="https://images.theconversation.com/files/470962/original/file-20220626-19-mjscln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women who have children over a long time lose more teeth. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/mothers-wait-to-have-their-children-immunized-against-a-news-photo/50989067?adppopup=true">Jacob Silberberg/Getty Images</a></span></figcaption></figure><p>Childbearing has an impact on the health of women, and the <a href="https://patient.info/doctor/gravidity-and-parity-definitions-and-their-implications-in-risk-assessment#:%7E:text=Parity%20is%20defined%20as%20the,born%20alive%20or%20was%20stillborn">impact</a> grows with the number of times a woman has been pregnant for longer than 24 weeks. Pregnancy and breastfeeding put energy demands on a woman and can cause permanent changes to a mother’s health.</p>
<p>What’s less well known is the relationship between parity and oral health. That’s despite a widespread customary belief that having an increasing number of children results in tooth loss. <a href="https://pubmed.ncbi.nlm.nih.gov/9683217/">“Gain a child, lose a tooth”</a>, or “for every child, a tooth is lost” are common proverbs in many societies. The biological basis of these beliefs is still questioned.</p>
<p>There are few studies on parity and tooth loss. In addition, the available results are inconsistent. Nevertheless, increasing number of children in women has been associated with tooth loss in some populations, as seen in studies in <a href="https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-9-18">Uganda</a> and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424105/">US</a>. </p>
<p>We decided to <a href="https://pubmed.ncbi.nlm.nih.gov/33340105/#affiliation-2">study</a> this relationship to add to the evidence. Our study of rural women in northern Nigeria looked at how age, reproductive and socioeconomic factors and oral health practices contributed to tooth loss.</p>
<p>We found that women with more than five children lost more teeth than women of the same age who’d had fewer children.</p>
<p>Tooth loss matters because teeth are important for both functional and aesthetic roles. The loss of a tooth affects an individual socially, functionally and psychologically, negatively affecting their quality of life. Tooth loss can affect beauty, self-esteem, mastication, speech and social interaction. </p>
<h2>Tooth loss</h2>
<p>Our study involved 612 women who live in rural northern Nigeria. They were between the ages of 13-65. They all identified as Hausa. We decided on this cohort because women in this area have very high <a href="https://pubmed.ncbi.nlm.nih.gov/33340105/#affiliation-2">fertility</a> rates. Nigeria has a <a href="https://dhsprogram.com/pubs/pdf/FR148/04Chapter04.pdf">total fertility rate</a> of 5.7 children per woman. However, in the northwest zone where Hausa and closely related Fulani populations are predominant, <a href="https://dhsprogram.com/pubs/pdf/fr222/fr222.pdf">the rate is 7.3</a>. </p>
<p>Sociodemographic status and oral health practices were collected using a questionnaire. All teeth present (excluding third molars) and missing teeth were noted. </p>
<p>Generally, tooth loss experience in the participants was low: an overall prevalence of 14.1%. This means that 14% of women had lost some teeth. The presence of tooth loss in the women differed based on how many children they’d carried beyond 24 weeks, with more tooth loss experienced among women who had had more children. </p>
<p>There was no discernible pattern between tooth loss and number of children among those with fewer than five children. </p>
<p>At five children and above, tooth loss increased with each additional child.</p>
<p>The participants in the study displayed generally similar socio-economic statuses and dental service usage. This reduced the potential effects of other factors such as dietary quality and oral health status that can result in tooth loss. </p>
<p>The results showing a relationship between child bearing and tooth loss were as we had expected. Importantly, the duration of reproduction (the span of reproductive years) was found to be a critical contributor. Women who had children over a longer period of time lost significantly more teeth. </p>
<p>Also, socio-economic status contributed significantly to tooth loss, as women of middle socio-economic experienced significantly greater tooth loss. This was age related, most women in the middle socio-economic class were older while those in the low socio-economic status were younger. </p>
<p>Age played a significant role more generally too. Our study found that age was strongly associated with tooth loss. Tooth loss is typically the culmination of degenerative biological processes rather than an event. The longer the tooth is in the oral cavity, the greater the probability that it is exposed to the factors leading to tooth loss. In addition to the effects of increasing age, women face heightened risks stemming from their reproductive histories. </p>
<h2>Hormones and tooth decay</h2>
<p>Tooth loss is the result of multiple processes involving infection and weakening of the tooth structure or supportive tissues. Diet, hormonal changes, oral hygiene and dental treatment all play a part. In addition, teeth can be lost to trauma and cosmetic cultural practices. Gum disease following tooth decay is a major cause of tooth loss. </p>
<p>Gender-based differences exist in oral health, with more tooth loss in females than males. This is <a href="https://pubmed.ncbi.nlm.nih.gov/20652339/">largely attributed</a> to the role of female sex hormones, pregnancy and reproductive history. Estrogen levels are <a href="https://pubmed.ncbi.nlm.nih.gov/2637066/">higher during pregnancy</a> than during any other period in the life cycle. <a href="https://pubmed.ncbi.nlm.nih.gov/16788889/">Pregnancy reduces</a> the buffering capacity of saliva and promotes growth of bacteria that cause tooth decay. </p>
<p>Estrogen and progesterone are known, among others, to inhibit a body’s ability to produce a normal immune response. This is known as <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunocompetent">immunocompetence</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/6103927/">The result</a> is faster tooth decay. </p>
<h2>Way forward</h2>
<p>This study highlights the need to give more attention to the oral health of women during the reproductive years, in particular those who have many children. </p>
<p>Generally in Nigeria, the use of dental care service is poor due to limited availability and accessibility of oral health clinics. This affects early treatment of dental problems, which contributes to more tooth loss. Furthermore, dental problems are not considered as life threatening, thus low priority is given to dental care.</p>
<p>We found in our study that pregnancy and maternity made women even less likely to use oral healthcare service. </p>
<p>Oral health should be incorporated into the general healthcare. Dental care should also be made available and accessible to the general public, especially to those in the rural communities. And women’s oral health should be monitored as part of pregnancy support too. </p>
<p>There is need for oral health awareness and education too to identify barriers to dental care services.</p><img src="https://counter.theconversation.com/content/184082/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Oziegbe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More attention should be given to the oral health of women during the reproductive years, in particular those who have many children.Elizabeth Oziegbe, Associate Professor of Dentistry, Obafemi Awolowo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1822672022-05-02T16:38:45Z2022-05-02T16:38:45Z7 principles to guide a national dental care program in Canada<figure><img src="https://images.theconversation.com/files/460635/original/file-20220501-24-htxo8o.jpg?ixlib=rb-1.1.0&rect=216%2C0%2C4220%2C2643&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A national dental care program for low-income Canadians plans to launch coverage for children under age 12 in 2022.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Prime Minister Justin Trudeau recently announced plans to establish a <a href="https://pm.gc.ca/en/news/news-releases/2022/03/22/delivering-canadians-now">national dental care program</a> for low-income Canadians. The program arguably represents one of the most significant health-care initiatives since Canadian Medicare and flows from the Liberal–NDP “<a href="https://pm.gc.ca/en/news/news-releases/2022/03/22/delivering-canadians-now">supply and confidence</a>” agreement.</p>
<p>The program will cover an estimated <a href="https://www.cbc.ca/news/politics/liberal-ndp-dental-plan-1.6393981">6.5 million</a> Canadians, paying dental care fees for families making less than $90,000 annually, with no co-pays for those under $70,000. Coverage will start with children under age 12 in 2022, then expand to those under age 18, seniors and people living with disabilities in 2023, with full implementation by 2025.</p>
<h2>Billion-dollar questions</h2>
<p>The federal budget committed <a href="https://budget.gc.ca/2022/home-accueil-en.html">$5.3 billion</a> for the new program, resulting in several “billion-dollar” questions, including: </p>
<ul>
<li><p>How will the money flow? Will this be a direct federal program administered by a public agency <a href="https://www.thestar.com/politics/2022/03/24/jagmeet-singh-expects-federal-dental-plan-to-remain-faithful-to-ndp-campaign-promise.html">as promoted by the NDP</a>? Or will the money flow through <a href="https://doi.org/10.1503/cmaj.200143">traditional federal/provincial/territorial</a> (FPT) arrangements for health care? </p></li>
<li><p>How will the national program align with other existing programs at the FPT level, let alone employer and individually sponsored dental benefit plans? </p></li>
<li><p>How will the services be delivered? In public clinics, including community health centres and hospitals, and/or through private clinics where most dental care is provided today? And what services will be covered?</p></li>
</ul>
<p>There are myriad details here, but at minimum, there appears to be increasing policy, public and political consensus that access to dental care should be made consistent, reliable and equitable for all Canadians across all jurisdictions. As a result, like it is for health care, federal policy leadership is key.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/filling-the-gaps-why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare-181306">Filling the gaps: Why Canada still needs a public dental health plan despite decades of medicare</a>
</strong>
</em>
</p>
<hr>
<p>This means the federal government could establish a set of principles to guide either its own direct program or the provinces and territories in qualifying for funding.</p>
<h2>Principles and possibilities</h2>
<figure class="align-center ">
<img alt="A woman in a blue suit stands at a lectern with people seated behind her" src="https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460636/original/file-20220501-26-qn2ibi.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Finance Minister Chrystia Freeland tables the federal budget in the House of Commons on April 7, 2022. The budget committed $5.3 billion over five years to a national dental care plan.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<p>As dental public health specialists, we propose a set of principles that we hope FPT governments, the oral health-care professions, patient advocates and the public can rally around. The principles apply to both a direct program and/or traditional FPT arrangements. In any case, these are early days, but the timeline is tight, so we believe these principles can be used to facilitate efficient policy and program development.</p>
<p>Most importantly, we offer these principles to move forward in a healthy way: in the service of Canadians who, for far too long, have been unable to meet their oral health-care needs because of a <a href="https://www.cbc.ca/news/canada/toronto/getting-dental-care-a-major-problem-for-a-third-of-torontonians-report-says-1.6345318">lack of access to care</a>.</p>
<p>The principles are:</p>
<ol>
<li><p><strong>Core basket of services.</strong> The federal government can establish a dental services schedule that is scientifically and ethically defensible. Defining this basket can help solve a pressing question in Canadian health-care policy: What is <a href="https://doi.org/10.1177/2380084420941777">medically necessary</a> or essential dental care? There should be a core service basket that all Canadians should have access to. <a href="https://hdl.handle.net/1807/35647">Such a basket</a> would arguably relieve pain and infection (for example, extractions), prevent disease (for example, topical fluorides), and restore physical and social function (for example, dentures). In the context of current FPT health-care arrangements, provincial and territorial programs would need to deliver this defined basket to qualify for funding.</p></li>
<li><p><strong>Fair remuneration.</strong> Public dental programs across FPT jurisdictions can vary substantially in <a href="https://www.caphd.ca/sites/default/files/FINAL%2520-%25202015%2520Environmental%2520Scan%2520-%2520ENGLISH%2520-%252016%2520Feb%252016.pdf">their remuneration rates</a> for services delivered in the private sector. In some jurisdictions, <a href="https://www.canadianscholars.ca/books/the-politics-of-dental-care-in-canada">reimbursement rates</a> are so low that it discourages practitioners from providing the care, limiting access for those that need it most. A negotiated fee schedule should recognize this fact, as well as understand the changing realities imposed by <a href="https://jcda.ca/l5">COVID-19</a>, which have made delivering dental care that much more expensive.</p></li>
<li><p><strong>Public and private administration.</strong> The new program can be publicly and privately administered. Governments need not be in the business of claims-processing. Many FPT dental care programs already take advantage of the efficiencies of <a href="https://www.canadianscholars.ca/books/the-politics-of-dental-care-in-canada">non-profit and for-profit claims-processors</a> specialized in paying dental bills. Yet, to maintain accountability, public oversight of appropriate spending is important to make best use of scarce public resources.</p></li>
<li><p><strong>Public and private delivery.</strong> Across FPT jurisdictions, <a href="https://www.caphd.ca/sites/default/files/FINAL%20-%202015%20Environmental%20Scan%20-%20ENGLISH%20-%2016%20Feb%2016.pdf">publicly funded programs</a> are delivered in private, public or combined settings. Private sector delivery currently dwarfs public sector delivery, yet both sectors are important. Leveraging the strength of both could help fill specific pockets of need, especially in a program that aims to target the unique and complex needs of medically compromised seniors and those living with disabilities.</p></li>
<li><p><strong>Portability.</strong> One of the strengths of our Medicare system is that no one falls through the cracks when moving from one province or territory to another. The home jurisdiction <a href="https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act-frequently-asked-questions.html#a7">maintains coverage</a> until coverage from the incoming jurisdiction begins. This approach should apply to the new program.</p></li>
<li><p><strong>Accessibility.</strong> Another positive aspect of Medicare is that it facilitates accessibility by not asking for any up-front costs from the patient. The new program would leverage the same principle for those whose income falls below $70,000. For those who make between $70,000 and $90,000, co-payments will apply, but they should be proportional to income. There could also be a subset of services (those deemed most important) whose costs would be completely captured by government, and then another set of services where co-pays would apply, again proportional to income.</p></li>
<li><p><strong>Data, evaluation, and reporting.</strong> Canada does not have a well developed <a href="https://www.canadianscholars.ca/books/the-politics-of-dental-care-in-canada">data infrastructure</a> to collect, share and analyze information on oral health. As a result, public investments for dental care in Canada have gone without appropriate evaluation. This will be key for the new program given its importance, and thus investments in surveillance and/or population health assessment are required. Evaluation and, more importantly, reporting of evaluation findings should be part of accountability measures.</p></li>
</ol>
<p>Funds are on the table, and we are still in the early days of resolving what is referred to as a “<a href="https://www.carequest.org/resource-library/wicked-problem-oral-health-care-system">wicked problem</a>.” In other words, dental care is arguably one of the most challenging, complex and underappreciated issues in health care. It is welcome news that there is now a real chance to clarify and act on this important part of Canada’s health-care system.</p><img src="https://counter.theconversation.com/content/182267/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonica Singhal consults or has consulted to federal, territorial, and municipal governments, and dental regulatory authorities. She receives or has received funding from these organizations. She is affiliated with various national and provincial dental professional associations.</span></em></p><p class="fine-print"><em><span>Carlos Quiñonez consults or has consulted to federal, provincial, territorial, and municipal governments, dental and dental hygiene regulatory authorities, dental professional associations, third-party benefits carriers, and not-for-profit agencies. He receives or has received funding from these organizations. He is affiliated with various national and provincial dental professional associations.</span></em></p>A national dental care program is welcome news, but raises several ‘billion-dollar’ questions about how the program will work and what will be covered. Here are seven principles to guide decisions.Sonica Singhal, Assistant Professor, Faculty of Dentistry, University of TorontoCarlos Quiñonez, Vice Dean and Director of Dentistry, Schulich School of Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1813062022-04-25T17:13:39Z2022-04-25T17:13:39ZFilling the gaps: Why Canada still needs a public dental health plan despite decades of medicare<figure><img src="https://images.theconversation.com/files/458978/original/file-20220420-24684-mk2q31.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4827%2C3437&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A public dental care plan would give many Canadians reason to smile.</span> <span class="attribution"><span class="source">(Unsplash)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/filling-the-gaps--why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare" width="100%" height="400"></iframe>
<p>Canadians pride ourselves on our health-care system, especially in comparison with our neighbours to the south. But there are significant gaps in coverage. <a href="https://www.cda-adc.ca/stateoforalhealth/snap/">Nearly one-third of Canadians do not have dental insurance, and that number climbs to 50 per cent for lower-income Canadians</a>. Without dental care, minor issues like cavities can result in serious infections. </p>
<p><a href="https://publications.gc.ca/collections/collection_2010/sc-hc/H34-221-2010-eng.pdf">Over 10 per cent of Canadians live with pain in their mouth</a>. People <a href="https://www.tvo.org/article/these-ontario-experts-are-calling-for-universal-dental-care">visit emergency rooms</a> for care that could be better delivered in a dental office. Canadians lose teeth that could have been saved, which makes it hard to eat nutritiously and can make it <a href="https://www.dentistrytoday.com/missing-teeth-damage-job-prospects/">more difficult to find work</a>. </p>
<p>Poor oral health can also <a href="https://www.dentalhygienecanada.ca/pdfs/Profession/Resources/Disease_Link_Article.pdf">complicate or contribute to diabetes, heart disease and other chronic diseases</a>. </p>
<h2>Why was dental care not included in medicare?</h2>
<p>My forthcoming book, <a href="https://www.mqup.ca/smile-gap--the-products-9780228010623.php"><em>The Smile Gap: The History of Oral Health and Social Inequality</em></a>, explores why dental care was left out of medicare. <a href="https://www.canada.ca/en/health-canada/services/health-care-system/commissions-inquiries/federal-commissions-health-care/royal-commission-health-services.html">The 1964 Royal Commission on Health Services</a>, which set the stage for medicare, recommended the establishment of a dental care program for children, using dentists and dental professionals with less training called dental auxiliaries. </p>
<p>The idea was to start with younger children and then expand eligibility to older children. Eventually, adults might be included. </p>
<figure class="align-right ">
<img alt="Book cover will an illustration of two smiling children" src="https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&rect=6%2C95%2C239%2C359&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458022/original/file-20220413-20-estivy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘The Smile Gap: The History of Oral Health and Social Inequality’ explores why dental care was left out of medicare.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>At the time, there was a significant shortage of dentists in Canada and a universal program was not practical. Dentists opposed the idea of publicly funded denticare, especially the use of auxiliaries to treat children. </p>
<p>The idea of using auxiliaries came from New Zealand, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2554050/">where specially trained dental nurses provided treatment in schools</a>. Despite the success of the New Zealand program, dentists did not believe that dental auxiliaries had sufficient training to work without a dentist’s direct supervision. </p>
<p>Dentists thought that more emphasis should be placed on prevention, especially education and water fluoridation. <a href="https://doi.org/10.3138/chr.89.3.345">Many had been fighting for water fluoridation in their communities for over a decade</a>. Water fluoridation had been shown to significantly reduce cavities and yet Canadians repeatedly <a href="https://doi.org/10.3138/jcs.44.2.146">rejected water fluoridation in municipal referendums</a>, leading dentists to conclude that Canadians did not value their oral health. </p>
<p>When the <a href="https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html">Medical Care Act of 1966</a> passed, dental care was not included. For the most part, dentists were delighted that they could continue their practices without state interference.</p>
<h2>The provinces step in</h2>
<p>My book covers the history of dental programs in Canada. Even before medicare, quite a few provinces provided public dental insurance for people on social assistance. </p>
<p>The Ontario dental insurance program, for example, was established in 1958 to provide care for children whose mothers received state support. In 1965, all parents who received family benefits became eligible. Unfortunately, many people who lived in regions without a dentist were unable to access the program. </p>
<p>According to a study by dental public health researcher <a href="https://www.dentistry.utoronto.ca/news/award-distinction-2018">James Leake</a>, dentists also had problems with the program. They disliked it because it only included basic services and they found it professionally challenging to not provide the best possible service. Dentists also complained that people on social assistance were much more likely to miss appointments than other patients. </p>
<figure class="align-center ">
<img alt="A child in a dentist's chair, obscured by the dentist's shoulder and hands." src="https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458981/original/file-20220420-15105-4d4vjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the years after the Second World War, some provinces began providing dental care to all children.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Access to care continues to be a problem today. While <a href="https://www.caphd.ca/sites/default/files/FINAL%20-%202015%20Environmental%20Scan%20-%20ENGLISH%20-%2016%20Feb%2016.pdf">all provinces provide some dental services to people on social assistance</a>, dentists are often reimbursed at less than their usual fees, making them reluctant to serve these patients. </p>
<h2>Dental care for children</h2>
<p>In the years after the Second World War, some provinces began providing dental care to all children. <a href="https://policyalternatives.ca/newsroom/updates/putting-our-money-where-our-mouth">The most innovative program was in Saskatchewan</a>, where dental nurses — later called dental therapists — provided care in schools beginning in the mid-1970s. The College of Dental Surgeons opposed the program and it was cancelled in 1987. </p>
<p>In other provinces, children received state-funded care in private dental offices. Although there were significant cutbacks to children’s programs in the late 20th century, Québec, Newfoundland and Labrador, Prince Edward Island and Nova Scotia still have universal dental care programs for children. <a href="https://www.caphd.ca/sites/default/files/FINAL%20-%202015%20Environmental%20Scan%20-%20ENGLISH%20-%2016%20Feb%2016.pdf">In the past 15 years</a>, there has been an expansion of targeted programs aimed at low-income children, such as <a href="https://www.health.gov.on.ca/en/pro/programs/dental/">Ontario’s Healthy Smiles</a> </p>
<h2>Rise of private dental insurance</h2>
<figure class="align-center ">
<img alt="A man holding a compress to his jaw and wincing" src="https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458983/original/file-20220420-20-himkco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in 10 Canadians live with mouth pain.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>In the 1970s, unions began demanding dental insurance. Companies that no longer needed to provide medical benefits to their employees began to offer dental insurance. <a href="https://books.google.ca/books/about/Dental_Care_Programs_in_Canada.html?id=rvp93b4XSvMC&redir_esc=y">By 1982, approximately two-thirds of collective agreements included dental benefits and just over one-third of Canadians had private dental insurance</a>. <a href="https://publications.gc.ca/collections/collection_2010/sc-hc/H34-221-2010-eng.pdf">By the mid-90s, over half of all Canadians had private dental insurance</a>. </p>
<p>Even though dental insurance did not cover all services, access to insurance diminished the demand for universal dental insurance.</p>
<h2>Gaps in care</h2>
<p>This has left some Canadians without dental care. In 2007, journalist Moira Welsh wrote about <a href="https://www.thestar.com/news/2007/02/10/why_is_he_out_of_work.html">Jason Jones for the <em>Toronto Star</em></a>. Jones was a young man, but his teeth had rotted away. In severe pain, he spent his wife’s life savings to remove them. </p>
<p>At the time the article was published, Jones had just two teeth, which the dentists had left in as anchors for dentures. He could only eat soft foods, his appearance was adversely affected and he couldn’t find a job. </p>
<p>Jones’ story had a happy ending. <a href="https://policyalternatives.ca/sites/default/files/uploads/publications/National%20Office/2011/04/Putting%20our%20money%20where%20our%20mouth%20is.pdf">In response to the front-page story</a>, numerous dentists and denturists reached out and dentist Raj Singh provided him with a new smile. Unfortunately, many other Canadians are not so lucky.</p>
<h2>The future of denticare</h2>
<p>In 2011, the Canadian Centre for Policy Alternatives published the report <a href="https://policyalternatives.ca/publications/reports/putting-our-money-where-our-mouth">Putting Our Money Where Our Mouth Is</a>, drawing attention to the need for better dental care. In 2019, the NDP included denticare in its <a href="https://www.cbc.ca/news/politics/ndp-singh-health-policy-federal-election-1.5175899">federal election platform</a>. The Liberal government promised to explore universal dental care in its <a href="https://www.canada.ca/content/dam/pco-bcp/documents/pm/Speech-from-the-Throne_2019.pdf">throne speech of December 2019</a>, and in October 2020, the <a href="https://www.pbo-dpb.gc.ca/web/default/files/Documents/Reports/RP-2021-028-M/RP-2021-028-M_en.pdf">Parliamentary Budget Office costed a program</a> to provide dental care to all Canadians with a household income of under $90,000, similar to what the <a href="https://www.sac-isc.gc.ca/eng/1576790320164/1576790364553">Non-Insured Health Benefits</a> program provides for Indigenous people. </p>
<p><a href="https://www.ndp.ca/news/ndp-will-help-more-canadians-get-dental-care-they-need">The NDP made denticare a key demand</a> in its 2021 electoral platform. Most recently, the <a href="https://www.cbc.ca/news/politics/trudeu-jagmeet-singh-deal-government-1.6393021">Liberal government agreed to provide a denticare program</a>, starting with children under 12 and expanding it until everyone with a household income of under $90,000 is covered, with no co-payments for people with a family income of under $70,000. </p>
<p>If the Liberals follow through on their promise, this will reduce the gaps in care and relieve the suffering of many Canadians.</p><img src="https://counter.theconversation.com/content/181306/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Carstairs received funding from SSHRC and AMS Health Services for this research.</span></em></p>Canada’s health system does not include dental coverage, leaving a large gap in care that’s existed since its beginning. It’s time to ensure access to oral care.Catherine Carstairs, Professor, Department of History, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1812392022-04-14T05:22:28Z2022-04-14T05:22:28ZThe Greens want Medicare to cover a trip to the dentist. It’s a grand vision but short on details<figure><img src="https://images.theconversation.com/files/457830/original/file-20220413-25-w4ga3t.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/european-mid-pleased-dentist-woman-face-1941089188">Shutterstock</a></span></figcaption></figure><p>Universal and affordable access to dental care is the perennial health-care issue everyone cares about but no major political party seems willing to address in any substantive way. </p>
<p>Thank goodness the Greens consistently remind us of the pressing need to make dental care an essential part of health care. This election, they’ve been quick to push out <a href="https://greens.org.au/sites/default/files/2022-04/Greens-2022-Policy-Platform--Health--Dental.pdf">their policy</a> to integrate dental care into Medicare.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1513934052839018504"}"></div></p>
<p>They propose everyone with access to Medicare be eligible for what are described as the “clinically relevant services they require”. This includes general dental, orthodontics (such as braces) and restorative services (such as crowns). </p>
<p>To make sure there are enough dental professionals, the Greens propose university education and training for the dental workforce be fee-free.</p>
<p>Such an expansive scheme is very expensive. This has been costed at A$77.6 billion over the next decade, funded with new taxes on big corporations and billionaires.</p>
<p>The Greens (who might hold some sway in a new parliament but will never be in government with budget responsibilities) have the luxury of proposing a large-scale program with no information about its presumable gradual introduction.</p>
<p>The Greens have also proposed a funding mechanism that is very unlikely to fly, given both the Coalition and Labor view new taxes and tax reforms <a href="https://independentaustralia.net/politics/politics-display/bad-politics-and-the-death-of-tax-reform,15544">as political poison</a>. </p>
<p>The Greens’ publicly available <a href="https://greens.org.au/sites/default/files/2022-04/Greens-2022-Policy-Platform--Health--Dental.pdf">policy document</a> is just three pages long and very short on detail. A number of key questions go unacknowledged and unanswered.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/voters-love-the-greens-message-more-than-ever-but-it-may-not-lead-to-a-surge-of-votes-for-them-180671">Voters love the Greens' message more than ever – but it may not lead to a surge of votes for them</a>
</strong>
</em>
</p>
<hr>
<h2>How much will this cost?</h2>
<p>The policy has been costed by the independent <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Budget_Office">Parliamentary Budget Office</a>, so there must be more detail available about the program’s rollout and scope. </p>
<p>The policy document does not say if the proposed $77.6 billion investment includes, or is in addition to, current federal spending on dental care through the Medicare-funded dental services for eligible <a href="https://www.servicesaustralia.gov.au/child-dental-benefits-schedule">children</a>, public dentistry for some <a href="https://federalfinancialrelations.gov.au/agreements/national-partnership-public-dental-services-adults">adults</a>, and GP and hospital visits for dental needs. </p>
<p>This figure likely does not include the costs of free university education for dentists, which is part of the Greens’ <a href="https://greens.org.au/sites/default/files/2022-03/Greens-2022-Policy-Platform--Education--Free-Tafe-Uni.pdf">separate education policy</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Dental students looking at dentures at university" src="https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458072/original/file-20220414-26-u6vq6n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Does the proposed funding include educating the next generation of dentists? That would cost extra.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dental-prosthesis-dentures-prosthetics-work-hands-458819089">Shutterstock</a></span>
</figcaption>
</figure>
<p>This $77.6 billion investment over ten years is substantial. This equates to an average of $7.7 billion a year – <a href="https://budget.gov.au/2022-23/content/bp1/download/bp1_bs5.pdf">about the same</a> (see table 5.8.1) as the annual cost to the federal budget of the subsidy to encourage people to purchase private health insurance.</p>
<p>However, these costs should be balanced against the economic benefits a federal government investment in a universal dental-care program would deliver in terms of reduced health-care costs and increased productivity. </p>
<h2>What is covered?</h2>
<p>The proposal is said to be costed on the basis <a href="https://www.vice.com/en/article/qjb5g5/the-greens-want-to-use-a-billionaire-tax-to-make-dental-free-for-all">that 80%</a> of dental services will be “routine”. But especially in the early years of such a program, there will be a pent-up demand from people who have <a href="https://adavb.org/news-media/media-releases/public-dental-waiting-lists-balloon-as-the-impacts-of-covid-19-bite">waited years for care</a>. These people will need more extensive and expensive services. </p>
<p>Formal guidelines about what is “routine” or “essential” and a focus on prevention and early intervention will be critical to ensure targeted care and prevent cost blow-outs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-million-aussies-delay-or-dont-go-to-the-dentist-heres-how-we-can-fix-that-113376">Two million Aussies delay or don't go to the dentist – here's how we can fix that</a>
</strong>
</em>
</p>
<hr>
<h2>The workforce</h2>
<p>Having the right dental workforce in the right places is essential for universal access to dental care.</p>
<p>Simply providing free university places for dental students will not address the current situation, <a href="https://pubmed.ncbi.nlm.nih.gov/30674395/">which sees</a> a surfeit of dentists in metropolitan areas and a scarcity in rural, remote and socially disadvantaged areas.</p>
<p>Many dental-care services can be delivered by <a href="https://grattan.edu.au/wp-content/uploads/2019/03/915-Filling-the-gap-A-universal-dental-scheme-for-Australia.pdf">dental hygienists and technicians</a> and any new scheme should encourage the most appropriate professional to deliver each service.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-brush-your-teeth-properly-according-to-a-dentist-177219">How to brush your teeth properly, according to a dentist</a>
</strong>
</em>
</p>
<hr>
<h2>What is missing?</h2>
<p>The policy does not specifically address providing oral health and dental care for people with special needs, including aged-care residents or people with a physical or mental disability.</p>
<p>The campaign materials talk about “free dental care” but provide no indication as to how this will be achieved. Under Medicare, neither the fees doctors and allied health professionals charge, nor bulk billing, <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1617/Quick_Guides/Medicare#:%7E:text=Bulk%20billing%20is%20not%20mandatory,service%20free%20to%20the%20patient.">are mandated</a>. It would be very difficult to impose set fees and a requirement to bulk bill on dental professionals.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-shocking-state-of-oral-health-in-our-nursing-homes-and-how-family-members-can-help-77473">The shocking state of oral health in our nursing homes, and how family members can help</a>
</strong>
</em>
</p>
<hr>
<h2>First steps</h2>
<p>For too many years, I <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2022">and</a> <a href="https://agedcare.royalcommission.gov.au/publications/final-report">others</a> <a href="https://grattan.edu.au/wp-content/uploads/2019/03/915-Filling-the-gap-A-universal-dental-scheme-for-Australia.pdf">have been writing</a> about the need to address <a href="https://johnmenadue.com/dental-care-must-be-on-the-election-agenda-its-time/">oral health and dental care</a>.</p>
<p>University of Sydney colleague Professor Heiko Spallek and I <a href="https://johnmenadue.com/dental-care-must-be-on-the-election-agenda-its-time/">recently proposed</a> that in the face of unwillingness of the major political parties to implement a universal dental-care program, there should be a more targeted approach to providing dental services.</p>
<p>For example, this could be a preventive program for children, oral hygiene programs for people in aged care, Medicare coverage of dental care for pregnant and post-partum women and for people with certain chronic medical conditions, such as cancer, diabetes or HIV/AIDS. Alternatively, a more limited approach could see the provision of designated essential services under a means-tested program.</p>
<p>I’ve <a href="https://theconversation.com/how-to-fill-the-gaps-in-australias-dental-health-system-35371">written before</a> about the need for teams of dental professionals and educators where they’re most needed, such as remote and under-served communities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-fill-the-gaps-in-australias-dental-health-system-35371">How to fill the gaps in Australia's dental health system</a>
</strong>
</em>
</p>
<hr>
<h2>It’s important to start the debate</h2>
<p>Dental health has a huge impact <a href="https://johnmenadue.com/dental-care-must-be-on-the-election-agenda-its-time/">on people’s quality of life</a>. This includes health outcomes, self-esteem and employability. </p>
<p>But for too many Australians, the <a href="https://grattan.edu.au/wp-content/uploads/2019/03/915-Filling-the-gap-A-universal-dental-scheme-for-Australia.pdf">burgeoning out-of-pocket costs</a> of private dental care and <a href="https://www.aihw.gov.au/about-our-data/our-data-collections/public-dental-waiting-times">long waiting lists</a> for publicly-funded care are a major barrier.</p>
<p>It is time for politicians and the medical profession to see oral health and dental care as an essential health-care issue worthy of substantial investment. </p>
<p>The Greens’ proposal – despite its inadequacies – has a vision that should serve as a starting point for public debate.</p><img src="https://counter.theconversation.com/content/181239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lesley Russell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Such an expansive scheme is very expensive. It has been costed at A$77.6 billion over the next decade, funded with new taxes on big corporations and billionaires.Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698842021-11-15T13:05:12Z2021-11-15T13:05:12ZWhy having bad oral health could raise the risk of COVID<figure><img src="https://images.theconversation.com/files/431262/original/file-20211110-15-14aurfd.jpg?ixlib=rb-1.1.0&rect=286%2C220%2C6864%2C4352&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-man-bad-teeth-hand-holding-604410845">Shutterstock</a></span></figcaption></figure><p>Not brushing your teeth will get you in trouble with the dentist – but since the arrival of the pandemic, it could lead to bigger problems too. There’s growing evidence that poor oral health raises the risk posed by COVID. </p>
<p><a href="https://www.nature.com/articles/s41415-021-2656-1">Research</a> shows that people with poor oral health can end up with more severe symptoms if they catch the coronavirus. COVID patients who <a href="https://pubmed.ncbi.nlm.nih.gov/33527378/">also have gum disease</a> are 3.5 times as likely to be admitted to intensive care compared to those without. They’re also 4.5 times as likely to need to be put on a ventilator and nine times as likely to die from COVID.</p>
<p>This may seem shocking, but the fact that there’s a link between oral health and COVID is less surprising when considering the link between oral hygiene and other diseases. Bad oral hygiene has been associated with making many other diseases worse. Principally this happens when bad hygiene is sustained for long periods, leading to <a href="https://pubmed.ncbi.nlm.nih.gov/23134607/">dysbiosis</a> – where the bacteria in the mouth change from a peaceful state into an aggressive one.</p>
<p>Once the mouth’s bacteria become aggravated, they can cause gum disease, <a href="https://pubmed.ncbi.nlm.nih.gov/24320956/">chewing away at the tissues</a> of the mouth and entering the blood stream. And once there, the bacteria can then flow around the body and settle in various organs, raising levels of inflammation and over time contributing to various specific and chronic conditions.</p>
<p>Indeed, if this happens, there’s barely a part of the body that can’t potentially be affected. Poor oral health can have an impact on the <a href="https://pubmed.ncbi.nlm.nih.gov/8471920/">heart</a>, raise <a href="https://pubmed.ncbi.nlm.nih.gov/27468793/">blood pressure</a> and make diabetes worse by raising <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/">blood sugar levels</a>. It’s been linked to <a href="https://pubmed.ncbi.nlm.nih.gov/15691348/">premature births</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/11022780/">arthritis</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809193/">kidney diseases</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/31715080/">respiratory disease</a> and even some <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2021.651437/full">neurodegenerative diseases</a>, including <a href="https://pubmed.ncbi.nlm.nih.gov/23666172/">Alzheimer’s</a>.</p>
<h2>So is the same thing happening with COVID?</h2>
<p>Possibly. Compared to those with mild or moderate symptoms, people with severe COVID have elevated levels of a specific inflammatory marker (called CRP). Some people with severe COVID also suffer what’s called a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527296/">“cytokine storm”</a>, where the immune system <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460647/">goes into overdrive</a> fighting off the virus and harms the body’s own tissues at the same time. </p>
<p><a href="https://www.nature.com/articles/s41415-021-2656-1">Research</a> shows that people with poor oral health also sometimes have elevated levels of CRP and cytokines – which suggests that gum disease can trigger the same sort of zealous immune response as COVID (though to a lesser degree). So if the two diseases are encountered at the same time, with the coronavirus and aggressive mouth bacteria both circling in the blood, then it’s possible that they together might tip the immune response into harming the body’s own tissues, leading to worse outcomes for people. </p>
<figure class="align-center ">
<img alt="A hospital ward with patients on oxygen" src="https://images.theconversation.com/files/431264/original/file-20211110-27-gfwl3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431264/original/file-20211110-27-gfwl3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=339&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431264/original/file-20211110-27-gfwl3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=339&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431264/original/file-20211110-27-gfwl3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=339&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431264/original/file-20211110-27-gfwl3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=427&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431264/original/file-20211110-27-gfwl3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=427&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431264/original/file-20211110-27-gfwl3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=427&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Often severe COVID symptoms are driven by an overactive immune response – which gum disease could contribute to.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/collapsing-beds-situation-corona-virus-patients-1852768240">faboi/Shutterstock</a></span>
</figcaption>
</figure>
<p>However, we currently understand little about how exactly oral hygiene and COVID interact, and it could be that they are combining in other ways to make the disease worse too.</p>
<p>For instance, a <a href="https://www.nature.com/articles/s41415-020-1747-8">big problem</a> with COVID and other respiratory viral illnesses are bacterial superinfections. These are where areas directly infected by the virus – such as the lungs and airways – are simultaneously infected with bacteria. </p>
<p>Bacterial superinfections are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext">common</a> in <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254671">people who have COVID</a>, and they’re <a href="https://www.nature.com/articles/s41415-020-1747-8">significantly more common</a> in people with severe disease. It’s not known precisely what impact they have, but it’s <a href="https://www.karger.com/Article/FullText/515067">reasonable to assume</a> that these concurrent infections raise the risk of severe disease and death. Throughout the pandemic, <a href="https://academic.oup.com/ofid/article/8/3/ofab065/6128788">studies</a> have found that a large proportion of people dying from COVID – <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30009-4/fulltext">in some cases, 50%</a> – were also infected with bacteria at the same time.</p>
<p>If someone’s oral hygiene is poor, this could raise the risk of a superinfection. Poor oral hygiene means more aggressive bacteria in the mouth, which could then easily be <a href="https://www.nature.com/articles/s41415-020-1747-8">breathed into</a> the airway and lungs to launch a superinfection.</p>
<p>On top of this, poor oral health may also help the coronavirus infect the body. Enzymes from the bacteria that cause gum disease can <a href="https://www.nature.com/articles/s41415-020-1747-8">alter the surface</a> of the mouth and respiratory tract, making it easier for other microbes – such as the coronavirus – to adhere to these surfaces and grow there. </p>
<figure class="align-center ">
<img alt="Bacteria" src="https://images.theconversation.com/files/431273/original/file-20211110-17-1cpxyhf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431273/original/file-20211110-17-1cpxyhf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431273/original/file-20211110-17-1cpxyhf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431273/original/file-20211110-17-1cpxyhf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431273/original/file-20211110-17-1cpxyhf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431273/original/file-20211110-17-1cpxyhf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431273/original/file-20211110-17-1cpxyhf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Having uncontrolled bacteria in the mouth raises the risk of getting a joint COVID-bacterial infection in the airway or lungs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteria-lactobacillus-3d-illustration-normal-flora-1104385652">Kateryna Kon/Shutterstock</a></span>
</figcaption>
</figure>
<p>As time passes it will become clearer exactly how oral health affects the progress of COVID. It may be that for some people, all of these mechanisms are at play at the same time. </p>
<p>But for the meantime, there is enough evidence to consider poor oral hygiene a risk factor for complications in those who have COVID – and especially in those who are already suffering with conditions such as diabetes, high blood pressure or cardiovascular disease, as these can be aggravated by poor oral health and are themselves risk factors for COVID. </p>
<p>It’s therefore more important than ever to maintain proper oral hygiene. This means brushing twice a day for at least two minutes with a fluoride-containing toothpaste and visiting the dentist on a regular basis. Hopefully you won’t catch the coronavirus, but if you do, having good oral health and caring for your mouth could significantly reduce your risk of developing severe symptoms.</p><img src="https://counter.theconversation.com/content/169884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Badly controlled bacteria in the mouth pose multiple risks.Sim K. Singhrao, Senior Research Fellow in the School of Dentistry, University of Central LancashireAlice Harding, Specialist Care Dentist and PhD candidate, School of Dentistry, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1691082021-10-26T17:25:31Z2021-10-26T17:25:31ZIs brushing your teeth for two minutes enough? Here’s what the evidence says<figure><img src="https://images.theconversation.com/files/428479/original/file-20211026-23-2je9r8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C10068%2C5663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The two minute rule has been recommended since the 70s. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hygiene-morning-routine-teeth-whitening-concept-1425774137">WAYHOME studio/ Shutterstock</a></span></figcaption></figure><p>A lot of us are familiar with the advice that we should brush our teeth twice a day, and for at least two minutes each time. Many of us <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12359">over-estimate</a> <a href="https://pubmed.ncbi.nlm.nih.gov/10518854/">how long</a> we brush our teeth for – by as much as a <a href="https://pubmed.ncbi.nlm.nih.gov/8354721/">whole minute</a> in some cases. And yet there’s some evidence that even two minutes of teeth brushing may not be enough. </p>
<p>According to <a href="https://saudijournals.com/media/articles/SJODR-45-302-304-c.pdf">research</a>, to remove <a href="https://onlinelibrary.wiley.com/doi/full/10.1034/j.1600-051X.2003.20008.x?sid=nlm%253Apubmed">as much plaque as possible</a> more is better – with the best results at <a href="https://pubmed.ncbi.nlm.nih.gov/19723429/">three to four minutes</a>. Does that mean we should double our brushing time?</p>
<p>Dentists began <a href="https://bda.org/about-the-bda/campaigns/oralhealth/Pages/brushing-myth-busters.aspx">recommending</a> we should brush our teeth for two minutes in the <a href="https://aap.onlinelibrary.wiley.com/doi/epdf/10.1902/jop.1979.50.12.661">1970s</a>, and later on, to use a toothbrush with soft bristles. However, <a href="https://www.ada.org/en/member-center/oral-health-topics/toothbrushes">today’s</a> <a href="https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-8-oral-hygiene">consensus</a> is mostly based on studies published since the 1990s, which looked at brushing times, techniques and toothbrush type. </p>
<p>These studies showed two minutes of brushing led to good (but not excellent) plaque reduction. But, while brushing longer than two minutes is shown to remove more plaque, there’s still a <a href="https://www.scottishdental.org/wp-content/uploads/2014/04/SIGN138.pdf">lack of research</a> which has looked at whether more than two minutes of brushing is linked with better long-term oral health compared with two minutes. </p>
<p>However, based on what we know of the harms of plaque overgrowth, it’s likely that removing more of it each time we brush is linked to better oral health. It’s also important to note that this lack of evidence is because long-term studies can be difficult to conduct.</p>
<p>When we brush our teeth, we do so with the main aim of removing microbes (known as dental plaque) from tooth surfaces. This plaque is an accumulation of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/eos.12527">bacteria, fungi and viruses</a> that live together in a community known as a microbial biofilm. Biofilms are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/prd.12361">very sticky</a> and can only be removed by brushing.</p>
<p>Many things can make it easier for these microbes to grow, including rough areas on the tooth’s surface (such as from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213966/">some fillings</a>), being unable to reach certain areas with a toothbrush (like the <a href="https://pubmed.ncbi.nlm.nih.gov/18715352/">spaces between teeth</a>), or <a href="https://www.sciencedirect.com/science/article/pii/S1761722710001361">having braces</a>. In fact, plaque biofilms re-grow on our teeth <a href="https://journals.asm.org/doi/full/10.1128/AEM.03984-15">within hours of brushing</a> – which is why we’re advised to brush <a href="https://www.ada.org/en/member-center/oral-health-topics/toothbrushes">twice a day</a>.</p>
<p>Not brushing our teeth properly or for long enough can lead to higher levels of plaque, which may ultimately activate our body’s immune response – eventually leading to <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0757.2009.00339.x">inflammation</a> and conditions such as gingivitis. Inflammation is usually not painful, but often causes bleeding gums when brushing and sometimes bad breath. Biolfilms can also cause <a href="https://theconversation.com/the-truth-about-tooth-decay-132172">tooth decay</a>.</p>
<h2>Proper technique</h2>
<p>The aim of brushing our teeth is to reduce as much plaque on each tooth as possible.</p>
<p>Current evidence suggests that spending more time brushing – <a href="https://pubmed.ncbi.nlm.nih.gov/19723429/">up to four minutes</a> each time you brush – leads to cleaner teeth. This longer brushing time means we can more effectively clean our teeth and get those hard-to-reach places. </p>
<p>But be careful not to brush too often (such as more than two times a day) and avoid brushing hard or using abrasive toothpastes and brushes, as this can also cause <a href="https://www.sciencedirect.com/science/article/pii/S0020653920358962">damage to our teeth and gums</a> – especially when using a toothbrush with hard bristles or abrasive toothpastes.</p>
<p>There are many <a href="https://www.nature.com/articles/sj.bdj.2014.651">different brushing techniques</a> you can use to brush your teeth properly. One of the most recommended ones is the <a href="https://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth">modified “Bass” technique</a>, which is intended to clean at and below the gum line – the area where plaque forms first and is most likely to cause inflammation. </p>
<p>You should always brush your teeth with a <a href="https://www.cdha.ca/pdfs/Profession/Resources/tooth_brushing_paper_reprint.pdf">gentle force</a> – though precisely how hard this should be is currently not conclusive. Gentle brushing is preferred so that we don’t damage the hard and soft tissues in our mouth. </p>
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<p>Many factors can affect which type of technique, brush and toothpaste or floss you use. For example, people who may have damaged the surface of their teeth from drinking too many acidic <a href="https://www.nature.com/articles/4811747">fizzy drinks</a> may have <a href="https://www.sciencedirect.com/science/article/abs/pii/S0003996907001586">weaker teeth</a>. </p>
<p>This may mean they’re more susceptible to further tooth damage if they use <a href="https://www.sciencedirect.com/science/article/pii/S030057121000062X?casa_token=Wpp6XNZhB6IAAAAA:h-7VVNMbCWNJTnfLCipCaEKv9VhNwDff6kElmhfXi8vwUsuuejnQh7ObAI5wOi_GMfFqsLix8g">abrasive toothpastes</a> and harder bristles. It’s worth consulting your dentist to know what you should use to brush.</p>
<p><a href="https://www.ada.org/en/press-room/news-releases/2016-archive/august/statement-from-the-american-dental-association-about-interdental-cleaners">Interdental cleaning</a> – which most of us know simply as flossing – is also recommended alongside brushing our teeth. Studies have found that both tooth decay and gingivitis can be <a href="https://www.mdpi.com/2304-6767/7/2/56">reduced by flossing</a>. </p>
<p>The most <a href="https://www.youtube.com/watch?v=HhdoPXNKNm">effective way of flossing</a> is sliding the floss between the gums and tooth and holding it firmly against the tooth – such that the floss “hugs it” – and rubbing along the surface of the tooth in a gentle up and down motion, gently advancing the floss beneath the gum line. </p>
<p><a href="https://www.youtube.com/watch?v=RbGLOmwB1To">Interdental brushes</a>, which can be pushed between the teeth at the gum level, can be even more effective. Less is known about other cleaning aids – including tooth picks, water jets, or tongue cleaners – and how effective they are.</p>
<p>While we may be used to the advice that we should brush our teeth twice a day for two minutes each time, it’s important that we also concentrate on using proper technique to ensure that we’re brushing thoroughly and properly. Brushing for longer than two minutes may also help us ensure that we remove more plaque off of our teeth – which will likely lead to better dental health.</p><img src="https://counter.theconversation.com/content/169108/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Josefine Hirschfeld does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Three to four minutes may actually be ideal for plaque removal.Josefine Hirschfeld, Academic Clinical Lecturer in Restorative Dentistry, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1695822021-10-17T08:39:42Z2021-10-17T08:39:42ZDental workers face particular risks: we designed a device to protect them<figure><img src="https://images.theconversation.com/files/426396/original/file-20211014-17-1onqt8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Oral healthcare workers are exposed to disease-causing organisms during dental procedures.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Dentistry faces a relatively high risk of exposure to a wide variety of infectious diseases originating from viruses and bacteria present in people’s mouths.</p>
<p>The COVID-19 pandemic (SARS-CoV-2) brought to the forefront the concern of infection spread and transmission in the dental setting, especially since evidence built up about how it’s airborne and transmitted in various environments.</p>
<p>Oral healthcare workers are exposed to disease-causing organisms during dental procedures that generate dental aerosol – the fine mist from saliva, and other fluids, created by the equipment dentists use in patients’ mouths. Water combined with compressed air by equipment such as the fast turbine and ultrasonic scalers during procedures such as fillings and tooth cleanings respectively produces aerosol, droplets and splatter. The cooling liquid of the instrument – usually water – become contaminated in the oral cavity from any organisms in the patient’s mouth and these developed aerosol find their way into the air. </p>
<p>These contaminated aerosols and droplets can remain suspended in the air for extended periods before entering the respiratory tract or settling on surfaces. </p>
<p>The dental practice also has a wide variety of surfaces made from different materials. Effective floor and surface disinfection protocols are essential after every aerosol-generating procedure. </p>
<p>Pre-COVID-19 oral healthcare workers wore some sort of respiratory protection in the form of examination masks, surgical masks or respirators. The COVID-19 pandemic has elevated the additional number of personal protective equipment needed. These now include face shields, protective eye wear, fluid-resistant aprons, mop caps and shoe covers. </p>
<p>It would also be useful to have technologies that reduce aerosol, droplets and splatter to reduce the microbial contamination of the dental environment. </p>
<p>My colleagues and I have invented a novel aerosol suction device. A design patent has been registered and the device was extensively <a href="https://www.mdpi.com/1999-4915/13/10/1928/htm">evaluated</a> during 2019/2020. This was done in both laboratory and clinical environments. The device is called the Dental Aerosol Suction Device (DASD). It’s main purpose is to reduce dental aerosols.</p>
<p>When we tested the device, we found it reduced aerosol, droplets and splatter that landed on the oral healthcare workers, compared to existing suction devices. The main advantage of the device is that it functions outside the patient’s mouth. This increases the visual field of view for the oral healthcare worker. </p>
<h2>Dental Aerosol Suction Device (DASD):</h2>
<p>The device is constructed from a durable chemically resistant and inert medical grade material. It fits in all sterilisers with chambers larger than 20cm(W) x 29cm(L). </p>
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<iframe src="https://player.vimeo.com/video/632030128" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dental aerosol suction machine.</span></figcaption>
</figure>
<p>The device has a number of advantages. </p>
<p>The first is that its versatile. It can be used in various positions outside the mouth to capture the aerosol, splatter and droplets.</p>
<p>It is also ergonomic and reusable. It can be sterilised in an autoclave. Other suction devices are usually disposable.</p>
<p>The device is also less expensive than other current extra-oral evacuation systems. The DASD doesn’t require any additional electricity and internal filters that require replacement. It’s a simple plug-and-play device. It can go on any dental chair or suction system.</p>
<p>Another advantage is that the device can remove aerosol, droplets and splatter from multiple positions. We recommend it’s positioned 10cm-15cm from the working area. This gives a better view of the mouth compared to high-volume suction that needs to be positioned up to 1cm from the working field. </p>
<p>One extremely important reason the DASD device is so effective is the <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162020000400003">known routes</a> of transmission of SARS-CoV-2 in humans. This includes contact through oral, nasal and eye mucosal membranes and direct transmission through coughing, sneezing and droplet inhalation.</p>
<p><a href="https://www.nature.com/articles/s41591-020-0946-9">Studies</a> have <a href="https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.001328">demonstrated</a> the presence of SARS-CoV-2 in the aerosol produced during patient exhalation. </p>
<p>A dental dam is used for isolation procedures during various dental procedures like fillings and root canal treatments. A rubber dam is not effective alone for isolation, due to the SARS-CoV-2 virus is present in the patients expelled breath.</p>
<p>During aerosol generation, the conventional 11 millimetre high-volume evacuation canula suction tip only operates for limited time frames during close approximation to the tooth during procedures. Because it needs to be placed in close proximity of the tooth to function optimally it has a reduced efficacy of minimising aerosols exhaled by the patient. </p>
<p>The new devise, on the other hand, has the advantage of a large catchment area and can be placed statically to continuously eliminate aerosols produced during patient exhalation from the 6 O’clock position up to 15 centimetres from the patient’s mouth.</p>
<p>A <a href="https://www.mdpi.com/2076-3417/11/4/1914">study</a> showed that aerosols, droplets and splatters have been identified as far as 1.2 metres from the source.</p>
<p>Our study found that the device reduced aerosol, droplets and splatter more than the conventional 11 millimetre high-volume evacuation canula suction tip.</p>
<p>The use of the conventional 11 millimetre high-volume evacuation canula suction tip reduced contamination of the oral healthcare workers by 53% compared to low-volume saliva ejectors alone. </p>
<p>When the DASD was used with the low-volume saliva ejector, our device reduced contamination of the oral healthcare worker’s wrists by 50% and of the chest area by 30%. This was in comparison to the test group where low-volume and high-volume ejectors were used together.</p><img src="https://counter.theconversation.com/content/169582/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Riaan Mulder works for The University of the Western Cape and hold the licence for the sale of the Dental Aerosol Suction Device (DASD). He receives funding from the Technology Innovation Agency of South Africa for the development of the DASD device.</span></em></p>Pre-COVID-19 dentists wore some sort of respiratory protection like examination masks, surgical masks or respirators. COVID-19 has elevated the number of personal protective equipment needed.Riaan Mulder, Senior Lecturer / Stomatologist, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670882021-09-09T20:09:43Z2021-09-09T20:09:43ZWhy dental care needs to be part of health care — and on the federal election agenda<figure><img src="https://images.theconversation.com/files/420111/original/file-20210908-27-1holpoy.jpg?ixlib=rb-1.1.0&rect=1201%2C49%2C6953%2C5395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dental decay is the most common non-communicable disease globally, but treating it is not part of our public health-care system.</span> <span class="attribution"><span class="source">(Pexels/Cedric Fauntleroy)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-dental-care-needs-to-be-part-of-health-care---and-on-the-federal-election-agenda" width="100%" height="400"></iframe>
<p>In Canada, dental care is not part of medical care. <a href="https://www.cda-adc.ca/stateoforalhealth/">Approximately six per cent of dental care is paid for by public funds, with the rest being paid through private insurance (56 per cent) or out-of-pocket (38 per cent)</a>. </p>
<p>This contributes to significant inequalities in oral health and dental care, with <a href="https://cahs-acss.ca/improving-access-to-oral-health-care-for-vulnerable-people-living-in-canada/">the poorest Canadians having both the greatest burden of oral disease and the most difficulty accessing dental care</a>. </p>
<p>While Canada’s medical care system has its problems, the fact that it is free at the point of service substantially helps all Canadians access it. The teeth and mouth are part of the body, and this false segregation of care systems costs individual Canadians and the country as a whole money we can ill afford. Writing as a researcher in the field of dental public health, it is my opinion that dental care should be part of medical care. </p>
<p>When health care is discussed as an issue in the federal election, dental care should be part of the discussion.</p>
<h2>Irony and inequality</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gloved hands holding an iPad showing a dental X-ray" src="https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420121/original/file-20210908-19-5wzdxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Twenty-two per cent of Canadians — about eight million people — avoid going to the dentist due to cost.</span>
<span class="attribution"><span class="source">(Pexels/Tima Miroshnichenko)</span></span>
</figcaption>
</figure>
<p>There is an awful irony that <a href="https://doi.org/10.1016/S0140-6736(19)31146-8">dental decay is among the most common non-communicable diseases globally</a>, but treating it is not part of our public health-care system. The burden of oral disease for those individuals suffering the pain, difficulty eating, embarrassment smiling or talking and time off work or school is enormous. </p>
<p>Furthermore, <a href="https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00010-eng.htm">22 per cent of the population</a> (approximately eight million people) reports avoiding the dentist due to cost. As a result, the public medical system ends up treating oral disease but often in inefficient and inappropriate ways. </p>
<p>For example, from 2010 to 2012, treatment of dental decay was by far the most common reason for one- to five-year-old children receiving general anesthesia, <a href="https://publications.gc.ca/collections/collection_2014/icis-cihi/H118-94-2013-eng.pdf">accounting for 31 per cent of all general anesthesia care in that age group</a>. In addition, this procedure was much more common among Indigenous children, the poorest families and those living in rural areas. These children often have several severely decayed teeth because their parents are unable to afford dental care. </p>
<p>On top of this, increasing numbers of <a href="https://files.ontario.ca/books/mol_changing_workplace_report_eng_2_0.pdf">Canadians have precarious jobs with lower wages and fewer workplace benefits</a> so have to pay for dental care out of pocket. This results in <a href="https://doi.org/10.17269/CJPH.108.5950">more people consulting physicians and/or emergency departments for dental problems</a>, but often receiving sub-optimal care as those facilities are not equipped to provide the necessary treatment. </p>
<h2>Oral care is health care</h2>
<p>To add to these issues directly related to oral disease and dental care, we also know that the body’s systems do not segregate the mouth from the rest of the body. There are important examples of direct links between oral health and general health. </p>
<p>For example, <a href="https://doi.org/10.1111/idj.12360">worsening gum disease can result in deterioration in diabetes, and vice versa</a>. And this burden of disease and difficulties accessing dental care is experienced very unequally among Canadians. The poorest groups, Indigenous people, recent immigrants, those with disabilities and those living in rural and remote Canada having significantly more problems. <a href="https://cahs-acss.ca/improving-access-to-oral-health-care-for-vulnerable-people-living-in-canada/">These inequalities are also greater among women than men in Canada</a>.</p>
<p>However, there is something that can be done to improve this situation. This has been recognized by the World Health Organization, and is increasingly recognized in Canada. This year, <a href="https://www.who.int/news/item/27-05-2021-world-health-assembly-resolution-paves-the-way-for-better-oral-health-care">the WHO passed a resolution</a> paving the way for improved oral health care globally with the observation that: </p>
<blockquote>
<p>“… oral health should be firmly embedded within the noncommunicable disease agenda and that oral health-care interventions should be included in universal health coverage programmes.” </p>
</blockquote>
<p>The current federal election provides the opportunity to bring this issue to the forefront of the discussion on health care in Canada. In December 2019, the <a href="https://pm.gc.ca/en/mandate-letters/2019/12/13/minister-health-mandate-letter">prime minister’s mandate letter for the Minister of Health</a> requested her to “work with Parliament to study and analyze the possibility of national dental care.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman dentist and a child patient" src="https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420120/original/file-20210908-23-17jz93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Treatment of dental decay is a common reason for one- to five-year-old children receiving general anesthesia. Most of these cases could have been prevented.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>In October 2020, the federal <a href="https://www.pbo-dpb.gc.ca/en/blog/news/RP-2021-028-M--cost-estimate-federal-dental-care-program-uninsured-canadians--estimation-couts-lies-un-regime-soins-dentaires-federal-destines-tous-canadiens-non-assures">Parliamentary Budget Office</a> published a cost estimate for a federal dental care program for uninsured Canadians. This was based on the NDP proposal for Canadians earning less than $90,000 annually receiving care. The total cost was estimated to be $1.5 billion per year to cover care for approximately 6.5 million Canadians. </p>
<p>However, another <a href="https://doi.org/10.11575/sppp.v13i0.69676">recent report</a> compared the costs of a “Denticaid” system providing public insurance to all children under 12 and others without private insurance, versus a “Denticare” system in which dental care is covered for all, just as with the medicare system. The report concluded that the net costs of the “Denticare” system were less, so Canada should adopt this approach.</p>
<p>Dental care should be moved into the medicare system. On top of the cost savings to individuals and the population as a whole, it would help reduce the substantial inequalities in oral disease and access to care, as well as promote the integration of medical and dental care so as to help people with gum disease and diabetes, the screening of young kids for dental decay and countless other situations in which our mouth is an integral part of our body.</p><img src="https://counter.theconversation.com/content/167088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Allison receives funding from CIHR, PHAC, the COVID-19 Immunity Task Force and other public research funding agencies. He is affiliated with the Association of Canadian Faculties of Dentistry and the Canadian Academy of Health Sciences. </span></em></p>Canada’s largely private dental care system exacerbates inequalities and is a barrier to integrating oral health with general health.Paul Allison, Professor of Dental Public Health, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1612642021-05-31T06:04:08Z2021-05-31T06:04:08ZWhat causes dry lips, and how can you treat them? Does lip balm actually help?<figure><img src="https://images.theconversation.com/files/403491/original/file-20210531-27-1pcrc50.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As we head into the colder weather, many of us might be afflicted with the irritating ailment of dry and chapped lips.</p>
<p>People have been trying to figure out how to fix dry lips for centuries. Using beeswax, olive oil and other natural ingredients have been reported as early as Cleopatra’s <a href="https://nationalpost.com/entertainment/movies/secret-gloss-a-brief-history-of-lip-balm-from-earwax-to-clorox">time</a>, around 40 B.C.</p>
<p>In 1833, there were even reports of human earwax being <a href="https://www.google.com.au/books/edition/The_American_Frugal_Housewife/-YYSAQAAMAAJ?hl=en&gbpv=1&dq=the+American+Frugal+Housewife,+Dedicated+to+Those+who+are+Not+Ashamed+of+Economy&printsec=frontcover">recommended</a> as a successful remedy for dry, cracked lips. Not long after, the first commercial lip balms hit the market.</p>
<p>So what causes dry lips, and which lip balms actually help? The key is to avoid lip balms that contain certain additives which might worsen the problem.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CPhuZbctAHL","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>They need to be soft but resilient</h2>
<p>Our lips are constantly exposed to the elements, such as sunlight, wind, dry air, and cold weather. They have to withstand our daily lifestyle, including contact with food, cosmetics, biting, picking, rubbing against clothes, kissing and more.</p>
<p>So, although they look soft and fleshy, our lips need to be resilient and tough.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-our-toes-and-fingers-get-wrinkly-in-the-bath-120229">Curious Kids: why do our toes and fingers get wrinkly in the bath?</a>
</strong>
</em>
</p>
<hr>
<p>Lips sit at the junction where our outside facial skin transitions into the <a href="https://www.youtube.com/watch?v=XsrlJn2cDh0&t=58s">tissue</a> layers lining the mouth. As such, the lips are structured similar to <a href="https://www.ncbi.nlm.nih.gov/books/NBK507900/">mucous membranes</a>, but with the addition of a <a href="https://link.springer.com/article/10.1007/s004030050453">protective</a> outside layer of skin. Lips don’t have hair follicles, or sweat, saliva and oil glands.</p>
<p>This unique structure means they’re particularly prone to dryness as they have a much lower ability to hold <a href="https://europepmc.org/article/med/15030342">water</a> than the rest of the face’s skin.</p>
<h2>What causes dry lips?</h2>
<p>Many of us get dry lips at certain times of the year. This can occur naturally, or be brought on by many different factors, including:</p>
<ul>
<li><p>inflamed lips, known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531998/">cheilitis</a>. This can be due to a skin condition, or an infection such as herpes or cold sores</p></li>
<li><p><a href="https://journals.lww.com/dermatitis/Abstract/2007/12000/Allergic_Contact_Cheilitis_from_Benzophenone_3_in.8.aspx">allergies</a></p></li>
<li><p>medications which impact the <a href="https://pubmed.ncbi.nlm.nih.gov/12974516/">salivary glands</a>, the mouth’s surrounding <a href="https://youtu.be/UNyKlwO23w4">muscles</a>, or sensations throughout the lip area</p></li>
<li><p>tongue injuries, teeth that rub against the lips, or other dental issues</p></li>
<li><p>poor oral health. This can be brought on by general neglect, <a href="https://pubmed.ncbi.nlm.nih.gov/22750232/">eating disorders</a>, or bad oral hygiene habits</p></li>
<li><p>burns, such as eating food that’s too hot, or sunburn. Burns can result in the lips swelling, <a href="https://youtu.be/T-FnAH9y1N4">scarring</a> and blistering, and it may take a long time for the pain to alleviate</p></li>
<li><p>some diseases or disorders, such as <a href="https://pubmed.ncbi.nlm.nih.gov/19445445/">Sjögren’s syndrome</a></p></li>
<li><p>dehydration, heat stroke, <a href="https://youtu.be/BxgEoLmOACo">fever</a>, or excessive heat</p></li>
<li><p><a href="https://www.sciencedirect.com/science/article/pii/S2352647520300988?via%3Dihub">nasal</a> congestion, which leads to chronic mouth-breathing. This can sometimes be a result of illness, such as when you have a common cold</p></li>
<li><p>cold weather or cold wind that runs along the lips and removes moisture</p></li>
<li><p>persistent licking, which can create a wet-dry cycle that excessively <a href="https://www.sciencedirect.com/science/article/pii/S2352647520300988">dries</a> out your lips.</p></li>
</ul>
<p>The dryness can also lead to pain, itching or stinging.</p>
<p>If dry lips start causing serious issues, it may be helpful to discuss this with a medical professional.</p>
<h2>How can you treat dry lips?</h2>
<p>It is important to identify what’s causing dry lips. If it’s due to lip licking, then you need to make habitual changes to stop the practice. If it’s due to cold, windy or dry weather, then certain balms and ointments can help protect the lips. </p>
<p>Drinking adequate amounts of <a href="https://www.sciencedirect.com/science/article/pii/S2352647520300988">water</a> can assist, because this helps prevent dry skin in general.</p>
<p>If this isn’t enough, bland, non-irritating, unflavoured lip balms can help, as they act as a film covering the lip surface, keeping moisture in.</p>
<figure class="align-center ">
<img alt="Man with beard applying lip balm" src="https://images.theconversation.com/files/403497/original/file-20210531-15-u2nxjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403497/original/file-20210531-15-u2nxjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403497/original/file-20210531-15-u2nxjk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403497/original/file-20210531-15-u2nxjk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403497/original/file-20210531-15-u2nxjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403497/original/file-20210531-15-u2nxjk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403497/original/file-20210531-15-u2nxjk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s best to choose a bland lip balm that doesn’t contain fragrances, flavours and colours.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In many cases these use petroleum jelly as a base (although it’s not <a href="https://onlinelibrary.wiley.com/doi/10.1111/ics.12533">required</a>), along with refined mineral oils to remove any <a href="https://www.hindawi.com/journals/jchem/2019/1680269/">hazardous</a> compounds, and other ingredients that can assist in retaining and maintaining a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ics.12583">barrier function</a>. </p>
<p>In the race to appeal to consumers, cosmetic manufacturers have trialled a number of new ingredients in their lip balms. Popular lip balms often contain additives which can make the balm smell or taste nice, or soften the feel when it rubs against the lips.</p>
<p>Some of these extra ingredients can help. For example, if you’re out in the sun a lot, lip balm with included sunscreen is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1227745/">great</a> addition.</p>
<h2>Products to avoid</h2>
<p>In many cases, these compounds provide the feeling of immediate relief on the lips but don’t actually help with the barrier function. And in some cases, they can become irritants and even worsen the dryness.</p>
<p>When choosing a lip balm, try to avoid products containing these ingredients:</p>
<ul>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477564/">fragrances</a></p></li>
<li><p><a href="https://enveurope.springeropen.com/articles/10.1186/s12302-016-0076-7">flavours</a>, such as mint, citrus, vanilla, and cinnamon</p></li>
<li><p>shiny <a href="https://www.nbcnews.com/health/health-news/not-just-lip-service-gloss-can-invite-skin-cancer-flna1c9459959">glosses</a>, which can intensify damage from the sun’s rays</p></li>
<li><p><a href="https://www.fda.gov/cosmetics/cosmetic-ingredient-names/color-additives-permitted-use-cosmetics">colours</a>, which can cause irritation and do nothing to assist the barrier function</p></li>
<li><p>menthol, phenol or salicylic acid, which can actually make your lips <a href="https://health.clevelandclinic.org/7-signs-your-lip-balm-use-is-just-a-bad-habit/">drier</a></p></li>
<li><p>additional, unnecessary <a href="https://www.aad.org/public/everyday-care/skin-care-basics/dry/heal-dry-chapped-lips">ingredients</a> such as camphor, lanolin, octinoxate, oxybenzone or propyl gallate.</p></li>
</ul>
<p>And be sure to stop biting, picking or excessively licking your lips.</p>
<p>Staying hydrated and applying a bland lip balm should be a routine incorporated into your every day lifestyle for healthy, protected, and moisturised lips.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CPhDQOdjh5a","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p><img src="https://counter.theconversation.com/content/161264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The key is to avoid lip balms that contain certain additives which might worsen the problem. Instead, try balms that are bland and don’t contain flavours, fragrances and colours.Christian Moro, Associate Professor of Science & Medicine, Bond UniversityCharlotte Phelps, PhD Student, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1568232021-04-07T20:29:36Z2021-04-07T20:29:36ZCanadians should be able to access dental care with a health card instead of a credit card<figure><img src="https://images.theconversation.com/files/393203/original/file-20210401-23-1an8cgw.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4977%2C3428&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman walks past a photograph of a smiling woman outside a dental office, in Vancouver, B.C., Aug. 3, 2020. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><p>The COVID-19 pandemic has <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/200527/dq200527b-eng.htm">raised Canadians’ anxiety levels</a>: anxiety about contracting the virus, financial hardship and isolation. But one thing Canadians don’t have to worry about is how they’ll pay for essential health care if they need it. For that, at least, all we need is our health card. </p>
<p>Actually, that last part is only partially true. Vital areas of health care were excluded from medicare, our <a href="https://www.canada.ca/en/health-canada/services/canada-health-care-system.html">universal health-care system</a>. And for many Canadians, access to these health services has worsened since the start of the pandemic. Many have lost their jobs, and with that, <a href="https://policyoptions.irpp.org/magazines/october-2020/a-drug-dental-and-mental-health-plan-for-uninsured-canadians/">essential health benefits</a> like dental care. </p>
<p>The COVID-19 pandemic has reinforced just how foundational medicare is. As we recover from the effects of the pandemic, we must strengthen that foundation. It’s time for Canadians to start using their health card, not their credit card, to access dental care.</p>
<h2>Health and oral health</h2>
<p>Dental care is not luxury. Oral health is a critical part of overall health. Dentists and emergency physicians see the consequences of poor oral health on a daily basis. </p>
<p>Poor oral health can <a href="https://doi.org/10.1017/cem.2019.437">cause or worsen other medical conditions due to chronic inflammation</a>. Providing dental care improves diabetic control, reduces the risk of aspiration pneumonia in long-term care homes, improves completion of treatment for substance use disorder and increases drug abstinence.</p>
<p>It has even been shown to increase employability. It’s hard to confidently interview for a job if you’re afraid to smile. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A dentist wearing PPE: gown, mask, face shield and gloves." src="https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393355/original/file-20210405-21-1jwyp8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dr. Serge Elbaz demonstrates enhanced protective equipment as dentists in Québec re-open amid the COVID-19 pandemic on June 1, 2020, in Laval, Que.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p><a href="https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00010-eng.htm">One in three Canadians lack dental insurance and one in five avoid seeing a dentist each year due to cost</a>. In terms of dental care, our “universal” health-care system is anything but. Of all dental care spending, only five per cent is public. <a href="http://ncohr-rcrsb.ca/knowledge-sharing/working-paper-series/content/garbinneumann.pdf">That’s less than the United States, where 10 per cent of dental care spending is public, and not even close to the United Kingdom, where it is 46 per cent</a>.</p>
<p>This already dire situation was worsening before the pandemic, <a href="https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed/Final%20April%2026%20Commentary%20510.pdf">with more seniors retiring and losing their work-related benefits and more people working in the precarious gig economy</a>. COVID-19 has only exacerbated this. </p>
<p>If Canada’s health-care system were a mouth, it would be too embarrassed to smile for fear of showing the large gap that is our missing dental care system. </p>
<h2>The cost of forgoing dental care</h2>
<p>Many Canadians forgo routine care because they can’t afford it, leaving small problems to fester and grow. Our current system not only stresses our individual wallets, it also puts additional strain on our health-care system. </p>
<p>With <a href="https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00010-eng.htm">four in 10 low-income Canadians avoiding seeing a dentist</a> due to cost, many end up relying on our emergency departments. <a href="https://www.allianceon.org/sites/default/files/documents/Information-ER-DR-visits-dental-problems_Jan-2017.pdf">Every nine minutes in Ontario, someone visits an emergency department for dental pain</a>, when they really need to see a dental professional. <a href="https://www.dentistrytoday.com/news/industrynews/item/2443-barriers-to-dental-care-send-thousands-to-emergency-rooms-for-treatment">The cost of these visits across the country is estimated to be more than $150 million a year</a>. </p>
<p>The <a href="https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html">Canada Health Act</a> makes the objective of Canadian health-care policy very clear: </p>
<blockquote>
<p>“to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” </p>
</blockquote>
<p>Given this, we must guarantee access to essential dental care for every Canadian. </p>
<p>Expanding public spending to guarantee dental insurance for all would help Canadians access routine care, reducing the need for more costly and complex procedures later. This would benefit individuals, reduce costs for employers and give businesses a competitive advantage similar to the way medicare does now. </p>
<h2>Challenges beyond public financing</h2>
<p>While public financing is important, it doesn’t guarantee access to a provider. The private delivery model has left many <a href="https://jcda.ca/article/f23">poor and rural communities significantly under-resourced</a>. Public delivery of some dental care can ensure that people actually have a provider near their community.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in scrubs and a surgical mask positions a light over a person in a dentist's chair" src="https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393356/original/file-20210405-21-to12gq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many Canadians forgo routine dental care because they can’t afford it, leaving small problems to fester and grow.</span>
<span class="attribution"><span class="source">(Pexels/Cedric Fauntleroy)</span></span>
</figcaption>
</figure>
<p>Many dentists in private practice <a href="https://doi.org/10.1186/s12939-017-0631-x">have historically been hostile to universal dental care and public delivery</a>. That’s no surprise because it cuts into their monopoly on care. </p>
<p>Doctors were once the same too. <a href="https://canadiandimension.com/articles/view/the-birth-of-medicare">Doctors were the biggest opponents of medicare when it was first introduced</a> in Saskatchewan. On July 1, 1962, the day medicare was born, most of the province’s doctors went on strike. But now, very few would want an American-style health-care system like we currently have for dental care — especially during the pandemic.</p>
<p>The COVID-19 pandemic hasn’t given Canadians many reasons to smile. Investing in a universal, publicly-funded dental care system would ensure that a healthy, pain-free smile is in sight for every Canadian. </p>
<p><em>This article was co-authored by Brandon Doucet, a dentist practising in Newfoundland with interests in surgery and public health and the founder of Coalition for Dentalcare.</em></p><img src="https://counter.theconversation.com/content/156823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hasan Sheikh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Oral health is a key part of overall health, but many Canadians skip dental care due to the cost, resulting in emergency room visits and health issues. It’s time for a dental care plan for all Canadians.Hasan Sheikh, Lecturer, Department of Family and Community Medicine, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1481902021-01-21T03:38:42Z2021-01-21T03:38:42ZYes, baby teeth fall out. But they’re still important — here’s how to help your kids look after them<figure><img src="https://images.theconversation.com/files/379833/original/file-20210120-15-18buj0g.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7788%2C5196&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Baby teeth, or milk teeth, act like lighthouses to guide the adult ones to their correct destination. A baby tooth will become wobbly and fall out because the adult tooth that follows pushes through to break down the roots of the baby tooth. </p>
<p>To lose baby teeth, particularly the first one, is a rite of passage for children. And while most baby teeth do fall out, some kids <a href="https://pubmed.ncbi.nlm.nih.gov/11484466/">won’t lose all their baby teeth</a>.</p>
<p>Sometimes, the adult teeth simply don’t form. In an average class, one or two students, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0528.2004.00158.x">or 6% of children</a>, will not form at least one adult tooth (this doesn’t include those with missing wisdom teeth). A missing adult tooth will often mean the baby tooth remains in place into adulthood.</p>
<p>For this and other reasons, it’s important to look after your child’s baby teeth.
Healthy baby teeth are paramount to children’s health and well-being both in the present and into adulthood.</p>
<h2>Kids get cavities too</h2>
<p>Just like in adult teeth, baby teeth can develop <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373711/">cavities</a> (holes). Factors including cavity-causing bacteria in the mouth, regular consumption of sugary drinks and snacks, and not brushing well can make cavities more likely.</p>
<p>Untreated cavities can grow to affect or even kill the nerves and blood vessels inside the tooth. If this happens, your child can suffer from <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ipd.12186">severe toothache</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/16415836/">infection</a>. These are among the most common <a href="https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-6-16">preventable reasons</a> for children to require dental treatment under general anaesthetic.</p>
<p>In some instances, it may be necessary to remove a baby tooth if it’s infected or has a very large cavity. This can potentially cause <a href="https://www.tandfonline.com/doi/abs/10.3109/00016357709019797">overcrowding</a>.</p>
<p>If a baby tooth is lost before the adult successor is ready, the teeth on either side drift into the space. Lacking space, the adult tooth may eventually come through in the wrong place. In such cases, your child is <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-263X.2008.00951.x">more likely</a> to need braces.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-lose-our-baby-teeth-111911">Curious Kids: why do we lose our baby teeth?</a>
</strong>
</em>
</p>
<hr>
<h2>Dental problems can lead to bigger problems</h2>
<p>Left untreated, infected baby teeth can affect your child’s health and well-being. </p>
<p>Children with healthy smiles <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002817718306871">fare better at school</a> relative to those who suffer with dental problems. Children who experience dental pain may lose sleep, have difficulty concentrating and participating in class, and miss school altogether.</p>
<p>Poor dental health also affects children’s <a href="https://pubmed.ncbi.nlm.nih.gov/19491160/">physical development</a>. Children with sore teeth may skip meals or eat less, which can affect their <a href="https://www.karger.com/Article/Abstract/481410">nutrition and growth</a>.</p>
<p>We also know cavities in baby teeth are associated with <a href="https://pubmed.ncbi.nlm.nih.gov/15341619/">an increased risk</a> of suffering from the same issues into adulthood.</p>
<figure class="align-center ">
<img alt="A smiling baby in a high chair chewing on a toothbrush." src="https://images.theconversation.com/files/379844/original/file-20210121-17-10w9zjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379844/original/file-20210121-17-10w9zjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379844/original/file-20210121-17-10w9zjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379844/original/file-20210121-17-10w9zjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379844/original/file-20210121-17-10w9zjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379844/original/file-20210121-17-10w9zjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379844/original/file-20210121-17-10w9zjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some children may keep some of their baby teeth into adulthood.</span>
<span class="attribution"><span class="source">Christian Hermann/Unsplash</span></span>
</figcaption>
</figure>
<h2>Some signs your child may have dental problems</h2>
<p>A child will describe and experience a toothache differently to adults, but there are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ipd.12186">a few signs</a> you can look out for. Your child may:</p>
<ul>
<li><p>complain of a sharp poking pain, an annoying, sore or itchy tooth, or even an earache</p></li>
<li><p>avoid hot, cold, sweet or hard, chewy foods</p></li>
<li><p>take longer than usual to finish a meal</p></li>
<li><p>complain about food getting stuck in their teeth</p></li>
<li><p>have difficulty brushing their teeth</p></li>
<li><p>have trouble falling asleep or wake up during the night more often than usual</p></li>
<li><p>be too tired to participate in class</p></li>
<li><p>perform poorly at school</p></li>
<li><p>experience difficulty socialising and speaking</p></li>
<li><p>be more irritable or grumpy than usual.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-i-need-to-floss-my-teeth-133245">Do I need to floss my teeth?</a>
</strong>
</em>
</p>
<hr>
<p>The good news is, once children’s dental issues are diagnosed, most if not all problems <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ipd.12259">can be fixed or managed</a>. </p>
<h2>Visiting the dentist</h2>
<p>You should book a <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Dental_care/">dental check-up</a> when your child’s first tooth comes through, or by their first birthday — whichever comes first.</p>
<p>After that, schedule check-ups regularly, depending on how frequently your dentist recommends. While your child’s teeth may be OK, frequent visits will help them get comfortable with the dentist, and allow for any issues to be dealt with early.</p>
<figure class="align-center ">
<img alt="A dentist shows a young child how to brush teeth using a model of teeth." src="https://images.theconversation.com/files/379845/original/file-20210121-23-3sd3ta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379845/original/file-20210121-23-3sd3ta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379845/original/file-20210121-23-3sd3ta.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379845/original/file-20210121-23-3sd3ta.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379845/original/file-20210121-23-3sd3ta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379845/original/file-20210121-23-3sd3ta.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379845/original/file-20210121-23-3sd3ta.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Establish going to the dentist as something positive.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>It’s no secret some children (and even adults) find the prospect of visiting the dentist daunting. It’s important parents of young children establish the dentist in a positive light. </p>
<p>These tips can help you and your child prepare for their first and subsequent visits:</p>
<ul>
<li><p>use positive, child-friendly terms when referring to the dentist, such as “the tooth fairy’s friend”</p></li>
<li><p>avoid emotionally laden words such as “needle”, which may frighten children</p></li>
<li><p>avoid threatening children with consequences for poor behaviour </p></li>
<li><p>avoid sharing poor dental experiences </p></li>
<li><p>make the visit fun by role playing going to the dentist at home beforehand, or likening the visit to a play date.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/child-tooth-decay-is-on-the-rise-but-few-are-brushing-their-teeth-enough-or-seeing-the-dentist-92113">Child tooth decay is on the rise, but few are brushing their teeth enough or seeing the dentist</a>
</strong>
</em>
</p>
<hr>
<h2>Dental care at home</h2>
<p>Alongside regular dental checks, it’s important to set up good habits with your children around looking after and <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Dental_care_video/">brushing their teeth</a>:</p>
<ul>
<li><p>talk about teeth and why they’re important</p></li>
<li><p>help your children brush their teeth with a soft, age-appropriate toothbrush</p></li>
<li><p>let your children have fun (for example, use toothbrushes that feature their favourite characters).</p></li>
</ul>
<p>Generally, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/adj.12742">Australian guidelines</a> recommend you use fluoridated toothpaste by the time the child reaches 18 months (before this, you can just use water). But you can discuss which toothpaste is appropriate for your child at their next dental appointment.</p>
<p>Parents who have dental issues may worry their child will suffer <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0528.2011.00641.x">the same fate</a>. But as a parent or guardian, you can influence your child’s dental habits and attitudes to help them now and into their future.</p><img src="https://counter.theconversation.com/content/148190/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon has received funding from Colgate for her research. She is a member of the Australian Dental Association as well as the International Association for Dental Research. She is a Fellow of the Royal Australasian College of Dental Surgeons.</span></em></p><p class="fine-print"><em><span>Mihiri Silva receives funding from a Clinician-Scientist Fellowship from the RCH Foundation and is a member of the Australian Dental Association.</span></em></p>Dental problems in children can affect their overall health and well-being. You can help establish good dental habits with your children from an early age.Arosha Weerakoon, Lecturer, General Dentist & PhD Candidate, The University of QueenslandMihiri Silva, Paediatric dentist, Senior Lecturer and Post-doctoral Research Fellow, Melbourne Dental School, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1527422021-01-19T13:10:31Z2021-01-19T13:10:31ZTooth or consequences: Even during a pandemic, avoiding the dentist can be bad for your oral health<figure><img src="https://images.theconversation.com/files/377476/original/file-20210107-24-ll42iu.jpg?ixlib=rb-1.1.0&rect=8%2C24%2C5455%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Your dentist should wear appropriate personal protective equipment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-more-and-the-agony-ends-royalty-free-image/1262270436?adppopup=true"> LukaTDB via Getty Images</a></span></figcaption></figure><p>Dental care remains critical for tens of millions of Americans, even during the pandemic. More than one-quarter of U.S. adults live with <a href="https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html">untreated tooth decay</a>, with nearly half of adults over 30 showing signs <a href="https://doi.org/10.1016/j.adaj.2018.04.023">of gum disease</a>. And nearly 1 in 4 adults report having felt pain in or around their mouth <a href="https://www.nidcr.nih.gov/news-events/2020-surgeon-generals-report-oral-health">in the past year</a>. </p>
<p>Poor oral health is associated with <a href="https://www.cdc.gov/pcd/issues/2011/may/10_0087.htm">numerous chronic diseases</a>, including heart disease and diabetes. These problems pose an immediate health risk and require urgent care. Yet, less urgent dental conditions can have long-term negative effects as well. </p>
<p>But how can you visit your dentist during a pandemic? <a href="https://ufhealth.org/andrew-j-corsaro">As a professor</a>, I can tell you that dentists have made many changes to the way your care is provided to improve safety. You should still go, but if you are <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">high risk</a>, you should discuss with your dentist first. Here are some things you need to know – and do – before visiting. </p>
<h2>Home care: More critical than ever</h2>
<p>With dentists worldwide <a href="https://www.who.int/publications/i/item/who-2019-nCoV-oral-health-2020.1">postponing non-urgent dental treatment</a>, your home care is your first line of defense. Consuming carbohydrates and the subsequent secretion of acid by oral bacteria is what causes tooth decay. Chronic inflammation of the tissues supporting your teeth is called gum, or periodontal, disease. Both conditions are exacerbated by poor diet, tobacco use, a weakened immune system and poor oral hygiene. </p>
<p>You can battle all of these things by controlling dental plaque - the soft, sticky material on teeth and gums consisting of saliva, food debris and bacteria. Plaque that remains on teeth for a period of time will form tartar (dental calculus), further promoting bacterial biofilms, ecosystems of bacteria that cause dental problems. </p>
<figure class="align-center ">
<img alt="A man suffering from a severe toothache." src="https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377479/original/file-20210107-15-2elp7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A severe toothache qualifies as a dental emergency.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-man-in-a-medical-protective-mask-on-her-face-royalty-free-image/1257746889?adppopup=true">reklamlar via Getty Images</a></span>
</figcaption>
</figure>
<p>To remove biofilms and plaque, and prevent tartar formation, you must clean all surfaces of the teeth and gums. That means brushing teeth for two minutes, twice a day, using a soft-bristled toothbrush with a fluoride-containing toothpaste. You must also clean the spaces in-between teeth once a day, typically with dental floss. </p>
<p><a href="https://doi.org/10.1111/jcpe.13126">Studies show</a> an electric toothbrush is more effective at cleaning teeth and gums than a manual one. An alcohol-free mouth rinse helps too, but is not a substitute for brushing or flossing. Over-the-counter mouth rinses with fluoride are available for those at higher risk for tooth decay. </p>
<p>You can also improve oral health with your diet. Limit sugar intake, along with other carbohydrate-containing foods and drinks, such as sodas, fruit juices, sweetened coffee and tea, and candy. You don’t have to completely avoid their consumption, of course, but cutting back on both can be extremely beneficial. Avoid hard and sticky foods that can break teeth and dental work.</p>
<p>COVID-19’s psychological impact has had <a href="https://doi.org/10.1016/j.janxdis.2020.102268">many indirect effects</a> on oral health. Medications prescribed for depression and anxiety are known to cause dry mouth, which <a href="https://www.ada.org/en/member-center/oral-health-topics/xerostomia">harms oral health</a>. Increased anxiety is linked to bruxism, the clenching or grinding of teeth. More tobacco and alcohol use are not good for your teeth. Poorer diet can lead to many health problems such as gastroesophageal reflux disease (GERD), which can damage teeth.</p>
<h2>When to see your dentist</h2>
<p>Oral pain may indicate an infection; take it seriously. Broken teeth and dental work are other examples of dental emergencies. In the early weeks of the pandemic, many states mandated the restriction of all non-emergency dental procedures. In response, the <a href="https://dental.ufl.edu/">University of Florida College of Dentistry</a>, along with many other care providers, instituted teledentistry services. This remote, virtual consultation with a dental professional is one way to help you decide whether to delay care or to visit a dentist.</p>
<p>If you have a loose or failing dental work, try to keep the area clean without further dislodging it. Usually it’s helpful to insert floss around a loose restoration, then gently pull the floss through to the side, to avoid lifting broken dental work out of place. A completely debonded crown can sometimes be temporarily recemented with over-the-counter dental cements or even toothpaste. A teledentistry consultation can help determine if this is appropriate. </p>
<p>A few rare oral problems can constitute life-threatening emergencies. If you have difficulty breathing or swallowing, or uncontrolled bleeding in or around the mouth, seek immediate emergency care. Extreme pain or a high fever associated with dental problems also requires immediate attention. </p>
<figure class="align-center ">
<img alt="A woman on a teledentistry consult." src="https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377482/original/file-20210107-15-mhyp9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many dental offices now offer teledentistry consults before an in-person visit.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-consulting-with-her-doctor-online-royalty-free-image/1282155372?adppopup=true">Marko Geber via Getty Images</a></span>
</figcaption>
</figure>
<h2>Changes at the dentist’s office</h2>
<p>For decades dental professionals have been sterilizing instruments and disinfecting surfaces. <a href="https://www.ada.org/%7E/media/ADA/Publications/ADA%20News/Files/ADAJ_1930.pdf?la=en">Early reports</a> show a lower COVID-19 prevalence among U.S. dentists than in the general public. With COVID-19, additional precautions are needed. Patients should ask their dentists if they are taking these precautions. </p>
<p>Here’s a brief checklist: First, your dentist’s office should screen you and other patients for COVID-19 symptoms. The office may call you in the days leading up to your appointment to make sure you don’t have symptoms. You may be asked to come to your appointment alone, wear a mask, and wash your hands while at the office.</p>
<p>When you arrive, you may be asked to wait outside or in your car until your appointment time. Waiting areas should have fewer chairs, all properly spaced. All magazines and toys should be removed. </p>
<p>Dental staff should wear appropriate personal protective equipment (PPE), including an N95 mask, along with protective gowns, head coverings, gloves, and face shields. Disposable barriers should cover commonly touched surfaces. Air quality controls, such as HEPA filters, single-pass air circulation, and negative pressure should be in use; they help to contain any aerosols generated during dental procedures. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>You may be asked to rinse your mouth with a solution containing diluted hydrogen peroxide. This will decrease the viral load prior to your dental procedure. High-volume evacuation, more commonly known as dental suction, should be used for all procedures that may generate aerosols. </p>
<p>The good news is this: the new safety measures now in place <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560385/">may be sufficient</a> to prevent infection in dental settings. Still, you must consult with a dental professional to help determine the need for treatment. As the COVID-19 pandemic evolves, and new research becomes available, expect more changes at your dentist’s office.</p><img src="https://counter.theconversation.com/content/152742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew J. Corsaro does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even during COVID-19, there are ways to keep your teeth healthy.Andrew J. Corsaro, Clinical Assistant Professor, College of Dentistry, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1410382020-07-23T04:41:41Z2020-07-23T04:41:41ZCollaborating with communities delivers better oral health for Indigenous kids in rural Australia<p>Aboriginal children in rural Australia have up to <a href="https://doi.org/10.22605/RRH4453">three times</a> the rate of tooth decay compared to other Australian children.</p>
<p>Tooth decay can affect a person’s overall health and nutrition because it can affect how they chew and swallow. Tooth decay can also reduce self esteem because of its effect on <a href="https://www.nhsinform.scot/illnesses-and-conditions/mouth/tooth-decay">appearance and breath</a>. And importantly, poor oral health increases the risk of <a href="https://www.agd.org/docs/default-source/self-instruction-(gendent)/gendent_nd17_aafp_kane.pdf">chronic disease</a> such as heart disease.</p>
<p>Yet tooth decay is both <a href="https://www.healthdirect.gov.au/tooth-decay">preventable and treatable</a>.</p>
<p>Broadly speaking, improving oral health is critical to closing the gap in health outcomes between Aboriginal and Torres Strait Islander Australians and Australians overall. Tackling this gap requires customised, <a href="https://pubmed.ncbi.nlm.nih.gov/29335090/">community-led solutions</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bulging-ear-drums-and-hearing-loss-aboriginal-kids-have-the-highest-otitis-media-rates-in-the-world-64165">Bulging ear drums and hearing loss: Aboriginal kids have the highest otitis media rates in the world</a>
</strong>
</em>
</p>
<hr>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/32212435/">research</a> demonstrates <a href="https://muse.jhu.edu/article/608838">co-design</a> — that is, engaging communities to design and deliver services for their own communities — is associated with significantly improved oral health among Aboriginal primary school children. </p>
<p>This approach may also hold the answer for closing the gap in other areas of health care.</p>
<h2>Oral health among Aboriginal children</h2>
<p>In the middle of last century, Aboriginal children actually had <a href="https://www.mja.com.au/journal/2008/188/10/oral-health-aboriginal-and-torres-strait-islander-australians">significantly better oral health</a> than other Australian children.
But today, Aboriginal children have <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/healthy-teeth">roughly double</a> the rate of tooth decay compared to other Australian children.</p>
<p>A range of factors have contributed to this recent problem, starting with colonisation — the effects of which have been compounded over time — and the shift to a highly processed Westernised diet.</p>
<p>Where interventions to prevent common oral diseases like tooth decay have become available to <a href="https://www.mja.com.au/journal/2008/188/10/oral-health-aboriginal-and-torres-strait-islander-australians">most Australian children</a> in recent decades, Aboriginal children in rural Australia have historically had limited access to public dental services. </p>
<p>The disparity is compounded by the cost of basic supplies like toothpaste and toothbrushes, which may be unattainable for some families, and <a href="https://theconversation.com/getting-clean-drinking-water-into-remote-indigenous-communities-means-overcoming-city-thinking-106701">poor availability</a> of cool filtered drinking water in remote communities.</p>
<h2>What we did</h2>
<p>We began our research in 2013 at primary schools in three rural communities in New South Wales.</p>
<p>We sought to reduce consumption of sugary drinks by installing refrigerated and filtered water fountains in schools and communities. We also engaged teachers to encourage students to fill up their water bottles and drink from them throughout the school day. </p>
<p>As well as this, we sought to increase fluoride intake (a naturally occurring mineral that helps to prevent tooth decay) by establishing daily in-school tooth brushing programs, supplying toothbrushes and toothpaste for school and home, and applying fluoride varnish to the children’s teeth once each term.</p>
<p>We also provided treatment for existing tooth decay and gum disease. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/antibiotic-resistance-is-an-even-greater-challenge-in-remote-indigenous-communities-121696">Antibiotic resistance is an even greater challenge in remote Indigenous communities</a>
</strong>
</em>
</p>
<hr>
<p>In 2018, we looked at the oral health and oral hygiene behaviours of children from the participating schools. Our findings have recently been <a href="https://pubmed.ncbi.nlm.nih.gov/32212435/">published</a> and show the project is working well.</p>
<h2>What we found</h2>
<p>In just four years we found a reduction in tooth decay, plaque and gingivitis (gum disease).</p>
<p>The average number of teeth with tooth decay per child in 2018 was 4.13, compared to 5.31 in 2014. Notably, the proportion of children with no tooth decay increased from 12.5% in 2014 to 20.3% in 2018.</p>
<p>There was also a dramatic reduction in the proportion of children with severe gingivitis from 43% in 2014 to 3% in 2018.</p>
<p>We also saw an increase in positive oral hygiene behaviour including tooth brushing, consumption of drinking water and reduced consumption of sugar-sweetened beverages.</p>
<p>In 2014, 13% of children reported brushing their teeth on the morning they took the survey. This increased to 36% in 2018. </p>
<h2>Collaborating with communities</h2>
<p>Co-design means working alongside communities to establish the most effective ways to implement evidence-based strategies, and sustain these. It’s about sharing knowledge to enable long-term, positive change to complex problems.</p>
<p>In our project, the co-design process has been central to these outcomes:</p>
<ul>
<li><p>local Aboriginal staff coordinate the programs and dental treatment services</p></li>
<li><p>clinical staff <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajr.12343">live and work</a> locally</p></li>
<li><p>we’ve established <a href="https://www.publish.csiro.au/ah/AH18051">scholarships for locals</a> to obtain qualifications as dental assistants, allied health assistants and oral health therapists</p></li>
<li><p>we’ve implemented daily in-school tooth brushing, regular fluoride varnish application and drinking water programs</p></li>
<li><p>the community decided on the location and installation of water fountains</p></li>
<li><p>we’ve set up highly <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/adj.12496">cost-effective</a> oral health services for the communities.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dental-report-card-fail-half-of-adults-and-one-third-of-kids-dont-brush-twice-a-day-93288">Dental report card fail: half of adults and one-third of kids don't brush twice a day</a>
</strong>
</em>
</p>
<hr>
<h2>Co-design and closing the gap</h2>
<p>We’ve now moved through all phases of implementing our co-designed programs, and are focusing on maintaining them with the support of school staff and the local Aboriginal Community Controlled Health Service.</p>
<p>Our research shows engaging communities to design and deliver oral health services was associated with reduced tooth decay and increased healthy behaviours.</p>
<p>The following elements of co-design in our project could readily be incorporated into the design and delivery of health-care services for Aboriginal Australians:</p>
<ol>
<li><p><strong>improved cultural safety</strong> — Aboriginal people feel safe and welcome</p></li>
<li><p><strong>co-design and shared ownership</strong> — local Aboriginal people shape the service model</p></li>
<li><p><strong>local employment</strong> — Aboriginal people work in the service and lead local delivery</p></li>
<li><p><strong>skills development</strong> — Aboriginal people complete qualifications that are nationally recognised</p></li>
<li><p><strong>long-term commitment</strong> — programs are designed and delivered with sustainable and reliable funding.</p></li>
</ol>
<p>The gap in health outcomes between Aboriginal and non-Aboriginal Australians remains stubbornly wide. Co-design enables much needed health-care services to be delivered in ways that strengthen communities, respect culture and build capacity.</p><img src="https://counter.theconversation.com/content/141038/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Gwynne receives funding from the Australian Research Council, the MRFF and NSW Ministry of Health. The authors of this article wish to acknowledge Boe Rambaldini, Bundjalung Elder and Director of the Poche Centre for Indigenous Health, The University of Sydney, for his contribution to this article, as well as the Armajun Aboriginal Health Service. </span></em></p><p class="fine-print"><em><span>John Skinner has received and currently holds funding from Colgate Palmolive and the MRFF in the area of oral health. </span></em></p><p class="fine-print"><em><span>Yvonne Dimitropoulos does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Indigenous children have poor oral health compared to Australian kids overall. Our research shows involving local Aboriginal people in designing and providing services can make a difference.Kylie Gwynne, Senior Lecturer, Health Leadership, Macquarie UniversityJohn Skinner, Senior research fellow, University of SydneyYvonne Dimitropoulos, Research Associate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1332452020-04-27T20:05:04Z2020-04-27T20:05:04ZDo I need to floss my teeth?<figure><img src="https://images.theconversation.com/files/320320/original/file-20200313-90628-1g40mzi.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As a dentist, my patients often ask whether they still need to floss even though they brush their teeth. The answer is – that depends.</p>
<p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008829.pub2/abstract">review of the research</a> on this topic found flossing, combined with regular brushing, reduced the chance of bleeding gums. But the review could not provide evidence flossing prevented holes (tooth cavities) from forming.</p>
<p>This is likely <a href="https://www.sciencedirect.com/science/article/abs/pii/S1532338216301877">because</a> all of the included studies were conducted within one to three month periods. A few months is long enough to detect bleeding gums, but not for cavities to grow substantially.</p>
<p>So studies in the review looked at the effectiveness of flossing on preventing gum disease rather than cavities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-often-should-i-get-my-teeth-cleaned-121310">How often should I get my teeth cleaned?</a>
</strong>
</em>
</p>
<hr>
<p>But at the very least, we know regular flossing protects our gum health, which in turn protects our teeth. So it’s definitely worth doing. </p>
<p>The advice may be different if you have certain dental conditions – but we’ll get to that later.</p>
<h2>Why should I floss?</h2>
<p>Cavities and gum disease are mainly caused by plaque that accumulates on our teeth and gums. Dental plaque is part of a complex ecosystem that includes <a href="http://www.homd.org">800 different types</a> of bacteria found in our mouth.</p>
<p>Our plaque’s unique <a href="https://www.pnas.org/content/108/10/4152.short">ecosystem</a> is a like a major city, and brushing is like Godzilla destroying the infrastructure. But plaque bacteria can rebuild infrastructure fairly quickly, which is why we brush frequently.</p>
<p>Brushing, however, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-051X.1991.tb00109.x">isn’t very effective</a> at cleaning in between your teeth. And it’s the plaque that remains in these areas that leads to most <a href="http://www.parodontologie-utrecht.nl/media/boeken/boekintraoralhygieneevidence.pdf">cavities</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-051X.1992.tb02174.x">gum disease</a>. So that’s where flossing comes in – to clean between the teeth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-make-saliva-130288">Curious Kids: why do we make saliva?</a>
</strong>
</em>
</p>
<hr>
<p>If plaque on our teeth and gums are left long enough, the mineral in our saliva hardens it to form a white chalky substance called calculus. The calculus acts as a home to many different types of bacteria that can advance gum disease. </p>
<p>Once formed, calculus is impossible to remove by brushing or flossing alone. It needs to be removed using special tools at the dentist. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320321/original/file-20200313-90664-23tju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320321/original/file-20200313-90664-23tju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320321/original/file-20200313-90664-23tju1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320321/original/file-20200313-90664-23tju1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320321/original/file-20200313-90664-23tju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320321/original/file-20200313-90664-23tju1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320321/original/file-20200313-90664-23tju1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your dentist or dental hygienist can give you advice about the best way to clean between your teeth.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What’s the big deal about bleeding gums?</h2>
<p>Similar to the way doctors measure health by checking your blood pressure, dentists and hygienists gently <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-051X.1990.tb01059.x">poke</a> your gums to see if they bleed. </p>
<p>Bleeding gums often signal the presence of uncleaned plaque and/or calculus in the area. You may even notice bleeding after you brush your teeth or eat certain foods.</p>
<p>To a dental practitioner, bleeding gums indicate you’re at risk of developing advanced gum issues, called <a href="https://www.nidcr.nih.gov/health-info/gum-disease/more-info">periodontal disease</a>. This condition sees the foundations that hold your teeth in your jaw bone deteriorate, eventually causing your teeth to loosen and fall out.</p>
<p>Socially embarrassing by-products of advanced gum disease include:</p>
<ul>
<li>loose teeth</li>
<li>a yellow/brown smile</li>
<li>large black gaps appearing between your teeth where the gums have shrunk away</li>
<li>bad breath.</li>
</ul>
<p>So the act of flossing can serve to safeguard your smile.</p>
<p>Current evidence also suggests periodontal disease is associated with an <a href="https://www.tandfonline.com/doi/abs/10.1185/03007990802131215">increased risk</a> of heart disease and diabetes, among other health issues. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-my-gums-bleed-and-should-i-be-worried-28456">Health Check: why do my gums bleed and should I be worried?</a>
</strong>
</em>
</p>
<hr>
<h2>OK, so I should definitely floss then?</h2>
<p>This depends on your current situation. Just like you wouldn’t mop your rug or vacuum the shower recess, we have specific <a href="http://168.176.239.58/cursos/odontologia/2016549/pdf/Claydon2008Cepilladoylimpiezainterdental.pdf">tools</a> to suit every cleaning situation. Flossing (effectively) is great if:</p>
<ul>
<li>you still have most of your teeth</li>
<li>your teeth are tightly jammed together </li>
<li>your gums haven’t receded to leave triangular gaps between your teeth.</li>
</ul>
<p>While for a lot of us this may be the case, for some of us, simply flossing our teeth and gums will be ineffective. Particularly if you have:</p>
<ul>
<li>gaps between your teeth that are too large for floss to clean</li>
<li>complex dental work such as <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/prd.12189">crowns, bridges</a> and <a href="http://www.quintpub.com/userhome/qi/qi_47_5_clark_p417.pdf">implants</a></li>
<li>partial dentures (dentures that replace some missing teeth)</li>
<li>orthodontic appliances such as <a href="https://orthodonticsaustralia.org.au/caring-for-braces/">braces</a>.</li>
</ul>
<p>In these instances, we have to start thinking about interdental cleaning, or using other tools to clean between your teeth such as special Christmas tree-shaped brushes or sticks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-flossing-flap-mind-your-dentist-and-floss-every-night-63496">The flossing flap: Mind your dentist, and floss every night</a>
</strong>
</em>
</p>
<hr>
<p>If you don’t think flossing is right for you, ask about interdental (between teeth) cleaning during your next visit to the dentist. Your dentist or hygienist will be able to recommend products and a cleaning routine to suit your needs.</p>
<h2>Tips for good flossing</h2>
<p>To floss effectively, keep in mind:</p>
<ul>
<li>floss at least once a day </li>
<li>floss before brushing so it becomes part of your routine</li>
<li>cut 30-40cm of regular floss for each use</li>
<li>wrap most of it around the finger of one hand and 2-3cm around the finger of another</li>
<li>slowly move the floss towards the gums to ensure you clean both teeth.</li>
</ul>
<p>Flossing can cause some bleeding, but this will resolve over time.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KypRbdD68QQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Flossing can take some time to master. But the more often you floss, the faster and better you’ll become. And what better time to practise than when you’re stuck at home during a pandemic?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-still-go-to-the-dentist-how-coronavirus-is-changing-the-way-we-look-after-our-teeth-135300">Can I still go to the dentist? How coronavirus is changing the way we look after our teeth</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/133245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon has received funding from Colgate for her research. She is a member of the Australian Dental Association as well as the International Association for Dental Research. She is a Fellow of the Royal Australasian College of Dental Surgeons.</span></em></p>If you still have most of your teeth and they’re tightly jammed together, flossing is important. But for some people, simply flossing might not be enough.Arosha Weerakoon, Lecturer, General Dentist & PhD Candidate, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1353002020-04-02T04:51:27Z2020-04-02T04:51:27ZCan I still go to the dentist? How coronavirus is changing the way we look after our teeth<figure><img src="https://images.theconversation.com/files/324764/original/file-20200401-23086-j4gfab.jpg?ixlib=rb-1.1.0&rect=5%2C7%2C992%2C553&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/professional-dentist-tools-dental-office-mirror-1039096114">Shutterstock</a></span></figcaption></figure><p>The coronavirus pandemic is changing the way we access health care, and dental care is no exception.</p>
<p>Dentists <a href="https://www.abc.net.au/news/2020-03-31/coronavirus-can-i-go-to-the-dentist-saliva-blood-covid-19/12105738">are no longer allowed</a> to provide a raft of care, such as regular check-ups and tooth whitening, to minimise the spread of COVID-19. However, if you’re in a lot of pain, your dentist will be able to treat you.</p>
<p>Here’s how the coronavirus is changing the way we look after our teeth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-often-should-i-get-my-teeth-cleaned-121310">How often should I get my teeth cleaned?</a>
</strong>
</em>
</p>
<hr>
<h2>Why are these restrictions in place?</h2>
<p>When dentists work on your teeth, they can produce aerosols – droplets or sprays of saliva or blood – in the air.</p>
<p>This happens routinely when your dentist uses a drill or when scaling and polishing, for instance.</p>
<p>And dentists are used to following stringent infection control precautions under normal circumstances to lower the risk of transmission of infectious diseases, whether they are respiratory diseases or blood-borne. </p>
<p>These precautions help keep both patients and dentists safe because it assumes all patients may have an infection, despite the reality that most won’t. </p>
<p>But with the coronavirus pandemic, there is an increased risk of aerosols carrying the virus either directly infecting dental staff, or landing on surfaces, which staff or the next patient can touch.</p>
<p>This transmission may be possible even if you feel perfectly well, as not everyone with the virus has symptoms.</p>
<h2>Who’s making these recommendations?</h2>
<p>The <a href="https://www.health.gov.au/committees-and-groups/australian-health-protection-principal-committee-ahppc">Australian Health Protection Principal Committee</a> – the key decision-making committee for health emergencies – <a href="https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-advice-to-national-cabinet-on-25-march-2020">has recently recommended</a> dentists only provide treatments that do not generate aerosols, or where generating aerosols is limited. And all routine examinations and treatments should be postponed.</p>
<p>This is based on level three restrictions, according to <a href="https://www.ada.org.au/Campaign/COVID-19/Managing-COVID-19/Practice-Resources/Dental-restriction-Levels/ADA-dental-restriction-levels-in-COVID-19-Publishe.aspx">guidance</a> from the Australian Dental Association.</p>
<p>Recommendations of what is and isn’t allowed may change over time.</p>
<h2>What does it mean for me? Can I still get a filling?</h2>
<p><strong>What’s not allowed?</strong></p>
<p>Non-essential dental care is now postponed. This includes routine check-ups and treatment where there is no pain, bleeding or swelling. So treatments such as whitening and most fillings will have to wait.</p>
<p>Other conditions or treatments that will need to be postponed <a href="https://www.ada.org.au/Campaign/COVID-19/Managing-COVID-19/Practice-Resources/Dental-restriction-Levels/ADA-dental-restriction-levels-in-COVID-19-Publishe.aspx">include</a>:</p>
<ul>
<li><p>tooth extractions (without accompanied pain or swelling)</p></li>
<li><p>broken or chipped teeth</p></li>
<li><p>bleeding or sore gums</p></li>
<li><p>halitosis (bad breath)</p></li>
<li><p>loose teeth (that aren’t a choking hazard)</p></li>
<li><p>concerns about dentures</p></li>
<li><p>crowns and bridges</p></li>
<li><p>clicking/grating jaw joint</p></li>
<li><p>scale and polish</p></li>
</ul>
<p><strong>What is allowed?</strong></p>
<p>Some patients will need urgent care for acute problems requiring treatments that produce aerosols. So such procedures have a risk of spreading COVID-19.</p>
<p>Permitted treatments <a href="https://www.ada.org.au/Campaign/COVID-19/Managing-COVID-19/Practice-Resources/Dental-restriction-Levels/ADA-dental-restriction-levels-in-COVID-19-Publishe.aspx">are limited to</a>:</p>
<ul>
<li><p>tooth extractions or root canal treatment when someone is in acute pain caused by damage to, or death of the nerve in the tooth</p></li>
<li><p>where upper front teeth are significantly damaged, for example, in an accident (this is an instance where a filling could be provided)</p></li>
<li><p>management of ulcers or other problems with the lining of the gums and mouth</p></li>
<li><p>providing care for patients with complex medical conditions and where not treating may lead to worsening of their general health</p></li>
<li><p>managing patients who have dental problems linked to social or cultural factors and that will develop quickly if professional care is not given</p></li>
<li><p>where a patient is referred by a doctor for care that is medically necessary. </p></li>
</ul>
<h2>Can I still go to my regular dentist?</h2>
<p>Many dental practices <a href="https://www.abc.net.au/news/2020-03-31/coronavirus-dentist-toothache/12103236">are only open</a> to manage dental problems causing pain, that are urgent or are an emergency. </p>
<p>So check with your usual dentist to see what services they can provide. And be prepared for prearranged treatments to be cancelled.</p>
<h2>What if I have COVID-19 or may have it?</h2>
<p>If you need urgent dental care and think you may have COVID-19, it’s important to <a href="https://www.ada.org.au/Campaign/COVID-19/Guide-to-Managing-COVID-19/ADA-Managing-COVID-19-Guide-v-2.aspx">call your dentist</a> to discuss your particular situation.</p>
<p>You may be able to be treated at your usual surgery, where infection control precautions will be <a href="https://www.ada.org.au/Campaign/COVID-19/Guide-to-Managing-COVID-19/ADA-Managing-COVID-19-Guide-v-2.aspx">stepped up</a>. </p>
<p>But if you have a dental emergency and have been diagnosed with COVID-19, you will be referred <a href="https://adavb.org/resources/for-dental-professionals/covid-19">to a hospital</a> with appropriate facilities.</p>
<h2>What can I do in the meantime?</h2>
<p>COVID-19 is going to be with us for many months. So it’s important to look after your oral health by <a href="https://www.abc.net.au/news/2020-03-31/coronavirus-can-i-go-to-the-dentist-saliva-blood-covid-19/12105738">maintaining a healthy diet and oral hygiene routine</a>.</p>
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Read more:
<a href="https://theconversation.com/how-to-gently-get-your-child-to-brush-their-teeth-102713">How to (gently) get your child to brush their teeth</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/135300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Holden is a Director and Federal Councillor of the Australian Dental Association Inc. </span></em></p><p class="fine-print"><em><span>Heiko Spallek and Ramon Zenel Shaban do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Your regular check-up will need to be postponed. But if you’re in acute pain, dentists may still be able to treat you. Here’s what’s allowed and what’s not.Alexander Holden, Senior Lecturer in Dental Ethics, Law and Professionalism, University of SydneyHeiko Spallek, Professor, Head of School and Dean, Sydney Dental School, University of SydneyRamon Zenel Shaban, Clinical Chair and Professor of Infection Prevention and Disease Control at the University of Sydney, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1299902020-02-10T13:56:17Z2020-02-10T13:56:17ZDentists in South Africa aren’t being taught genetics. Why they should<figure><img src="https://images.theconversation.com/files/310260/original/file-20200115-134842-1noolzf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many genetic abnormalities involve the oral and dental region of the face.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Genetic and genomic research has improved our understanding of the genetic origin of growth, development and disease and affects all areas of healthcare. There is also mounting <a href="http://www.dmrjournal.org/article.asp?issn=2348-1471;year=2016;volume=4;issue=1;spage=9;epage=17;aulast=Rai">evidence</a> that many complex conditions are the result of interactions between genes. These include diabetes and hypertension.</p>
<p>Genomics has become increasingly important to oral health too. Dentists regularly come across obvious expressions of genetic disorders or genetic-based diseases in the oral and head and neck region. There are <a href="http://www.jdentaled.org/content/72/2_suppl/86">approximately 5,500</a> known inherited conditions. More than 700 of these have abnormalities which involve the oral and dental region of the face. </p>
<p>These insights have been gained through continued and concerted efforts to understand the genetic aspects of diseases. This understanding, in turn, has generated novel approaches to prevent, diagnose and manage them. </p>
<p>In the area of dentistry, teaching has unfortunately not kept up with the science, particularly in Africa. This places dentists at a disadvantage. They can’t – or find it difficult to – contribute to the overall health of patients with genetic disorders because they don’t have the necessary knowledge. This would include the ability to recognise the indicators of genetic disorders and the confidence to manage these patients.</p>
<p>This is why dentists need a sound understanding of genetics. And it’s why genetics and genomics should be included in the undergraduate and postgraduate curriculum. Investing in structured dental genetics programmes in dental schools in Africa would ensure an increase in the dental genetics workforce. This would ultimately improve the management of patients with inherited conditions with oral and dental manifestations. </p>
<p>To evaluate the need for human genetics in the dentistry curriculum my colleagues and I conducted a <a href="https://journals.co.za/content/journal/10520/EJC-100b454c5f">survey</a> at the dental school at a South African university. Academic staff, 4th and 5th-year undergraduate dental students as well as postgraduate dental students participated in the survey.</p>
<p>The results indicated that students and clinicians had limited training and experience pertaining to the diagnosis and management of individuals with genetic disorders. </p>
<h2>The gap, and how to fill it</h2>
<p>Currently, there are no plans in place to train dentists with a sound understanding of genetics. There are also no programmes in place to allow trained African dentists to choose such a career pathway.</p>
<p>As a result, there is an over-dependence of African clinical practice on research findings from technologically advanced Western countries. Secondly, it means that clinical research capacity building isn’t happening. And finally, it means that patients aren’t being offered the best possible diagnosis and treatment.</p>
<p>There are several factors responsible for the lack of dental genetics in Africa. Among a few challenges are poor biomedical research infrastructure, minimal funding and an absence of a structured dentist genetics career pathways. </p>
<p>To address these challenges, African universities and dental schools need to develop and include dental genetics courses in undergraduate and postgraduate programmes. These should be designed to ensure they help members of the dental fraternity to treat patients with hereditary conditions. </p>
<p>The dental genetics workforce would, in turn, increase trained dentists some of whom could have the option of following a research career. This would enhance networking among African dental researchers and lead to better dental research output across the continent.</p>
<p>Several first world universities, such as the universities of Pittsburg, Manchester and Oslo have included dental genetics into their curricula. Their vast research capacity has resulted in evidence-based dentistry being offered to patients in those countries. </p>
<p>Another way to foster an interest and understanding of genetics in the dental community is by developing collaborative relationships. One already exists in South Africa between the division of human genetics at the University of Cape Town and the dental faculty at the University of the Western Cape. This <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162018000400028&lng=es&nrm=is">partnership</a> runs a dental genetics clinic which serves patients with genetic disorders from across the Western Cape province. Postgraduate students also rotate through the clinic and are mentored in the dental management of children with genetic disorders and congenital abnormalities.</p>
<p>Adding courses on human genetics in the curriculum at dental schools would be a first step to ensuring that more dentists have an understanding of the field.</p><img src="https://counter.theconversation.com/content/129990/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Manogari Chetty does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dentists need to have a sound understanding of genetics to treat and manage patients effectively.Manogari Chetty, HOD Oral Biology and Human Genetics, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.