Diabetes can cause gum disease and tooth decay

Though it's commonly known that diabetes can affect organ function and eyesight, an oral-health expert points out that the disease can also cause tooth decay and gum disease.

"Diabetics with uncontrolled glucose levels tend to develop more gum disease and may lose more teeth than diabetics who have good control of their glucose levels," writes Dr. John Novak, associate director of University of Kentucky's Center for Oral Health Research, in an op-ed piece for the Lexington Herald-Leader. A high carbohydrate/sugar diet can also lead to high levels of sugar in the blood, which can hamper the way the body deals with infection, he writes. Gum disease may be the result because the gums are inflamed by the increased levels of bacteria living in the mouth.

Diabetes can also cause dry mouth, which "creates the perfect environment for the growth of bacterial plaque and for fungal infections such as thrush," he writes. To avoid these problems, Novak recommends brushing teeth and gums twice a day with a fluoride toothpaste, flossing every day and using fluoride mouth wash before going to bed.

Signs of tooth decay or gum disease include tender gums that bleed easily when brushing or flossing; teeth sensitive to hot or cold temperatures; loose or broken teeth; sores, ulcers or a burning sensation in the mouth; and bad breath or a bad taste. (Read more)

Bill amendment could make dental, vision care more expensive

A last-minute amendment to a bill intended to limit when insurance companies could terminate policies may end up costing Kentuckians more out-of-pocket dental and vision expenses, Courier-Journal political writer Joseph Gerth writes in his weekly column.

The implications of House Bill 497 changed when Sen. Tom Buford, R-Nicholasville, "filed a one-paragraph amendment that was brought to him at the last minute by a lobbyist for the Kentucky Dental Association," Gerth writes. "That amendment said that if you have vision or vision insurance, your insurance provider can't require your health care provider to give you discounted rates on services that aren't paid for by the insurance plan."

That could mean that low-cost plans that only cover a few procedures but offer "added benefit by making sure you're not paying inflated prices for other services" may no longer be available, Gerth reports. Opponents say insurance companies will stop offering such plans because people won't buy them without the discounts. And people who can't afford more expensive plans will sacrifice dental and vision insurance.

On Tuesday, the Senate adopted the amendment and passed the bill. The bill cleared the House the next day. Gov. Steve Beshear has not indicated if he will sign or veto it.

Advocates say the bill will save in dental and vision care costs. Opponents say people will have difficulty having access to case. As for who's right, Gerth writes: "Bill advocates have presented no evidence to suggest that, and there have been no full-fledged hearings for the dentists behind the bill to make their case or to answer the questions that need to be asked." (Read more)

Effort to boost oral health in nursing homes gets tangled up with industry's attempt to insulate itself from lawsuits; both bills die

A bill to get nursing-home residents better dental services "appears to be dead after the Senate added language from another bill designed to shield the nursing-home industry from litigation," Deborah Yetter reports for The Courier-Journal.

House Bill 510 would have created a pilot project for the state's two dental schools to create "a program to provide better oral-health services to nursing home residents," Yetter writes. "But on Wednesday, the Senate Health and Welfare Committee added language from another bill that had stalled in the House that would require people who want to file malpractice lawsuits against nursing homes to first submit the complaint to a 'medical review panel'." (Read more) 

State starting free training for dentists in pediatric dentistry

One of the many problems with Kentucky's oral health is that not enough dentists are willing to accept children as patients, or lack proficiency in treating children when they are around age 1, the recommended time for a child's first dental visit.

Next week, the state Department of Public Health will start to offer free continuing education for dentists and other oral-health professionals who need or want training in pediatric dentistry, funded by a federal grant.

The Access for Babies and Children to Dentistry (ABCD) program will have one-day training sessions in Lexington on Friday, April 6, at the Embassy Suites on Newtown Pike next to the interstate, and in Somerset on Wednesday, April 11, at the Hampton Inn on US 27. Both sessions will start at 8:30 a.m. The sessions offer 8 continuing education units out of a possible 20 in the program.

For more information about the training, and to register for it, contact Meghan Towle at Meghan.Towle@ky.gov or 502-564-2154.

Board of Dentistry's relaxation of limits on hygienists is the latest sign of hope in Kentucky's all-too-grim story of oral health

By Al Smith
Kentucky Health News

With nearly a fourth of Kentucky’s 1 million children living in poverty and suffering some of the worst oral health in America, the state Board of Dentistry voted Saturday to develop regulations to permit hygienists to treat children in a public health setting perhaps stemming a near epidemic of tooth decay in the very young.

Hygienists will still be responsible to dentists when working in public-health settings such as schools, where they can apply preventive treatments on their own if the new regulation wins legislative committee approval. It isn’t as far as we want to go in confronting our horrific problems, but it may remove stones in our path that have kept a tight control on the use of hygienists.

In the past, organized dentistry in Kentucky, fearing competition from hygienists, has opposed expanding their scope of practice, but as Kentucky remains stalled near the bottom of state rankings of oral health, younger dentists are accepting the need for change, says Dr. James Cecil, a retired dentistry professor at the University of Kentucky.

Saturday’s action by the Board of Dentistry partly may have been “from desperation, over recent bad publicity as the popular press portrays the profession as unresponsive to the needs of our poor citizens,” Cecil said in an interview. “While dentistry still remains where medicine was 20 years ago,” when many doctors opposed licensing physician assistants and nurse practitioners, Cecil said dentists “will learn they can make more money when their services become more available through greater use of auxiliaries such as the hygienists.”

Cecil, former chief dental officer for the U.S. Navy and distinguished as a national leader in public health, earlier last week participated with Kentucky Youth Advocates in the organization of a new Kentucky Oral Health Coalition, whose startup is funded by a foundation grant to KYA.

This coalition of various organizations, including public health departments, nurses, physicians, insurers, and some dentists, will be independent of dental associations or the state’s two dental colleges, and it will campaign for better programs for general as well as oral health.

In the early months of a year when the Kentucky General Assembly, like the U.S. Congress, has reached little agreement on public issues, the state Department of Public Health, actively supported by Gov. Steve Beshear, seems to be gaining traction on oral-health needs.

Grants from the Appalachian Regional Commission are expected to go to two of 13 new local health coalitions in Eastern Kentucky. The grants will pay for one mobile dental van and equipment to reach out to an area with children whose teeth are so decayed they were one focus of an ABC "20/20" documentary viewed by 11 million people in 2009.

Through funding by the federal government, the oral health program will begin training general dentists in more pediatric care. And with additional funding from ARC, this project focuses on dentists in the ARC counties for participation.

Meanwhile, Dr. Cecil and KYA hope to organize more local dental coalitions in rural Western Kentucky. Coalitions may decide to include ‘senior days’ to help older citizens with appalling dental health needs.

There are now 25 such coalitions in the state. As more are established, the challenge is to expand the reach of the state’s 3,000 hygienists, to assist and encourage the state’s 2,400 active dentists to become more pro-active about solving problems that drag down oral health in Kentucky, and to educate parents to care for their children’s teeth, beginning in their first year of life.

Historically, in a culture with so much poverty, Kentuckians have stoically accepted being toothless in old age as part of the price. First, though, there are awful workforce problems. What starts with neglect in childhood evolves into a workforce of adults with severe tooth loss and poor self-image, plus illnesses associated with dental disease (obesity, diabetes, strokes, heart disease and Alzheimer’s) and last, a distressing cohort of toothless elderly poor, sadly, among the highest in the country.

It's a grim story, but Cecil sees determination in the profession to address the problems. With a new added role for hygienists, he says, “The dam may be broken.”

Journalist Al Smith, Lexington, a former federal cochairman of the ARC, and co-founder of the Institute for Rural Journalism and Community Issues at UK, is the retired host of KET’s "Comment on Kentucky."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Smile Kentucky! celebrates 10 years and more than 100,000 children helped

Smile Kentucky! celebrates its 10-year anniversary tomorrow, representing $1 million in free dentistry and benefiting more than 100,000 students.

"It's a wonderful program," said Arleta Watkins of Bullitt County Schools. "I've had children who've never had a dental exam before. They get that service for free."

The program serves children in Louisville and nearby counties. Since it began, more than 127,000 students in 143 schools and 11 counties have received classroom dental education, 35,000 kids have gotten free dental screenings at school and nearly 3,000 children have received free treatment.

Smile Kentucky! works with 30 elementary schools in Jefferson and surrounding counties each fall. Students receive dental education, and children in grades 3 to 6 get a free dental screening. Children without dental insurance or medical care get free treatments by going to the University of Louisville's School of Dentistry or private dental offices in February.

"Dental pain and infection is one of the leading causes of missed days at school and affects a child's ability to concentrate," said John Sauk, dean of U of L's School of Dentistry.

U of L is one of 30 agencies on the steering committee. Other founding partners include the Louisville Water Co.,  the Louisville Dental Society, Colgate, Sullivan Schein Dental, Northwest Area Health Education Center and the Bullitt County Health Department.

For more information about Smile Kentucky!, click here.