Good Health Requires a Healthy Mouth

A dog watching people go by at Echo Dale Park, Medicine Hat. (Dr. Noorali Bharwani)
A dog watching people go by at Echo Dale Park, Medicine Hat. (Dr. Noorali Bharwani)

An article in the Canadian Medical Association Journal (CMAJ September 2, 2014) titled, “Good health requires a healthy mouth: improving the oral health of Canada’s seniors” says one in six seniors decline recommended dental treatment because of cost.

The Canadian Health Measures Survey reported that one in six seniors aged 60 to 79 years in the community had untreated dental caries. More than half had periodontal disease, with 15 per cent having evidence of severe disease. About one in five had no remaining teeth.

Joan L Rush, Lawyer (retired) comments on the above article in the CMAJ. Rush’s letter is titled, “The dental profession fails those most in need.” She says more than 3.8 million Canadians are disabled, and 26 per cent of this group are defined to have very severe disabilities. These people face terrible barriers getting necessary dental treatment. This group is subject to inequality in oral health both in terms of prevalence of disease and unmet dental care.

As most of us know, dental and periodontal infection has serious health implications for all individuals but especially older people. Periodontal infection is associated with systemic diseases such as coronary artery disease, stroke and aspiration pneumonia. These are very serious conditions.

There is some evidence that dental disease has been linked with diabetes, rheumatoid arthritis and obesity, among other conditions, the strongest evidence for a relationship is found with cardiovascular disease, says the article.

Why do seniors have more dental problems?

Most seniors claim to brush and floss as regularly as younger people, says the article. But there are several factors contributing to an increased risk of poor oral health in this age group. For example, as the aging process proceeds, the salivary glands reduce the amount of saliva production and increase the bacterial load in the mouth.

Other oral issues, which may affect dental care in the seniors, are: attachment of gums to teeth loosens, mechanical difficulty with brushing and flossing, chronic diseases and poor nutrition contribute to reduced immunity against infection, leading to periodontal disease.

In Canada, only Alberta and Yukon Territories provide financial assistance for dental care to people over the age of 65 years who meet certain conditions. On retirement, most Canadians lose their dental benefits and many cannot afford private insurance. What is interesting is severe periodontal disease was most prevalent in those without health insurance. In fact, a lack of health insurance was the only factor that appeared to influence the prevalence of severe disease.

The authors of the article hope that the Canadian Dental Association will create a roadmap that will lead to tangible positive oral health outcomes for seniors. I wonder how long is that going to take. But there are measures that we can take to keep our teeth and gums healthy. Here is what the Mayo Clinic website recommends:
1. Brush your teeth at least twice a day.
2. Floss daily.
3. Eat a healthy diet and limit between-meal snacks.
4. Replace your toothbrush every three to four months or sooner if bristles are frayed.
5. Schedule regular dental checkups. Contact your dentist as soon as an oral health problem arises.

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Role of Flouride in Preventing Dental Caries

Dear Dr. B: Last evening I listened to a radio program regarding fluoride. The doctor who hosted the show had nothing good to say about fluoride and was quite adamant that it should not be in toothpaste or in our water. He said that just bathing in water with fluoride in it is causing too much absorption and is harming our bones amongst other things. I am especially interested because I have a hygienist appointment coming up and the procedure is always finished by applying fluoride in your favorite flavor.

Answer: Health Canada website is a good source of information on this subject. The information is summarized here.

There is enough evidence to show that the use of fluoride decreases dental caries. The introduction of fluoride to drinking water in 1958 resulted in a dramatic reduction of dental caries. It is also clear that the ingestion of too much fluoride can result in varying degrees of fluorosis.

Fluorosis is an abnormal condition caused by excessive intake of fluorides, characterized in children by discoloration and pitting of the teeth and in adults by abnormal bone changes. Thus, to prevent fluorosis, the administration of fluoride should strike a right balance.

Fluoride prevents caries mainly by its local effect. Dental caries result when plaque, a sticky film of bacteria on the surface of the tooth, feeds on sugar and food residue to produce acid, which dissolves the surface of the tooth (demineralization). Bathing the surface of the tooth with fluoride causes a dramatic decrease in enamel solubility. Ingested fluoride, on the other hand, has little effect on caries, but contributes significantly to the development of fluorosis.

Fluorosis of our skeleton is a progressive but not life-threatening disease in which bones become more brittle. In mild cases, the symptoms may include pain and stiff joints. In more severe cases, the symptoms may include difficulty in moving, deformed bones and a greater risk of bone fractures.

The Health Canada website has a statement from Dr. Peter Cooney, Canada’s Chief Dental Officer which says, “In light of recent news features, Canadians may be wondering if fluoride is, in fact, safe for use in our water supply and dental hygiene products such as toothpaste.

An expert panel, commissioned by Health Canada to review the scientific studies available on fluoride and its possible effects on health, made a number of recommendations to Health Canada, including:
-to decrease slightly the amount of fluoride that can be added to municipal drinking water,
-to encourage the availability and use of low-fluoride toothpaste by children, and
-to suggest to makers of infant formula to reduce levels of fluoride in their products.”

Community water fluoridation has been identified by U.S. Centers for Disease Control as one of 10 great public health achievements of the 20th century. Canadian and international studies agree that water that was fluoridated at optimum levels does not cause adverse health effects. About 40 percent of Canadians receive fluoridated water.

Experts say there are several steps you can take to maintain your fluoride intake within the optimal range for attaining the dental benefits. Never give fluoridated mouthwash or mouth rinses to children under six years of age, as they may swallow it. Health Canada does not recommend the use of fluoride supplements (drops or tablets).

Make sure that your children use no more than a pea-sized amount of toothpaste on their toothbrush, and teach them not to swallow toothpaste. Children under six years of age should be supervised while brushing and children under the age of three should have their teeth brushed by an adult without using any toothpaste.

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