With dental need at an all time high in California and access to dental care decreasing, local programs are using the Tobacco Tax funds to find ways to increase access to preventive dental and dental hygiene care in their communities. Dental hygienists (RDH) and dental hygienists in alternative practice (RDHAP) are in high demand. Qualified dental hygiene practitioners are encouraged to call Susan and see how we can be of service.

The following was composed by Susan McLearan, RDH, RDHAP, MS, for placement in the Journal of the California Dental Hygienists' Association. She allowed me to post is also in my blog, hoping to reach dental hygienists.

CDHA sent e-mails to the 52 counties/jurisdictions that are eligible for Proposition 56 (Tobacco Tax) funding for a Local Oral Health Program funded through the Office of Oral Health. Twenty two responses were received describing the projects in various stages of development and giving some ideas as to what their needs might be. The respondent reported that the most have hygienists on their advisory boards and several are already using hygienists in their programs.

Rural areas are most in need of help. There is a particular need for hygienist Medi-Cal Dental providers to work part time. Some would want hygienists to contract with the county, others would have hygienists contract directly with schools.

The following jurisdictions have been identified as wanting hygienists to consider their programs.
Alpine                                               Mariposa                                         Orange
Berkeley                                           Placer                                              San Diego
Calaveras                                        San Bernardino                                Solano
Humboldt                                         San Luis Obispo                              Trinity
Lassen                                            Santa Barbara                                  Tulare

Although the type of services, length of the need, and meas of payment will vary, it might be worthwhile to make inquiries in the area near you. For example, Placer County reports that they pay RDHs and RDHAPs quite well on an hourly basis. They are not required to do "the paperwork". They project director feels that what they offer might be good for someone who works in an office 4 days a week but want to make some extra money now and then. They will have quite a few days this Fall for screenings and fluoride varnish applications for preschools and kindergartners.

If you wish to learn more about potential opportunities and need a contact person, please e-mail Susan McLearan at smclearan@gmail.com

I have become a reluctant blogger. :-/ There is such need for the services of advanced dental hygiene clinicians, it is hard to 'pick a lane' or topic to write about services we can perform. However, today I found this article "Why Little Teeth Matter, written in Dimensions of Dental Hygiene, a journal for dental hygiene professionals, I thought was relevant and understandable, even if you are not a dental hygienist.

To make a long story short, if you have little ones, ask your dentist if he or she will be your baby's Dental Home. A Dental Home is just what it sounds like, a place where you can take your small child for dental care, if needed. When would that be?

• Toddlers fall.
• They can bang up their tiny teeth.
• Teeth come in, sometimes slowly.
• Teeth fall out.
• Sometimes they don't and need a dentist's help.

Basically, when your toddler needs a dentist or you, as a parent, have a question, a dental home is a place you can call, who knows your child and whom you child knows.

Sometimes your dentist does not want to be your baby's dental home. That is understandable. Some dental offices are not 'child friendly'. They may refer you to a pediatric dentist. Ask your pediatrician if he or she can be a dental home until your child can be seen by the dentist. Some pediatricians and their staff members are trained to  provide visual oral health screenings, provide oral hygiene instruction, and place fluoride varnish to prevent tooth decay. 

In the early stages of life, children need dental disease prevention. I started this post with the title "Caries prevention starts by protecting the first tooth". As soon as your baby's first tooth comes in, you should begin caring for it, keeping it clean, strengthening it with fluoride, and learning how to keep it and all next 19 primary (baby) teeth that come in healthy and cavity free. Yes. it can be done. Cavities are not inevitable. Our goal, as oral health providers, is to help your child never get a cavity.  

Call an RDHAP. He or she may be able to come to your home to provide this education and preventive care. An RDHAP is a dental hygienist licensed to work outside the traditional dental practice, caring for the oral health of patients unable to get dental hygiene care in the traditional office setting. Look on our "I Need an RDHAP" map for an RDHAP near you.

Aging comes with many challenges. Among them is maintaining good oral health. It seems that when we are young there is an emphasis on daily brushing with fluoridated toothpaste and consuming less sugar to reduce the risk of tooth decay. However, as we age, both of these decay preventive strategies seem to be put on the back burner. Why is this?

Below is an overview of the common reasons tooth decay or caries increases as we age. They include:

• Skimping on professional dental and dental hygiene care
• Dry mouth
• Dietary changes
• Decreased ability to manage optimal oral self care
• Root caries/Abfraction

Skimping on professional dental and dental hygiene care
Upon retirement, if you were lucky enough to have dental insurance prior to retiring, this benefit often gets dropped from retirement insurance coverage. Private dental insurance is available, but is notoriously pricey. As a dental hygienist in private practice, I have seem many patients who previously made regular preventive visits to the dentist, then start stretching them out and put off needed restorative care after retirement. Further, when our budgets get tight, professional dental care tends to get sidelined. It should not. Oral health is linked to general health. Maintaining a regular routine of preventive dental and dental hygiene care is as important as regular visits to the MD.

Dry mouth
Many medications have the side effect of reduced saliva or the feeling of a dry mouth, called xerostomia. Medications that commonly cause dry mouth include antihistamines, antidepressants, muscle relaxants, diuretics, and decongestants, to name a few. Other processes that can contribute to the reduced saliva flow include Sjogren's Disease, salivary gland dysfunction, cancer treatment, normal aging, and even snoring and mouth breathing. Why is this important to know?

Saliva plays an important role in maintaining our oral health. Saliva contains many minerals that assist in digestion. It keeps the mouth moist to assist chewing and swallowing. Saliva has antibacterial qualities, helping to keep our oral tissues healthy. Minerals in the saliva are key to maintaining a neutral pH in the mouth. If the pH becomes too acidic, minerals are pulled from the tooth in order to neutralize the pH. If the saliva is too acidic for an extended period of time, mineral loss (called demineraliziation) will outpace minerals being redeposited (remineralization), leading to tooth decay. There are, however, many ways to reduce the effects of a dry mouth. Dry mouth can be difficult to treat and there is often no cure. An oral health professional can help patients learn to manage dry mouth and maintain a more neutral saliva pH.

Dietary changes
We all know what we should eat and drink to reduce the risk of tooth decay - fresh fruits and vegetables, complex carbohydrates, unsweetened beverages and limit the processed sugar. Why don't we do that as we age? Several reasons come to mind. However, those elderly who seem to have the most cariogenic (cavity causing) diets are those who are bed or home bound, living in assisted living situations and not in control of their own diets, as well as those on limited incomes.

Those of us who have the choice and ability to choose healthy foods can still make poor choices. It is those who lack that ability who need the help of oral health care professionals to guide them to clean their teeth better and make better choices when possible.

Decreased ability to manage optimal oral self care
As we age, we need to change the way we brush and clean our teeth. The brushing technique we learned as children needs to be adapted to adult teeth and gums. Good oral self care is challenging for the healthy individual (how many of us love to floss?), and it takes time (two minutes brushing your teeth sounds like a long time). Becoming forgetful, possibly unable to stand and concentrate on our oral hygiene for 2-3 minutes, or having arthritic issues that make managing a toothbrush and dental floss difficult can create a situation where oral health begins to suffer. 

Root caries/Abfraction
Tooth decay along the gumline is the most challenging to treat and prevent. Abfraction is the breaking down of the tooth at the gumline for reasons unknown. We do know that the root surface is much softer than the enamel, so the patient who grew up with generally healthy teeth can become very prone to tooth decay on the root surfaces. The best advise from oral health care professionals is to have the roots checked regularly. The RDHAP can provide preventive care and place small temporary restorations that may slow down or stop the progress of decay until the patient can see his or her dentist..

So now what?
Tooth decay can happen very fast if the issues I have described converge. A visit to the dentist or dental hygienist is important to help identify any dental or oral hygiene issues a patient is having. These professionals can help guide the patient and/or caregiver to create new routines and strategies to help protect the oral health of the patients. 

If you or your loved one is elderly and challenged to get to a traditional dental office, we have a solution. The RDHAP is a private practicing dental hygienist who can come to your home and help you maintain your oral health. Go to the Map to find an RDHAP in your area.


Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. JADA. 2007. Accessed at https://jada.ada.org/article/S0002-8177(14)62738-0/fulltext  

The short answer is yes. If you have active caries lesions (cavities), they are filled with bacteria. First, you need to get the bacteria removed and the cavity filled. Then you have to change your habits in order to make your mouth uninhabitable for the cavity  'causing' bacteria. But, let's go back further.

The long answer to the question is much more complex. Like most other diseases humans are prone to, a lot of things have to happen for it to manifest itself. This is a story of prevention.

Tooth decay is the result of a preventable disease called dental caries. The result of untreated dental caries is a caries lesion or cavity. You read it correctly. This disease is preventable. The bacteria responsible for reeking most of the havoc of this disease are transmissible. You were not born with these bacteria in your mouth. They are passed on to use by loving parents, grandparents, siblings, or even fellow toddlers in the playroom.


There are four (4) components that have to be in place to get a cavity.

• Host - There has to be host - a tooth. No tooth. No cavity.
• Bacteria - Bad bacteria need to be in thriving in the mouth.
• Food - The bacteria need to eat! :-) They thrive on fermentable carbohydrates - sugar, refined flour products, like bread and crackers, rice, potato - you know, the usual suspects.
• Time - the bad actors all need to stay on the tooth for at least 20 minutes. AND...the more often you eat or drink sugary or refined carbohydrates, the happier the bacteria are. 

Let's address these one at a time.

Host/Tooth: Rarely are people born with weak teeth. Oh, there are diseases that causes weak teeth with defective or no enamel, but they are rare. Our teeth normally erupt healthy. It is the first 18-24 months in the mouth, when our immune systems are developing, that they become compromised if parents are not vigilant. To keep the newly erupting teeth healthy, the rule of thumb is to always wipe them with a clean wash cloth or use a small tooth brush after you feed the baby. Infant formula and breast milk contain sugars essential for growth, but not so good if left on their little teeth too long (20 minutes). Never put a baby to bed with a bottle that contains anything but water, since they are bathing their teeth in sugar, creating the perfect environment for tooth decay to start.

Bacteria: We all have them. Most are good and important to our digestion and general health. The bacteria that 'cause' tooth decay, however, are not among the good guys. The rule of thumb here is to avoid sharing saliva, where many of the bacteria live, with your infant or toddler. How does that happen? Sharing food, toys, and toothbrushes; pre-chewing food (yup, people do that). Never clean a pacifier with your saliva. In otherwise,  reduce the chance of infecting your baby with caries causing bacteria. Of course all of this may be OK if you or the other people loving on your baby are at low risk for dental caries. A few bad bacteria may get transmitted to your child, but we can keep them from growing in numbers by performing good regular oral hygiene. Read on.

Food (sugars and fermentable carbohydrates): Our bodies need carbohydrates to function properly, but the recommendations are to eat complex carbohydrates in the form of fresh fruits, vegetables, and legumes. In American culture, it is almost impossible to avoid the fermentable carbohydrates, though. We should all learn to curb them for lots of reasons, but that is for another blog post ;-). The rule of thumb here is to choose beverages that have no sugar (water), and snack on complex carbohydrates, such as fruit, vegetables, nuts. There are snacks that we can choose that actually have tooth-protective properties (white cheese, almonds, for example).

Time: So what does time have to do with all this? The bacteria that 'cause' tooth decay need about 20 minutes of exposure time to turn your cookie, cracker, or juice into an acid. It is actually the acid that causes the decay. The bacteria are really just the acid factories. If we look back on what we have read so far, the fewer bacteria (acid factories) you have in your mouth, the longer it is going to take to produce enough acid to cause a cavity. The less of their favorite foods the bacteria have to eat, the longer it will take to produce enough acid to cause cavities. The rule of thumb is to (1) avoid snacking, (2) remove the carbohydrates from your mouth (brush/floss/rinse) after snacking, and (3) minimize acidic beverages between meals.

Wow! That was a lot of information. My recommendation or RULE OF THUMB is to take baby steps. This post is basically about how to reduce the risk of ever developing tooth decay. It starts with protecting infants. Start small, wherever you think you have the best chance of success. Don't worry if you fail. We all fail now and then. I hate to even call it failing. It is part of learning. Just forget it, and keep trying. 

I have gone through how to prevent or reduce the risk of developing dental caries. So what if you already have it? What if you are grandparent or relative and the new baby in your family is kissable? What can you do? Stay tuned for Can I Stop Getting Cavities: Part 2.   

References

Clark MB, Slayton RL. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 2014;134:626-633 http://pediatrics.aappublications.org/content/pediatrics/134/3/626.full.pdf Accessed January 11, 2019

Featherstone JDB, Crystal YO, Chaffee BW, Shan L, Ramos-Gomez FJ. An Updated CAMBRA Caries Risk Assessment Tool for Ages 0-5 Years. CDA J. 2019;47(1):37-47. https://www.cda.org/Portals/0/journal/journal_012019.pdf. Accessed January 5, 2019