® wo rd of mo uth Summer-Fall 2009 A Semiannual Publication of the Massachusetts Dental Society

got dentist? ® got dentist? word of mouth

The Massachusetts Dental Society (MDS) is pleased to make this publication available to our member dentists as a way of commu- nicating important oral health information to their patients.

Information in WORD OF MOUTH articles comes from dental health care profession- als of the MDS and other leading professional dental organizations, including the American We know that many of you already have a dentist whom you Dental Association. If you have any questions visit twice a year for regular dental checkups and treatment. But about specifi c content that may affect your surprisingly enough, nearly half of all Americans (46 percent) do oral health, please contact your dentist. For not have a general dentist, according to the Academy of General timely news regarding oral health, visit the . And for those of you who move to a new city or town, “For the Public” section of the MDS Web site at www.massdental.org. or whose dentist retires, finding a new dentist can be a difficult task, especially if you are living in a community where you don’t Your comments and suggestions regarding know many people. Asking for referrals is a good place to start, but WORD OF MOUTH are always welcome. ultimately you will have to decide which dentist is best suited to your All correspondence and requests for individual needs and situation. A variety of factors can come into additional copies may be forwarded to play when choosing a dentist, ranging from the office’s location to Melissa Carman, Managing Editor, c/o the practice’s hours to the level of care you require to the languages Massachusetts Dental Society, Two Willow spoken to whether the practice is accepting new patients. Street, Suite 200, Southborough, MA 01745- 1027, or email [email protected]. There are many ways you can find a dentist. The Massachusetts Dental Society (MDS) and the American Dental Association (ADA) Robert E. Boose, EdD offer these suggestions to get you started: Executive Director

Scott G. Davis • Ask family, friends, neighbors, or coworkers for Chief Communications Offi cer recommendations. Melissa Carman • Ask your primary care physician, other health care Managing Editor, Publications providers, or your local pharmacist. and Web Site • If you’re moving to another town, ask your current Jeanne M. Burdette dentist to make a recommendation. Manager, Graphic Design • Use the MDS’s Find a Dentist Web site Shelley Padgett (www.massdental.org/find-a-dentist) to search Graphic Designer for dentists in Massachusetts or the ADA Member Bethann Dacey Directory (www.ada.org) to search for dentists Community Relations Coordinator out of state based on a variety of criteria.

Jessica Robinson Communications Assistant FIND AN MDS DENTIST Bill Donnelly Contributing Writer To find an MDS dentist, contact the Massachusetts Dental Society Copyright © 2009 at (800) 342-8747 or visit www.massdental.org/find-a-dentist.

2 word of mouth Consider this . . .

You may have specific considerations when choosing a dentist; these criteria should reflect your own needs and priorities. The following questions can help you define what is most important for you:

1. Where is the practice located? Will it be easy for you to get there? Is it accessible by public transportation? After you’ve gathered Is there ample parking? Is it handicapped accessible your research, you’ll want (e.g., elevators, ramps)? to evaluate your options and consider what the most im- 2. Which dental procedures are completed in-office portant attributes are for you. Once you have and which procedures will be referred out? selected the dentist who meets your needs, set up an appointment for a general exam, 3. How long will you wait for an appointment after which consists of a cleaning, X-rays, and you call? medical health history, to see if the dentist meets your expectations. This visit is your 4. Does the office keep open appointment times opportunity to give the dentist a test run. for emergencies? Bring any questions you have regarding the dental practice and your treatment, and don’t 5. What are the covering arrangements when your be afraid to ask them. dentist is unavailable or on vacation? Whom should you call if you have a problem after-hours? If the One other thing you’ll want to know is if dentist works in a group practice, are you comfortable the dentist you decide on is a member of with being seen by one of the practice associates? both the MDS and the ADA (MDS members are required to be members of the ADA). The 6. Is the office staff friendly and courteous? MDS and ADA help members stay current with

the latest information affecting dentistry and 7. If you call with a question about your care, does a clinical information to provide the best possible dentist or dental assistant return your call promptly? patient care. Additionally, MDS/ADA members

voluntarily agree to adhere to high ethical 8. Does the dentist speak your language fluently, standards of conduct, as described in the ADA or would he/she require an interpreter or other Principles of Ethics and Code of Professional translation services? Conduct.

9. What is the educational background of the dentist, and is he/she board certified in a specialty? You may want to call or visit more than one dentist before making your decision. Dental care is a very personalized service that requires a 10. Does the dentist accept your dental benefit plan? Does the office process insurance claims, or will you good relationship between the dentist and the be required to pay up front for services and file the patient, so you’ll want to make sure you find the claims yourself? best fit for you. o

word of mouth 3 DEN AL DEN AL

Have you ever asked a question, only to discover several differing—and contradicting—answers? When it comes to your oral health, misconceptions can also be all too common. But if taken as sound advice, some of these can jeopardize your oral and overall health, since the two are closely related. That’s why the Massachusetts Dental Society (MDS) wants to make sure that you are not in “dental denial” about issues related to your oral health.

Misconception: Smokeless tobacco is safer than cigarettes.

This is one common oral health misconception with deadly consequences. It’s a well-known fact that cigarette smoking is bad for your health. In fact, cigarette manufacturers have been required by law since 1965 to include a statement on each package that cigarette smoking may be hazardous to your health. People may think that smokeless tobacco is safer than smoking tobacco, but they would be wrong. But don’t take it from us. When it comes to smokeless Also known as spit, snuff, or chewing tobacco, smokeless tobacco, look no further than the package. In October tobacco is not a safe alternative to smoking. In fact, according 1986, the Federal Trade Commission issued regulations to the National Spit Tobacco Education Program, the nicotine that require smokeless tobacco packages to feature the content in a can of smokeless tobacco is approximately following warning labels, rotated on a quarterly basis: 144 milligrams, which is equal to about 80 cigarettes. In other words, one can of smokeless tobacco is equal to four WARNING: THIS PRODUCT MAY CAUSE packs of cigarettes. Smokeless tobacco is absorbed quickly MOUTH CANCER. and directly through the inside of the mouth, making it very dangerous. WARNING: THIS PRODUCT MAY CAUSE According to the American Heart Association, smokeless GUM DISEASE AND . tobacco has been directly linked to cancer of the mouth, pharynx (throat), and larynx (voice box). It can also cause WARNING: THIS PRODUCT IS NOT cancer of the esophagus, as well as gum disease and tooth A SAFE ALTERNATIVE TO CIGARETTES. loss. Research has shown that more than half of all smokeless tobacco users have noncancerous or precancerous lesions in For more information on oral cancer and smokeless their mouth, with the chance of their getting oral cancer tobacco, contact the Massachusetts Dental Society 400 percent greater than for nonusers. at (800) 342-8747 or visit www.massdental.org. o

One Time It’s Good to Be a Quitter

The third Thursday in November is designated as the American Cancer Society’s Great American Smokeout, and there’s no reason that smokeless tobacco users can’t join in. So on November 19, 2009, kick that smokeless tobacco can to the curb and give your health a chance. Better yet, why wait for November? Why not start now? For more information on overcoming a nicotine addiction, visit the Web sites of the American Heart Association (www.americanheart.org) or the American Cancer Society (www.cancer.org), or call (800) QUIT-NOW, a free service from the U.S. Department of Health and Human Services to help people stop using tobacco. Also, the Massachusetts Department of Public Health has a Web site (www.trytostop.org) devoted to making smoking history.

4 wordrd ooff mouthuth A Healthy Mouth Starts with Good Vision

Oral Health/ Access to Overall Health Care Prevention

Imagine a world where: The Massachusetts Dental Society (MDS) imagines such a world, and that’s why we have spent more than a year developing the Call to ACTION, a comprehensive vision plan • Everyone recognizes the importance of good oral health as it relates to total health and well-being. to improve the oral health of all residents in the Commonwealth by the year 2013. The Call to ACTION, which was offi cially released in February, focuses on three targeted • Every adult and child in Massachusetts has access goals: Oral Health/Overall Health, Access to Care, and Prevention. Specifi c objectives are to oral health services regardless of ability to pay. described within each goal. • Every child has at least one comprehensive dental The Oral Health/Overall Health Goal looks at the importance of a healthy mouth in exam prior to entering school and where no relation to a healthy body, and includes an objective requiring every child entering school for child ever has to suffer in silence from tooth pain the fi rst time to have a dental examination performed by a dentist. The MDS fi led a bill—An because he or she can’t afford treatment. Act Relative to Pupil Dental Health—regarding this objective in the state legislature earlier • Thousands of dentists participate in the state’s this year as part of its legislative agenda. MassHealth Program, providing care to underserved The Access to Care Goal addresses the need for all Massachusetts residents to have access populations; more dentists choose to work in community health centers; and dental students to dental care. Objectives of this goal include: increasing the number of dentists participating practice in these settings while in school or as in the MassHealth dental program, which the MDS has been successfully striving to do for part of a loan repayment or tuition reimbursement more than a year; enhancing the state’s oral health structure; increasing the capacity of program after graduation. community health centers; and fi ling and working to enact the Volunteer Dental License Bill, • Retired dentists can voluntarily donate the same creating opportunities for retired dentists to provide care to underserved populations. services they provided when they were in active The Prevention Goal seeks to educate the public and legislators on the importance of practice. preventive measures to avoid future oral health problems, such as and orofacial • The death rate for oral cancer declines dramatically injuries. Objectives of this goal include: supporting community water fl uoridation; fi ling through public education about risk factors and by legislation requiring students at all levels of school to wear mouthguards in contact sports; early detection, and anti-tobacco funds are utilized funding anti-smokeless tobacco education initiatives; and supporting legislation to ban the to discourage not just the use of cigarettes, but also sale of soda, fruit juices, sports drinks, and sugary snacks from school vending machines. the use of smokeless tobacco. Just as the obstacles to good oral health for all Massachusetts residents didn’t surface • Community water fl uoridation is available in every city overnight, the solutions won’t come immediately. And the MDS needs the support and and town in Massachusetts that can have access to it. partnership of a wide range of groups and concerned citizens to work collaboratively in • Soda and sugary snacks are no longer accessible to fi nding practical and meaningful ways to address these issues. With the Call to ACTION, it’s students through vending machines in schools. the MDS’s hope that we will have constructed a solid foundation on which together we can build a strong oral health care system that can be sustained for many years to come. o • Mouthguards are required protection for every child participating in any contact sport, thus preventing thousands of injuries and saving families hundreds For more information or to request a copy of the of thousands of dollars in dental costs. Call to ACTION, please call (888) MDS-2013 or visit www.massdental.org/calltoaction.

word off mouthuth 5 An Inconvenient Tooth Space Needed t’s a common problem in many aspects Supernumerary teeth fall into two general of life—lack of space, the trouble and categories—supplemental and rudimentary. Iinconvenience of how to fi t what where. In Supplemental supernumerary teeth resemble dentistry, proper spacing of teeth may be an normal teeth,and are in addition to the regular, aesthetic issue, but it can also be a factor in 32-tooth series. Rudimentary supernumerary one’s oral health. Selective extractions—notably teeth usually appear underdeveloped and small, and commonly of wisdom teeth—along with and are often pointed or cone-shaped. orthodontics are well-known approaches to correcting simple spacing problems in an otherwise normal set of teeth, allowing room in the mouth for each tooth to grow healthy and The exact cause of supernumerary teeth is still straight. However, some dental spacing issues subject to debate, but some theories include: grow into more than mere inconveniences and beyond the scope of standard procedures. • Hyperactivity of the dental lamina, which For those affected by a condition known as causes an overabundance of tooth supernumerary teeth, this may be all too clear. development • Splitting of the tooth bud, which creates extra Supernumerary The ideal mouth contains 32 teeth: 16 uppers tooth development from the resulting buds and 16 lowers. But, as the name implies, teeth exceed • Atavism, which is a regression to the dental supernumerary teeth exceed the typical number, forms of earlier stages in human evolution the typical potentially appearing at any position in the dental arch. A supernumerary tooth may appear 32 teeth in a as a primary (baby) tooth, but more commonly develops later, as part of the permanent set. person’s mouth. Whatever the root cause, identifying and Affecting approximately 2 percent of the locating supernumerary teeth is very important population, supernumerary teeth occur twice to an individual’s oral health. Generally, the as often in men as in women and most often as emergence of a supernumerary tooth can be anterior, or frontal, teeth. discovered through clinical examination by a As one might expect, the presence of dentist and standard X-rays. Once identifi ed, supernumerary teeth often leads to problems the dentist and patient can decide on the with the eruption and spacing of normal best approach to take with this potentially permanent teeth, at times causing crowding and “inconvenient tooth.” o displacement. Extraction of the supernumerary tooth is recommended in these cases, but if the For more information on supernumerary dental arch can accommodate the extra tooth, teeth or your oral health, please contact the and the development of regular teeth is not Massachusetts Dental Society at (800) 342-8747 impeded, removal may not be necessary. or visit www.massdental.org.

6 wordrd ooff mouthuth Baby Talk

s a rule, babies are pretty needy age 5 or 6, when they begin to loosen creatures. They can’t walk, they and fall out, according to the Academy of A can’t talk, and they can’t dress, General Dentistry (AGD). clean, or feed themselves. So, as a While your infant’s mouth may be parent, you take on the responsibility toothless, you still need to make sure of ensuring that your infant’s needs are he or she gets the proper oral care. met. You make sure she gets the proper Begin oral health care as soon as you nutrition necessary to grow. You take bring your baby home from the hospital him to the doctor’s offi ce for checkups. by cleaning his or her with a And just because he or she may not clean gauze pad or washcloth after sucking of fi ngers and/or toys, says have a full set of teeth yet doesn’t mean each feeding. The MDS recommends the AGD. When your child experiences that your baby’s oral health should be that as soon as the fi rst tooth appears, discomfort from teething, there are some overlooked. The Massachusetts Dental parents begin brushing baby teeth with things you can do to help alleviate the Society (MDS) wants to remind you to a soft-bristled and a small pain. Giving your baby a cold, wet cloth consider your baby’s oral health needs, amount of water. Unless your child’s to suck on can soothe painful gums. too, because taking care of your infant’s dentist advises it, do not begin using Many stores carry teething accessories teeth is not just “baby talk.” a fl uoridated until the age or toys that are designed specifi cally Generally, a baby’s four front teeth of 2, and then use only a pea-sized to help relieve the pressure that comes begin to appear between the ages of six amount. Children should be taught to from teething, such as water-fi lled plastic months to one year. The remainder of spit out toothpaste and rinse with water devices that can be frozen. primary, or baby, teeth will erupt usually after brushing. Flossing should begin as Primary teeth are just as important as in pairs on each side of the jaw, until the soon as any two teeth touch. Parents adult, or secondary, teeth because they child is approximately 3 years old. Most should assist their children until they are help children with biting, chewing, and children have a full set of primary teeth old enough to brush and fl oss on their speaking, and even help give the face by age 3 and will keep those teeth until own—usually by age 6 or 7. its shape and form, says the American As your child’s baby teeth begin Dental Association. Early tooth loss to erupt, he or she will most likely from dental decay can have a serious experience painful gums and oral impact on your child’s self-esteem and discomfort—“teething.” Signs that self-confi dence. teething is causing your infant discomfort Teach your child from an early age include crankiness, appetite loss, the importance of eating a healthy excessive drooling, pink or diet, along with practicing routine oral red cheeks, coughing, or hygiene, to maintain healthy teeth and increased chewing or gums for a lifetime of smiles. o

For more information on your baby’s oral health, contact the Massachusetts Dental Society at (800) 342-8747, or visit www.massdental.org.

word of mouth 7 Now that the dog days of summer are in full swing, many children and adults alike look to cool off in a nearby pool to beat the heat. Before they dive in, swimmers should be aware that excessive exposure to chlorinated water and pool-related oral injuries might hurt their teeth, as well as their summer fun, according Sm le to the Massachusetts Dental Society (MDS). Excessive exposure of the to chlorine, a chemical added to disinfect pools, may cause brownish discolorations, primarily on the front Safety Tips teeth. These discolorations are due to chemical additives in the chlorine, such as antimicrobials, for Summer Swimmers which give the water a higher pH than saliva, causing salivary proteins to break down quickly and form Swimmers (and sunbathers) should be careful not organic deposits on the swimmer’s teeth, according to run near the pool, to wear appropriate footwear to to the Academy of General Dentistry (AGD). avoid slipping on wet surfaces, and to be very cautious Swimmers—especially those who are in the pool for when jumping and diving. It’s also important to look more than six hours a week—can avoid this staining before you leap, so know where you are before diving by brushing their teeth immediately after swimming. in. Many accidents occur when swimmers misjudge Swimmers can also have regular cleanings and whiten dives into too-shallow water and hit the pool bottom, or their teeth to keep the staining under control. But pull up too close to the edge of the pool, hitting their this isn’t just a summertime concern. Since chlorine is face and/or loosening their front teeth. added to indoor pools, such as those found at hotels and YMCAs, year-round swimmers will want to adopt Whether swimming or playing in or around the these post-swimming oral care habits to keep their pool, everyone should be aware of their surroundings. pearly whites sparkling. Exercising caution around pools this summer (and year-round) is a must for avoiding any type of injury. While it sure is fun to frolic poolside on a hot The MDS wants you to have fun this summer, but we summer day, dental and mouth injuries as a result of also want you to have a healthy, pain-free mouth. o accidents near the pool are all too common. Those “No Running” and “No Diving” signs posted on the For more information on your oral health, contact fence at your local pool may seem like a killjoy, but the Massachusetts Dental Society at (800) 342-8747 they’re there for good reason, because swimming or visit www.massdental.org. pool accidents are the number one cause of dental emergencies during the summer, according to the AGD. The hard cement and ceramic surfaces around the pool ledge are oftentimes wet and slippery, and one can easily lose his or her footing and crash face- fi rst into the concrete or a chair, damaging teeth in the process.

word of mouth 9 How important is your oral health to you? If you’re like the 80 percent of respondents in a recent survey conducted by the American Dental Association (ADA) and and Oral-B, you believe that taking care of your mouth, teeth, and gums is absolutely necessary. Surprisingly though, only one-third (33 percent) of respondents believe they take “excellent” care of their oral health. So, when it comes to comparing your oral health to that of other Americans, do you talk the talk or walk the walk? The survey of 1,000 Americans ages 18 and older focused on the public’s perceptions of their oral health; Americans’ knowledge of effective and essential oral health care habits; oral health habits among young Americans; and the psychological benefi ts of a healthy smile. Some of the results are very telling. For instance, more than Survey Says half (55 percent) of respondents agreed that the smile is a person’s most important physical attribute, but more than one- third did not realize that a beautiful smile is not always a healthy smile and can in fact mask underlying problems. Thirty-three percent of those surveyed thought that a little bleeding from brushing is normal, when actually it is not and could be a sign of . One in three (33 percent) were unaware that periodontal disease needs to be treated because it will not go away on its own. And 37 percent didn’t know that poor oral health has been associated with other serious overall health True or False conditions such as stroke, heart disease, and diabetes. A little bleeding ? from brushing There’s More to a Smile Than You Think Survey participants realized that a healthy smile is not only is normal. essential to overall physical health, but it can also affect self- esteem and success in life. Only one in three (37 percent) said that they were completely happy with their own smile, while nearly one in fi ve said that they avoid having their picture taken True or False because they are self-conscious about their smile. Additionally, Poor oral health can? while many feel that a smile is the most attractive feature in another person, the majority (73 percent) are adamant that no cause serious health matter how nice a person’s smile is, yellowed teeth ruin the effect. conditions, such as When it comes to oral health habits, the survey found that stroke, heart disease, men and women differ in their attitudes toward their oral health. According to the results, 86 percent of women brush their teeth and diabetes. twice or more a day, while only 66 percent of men do so. However, the avoidance of fl ossing knows no gender lines: Only 49 percent of those surveyed said they fl oss their teeth one or more times a day, and 10 percent said they never fl oss at all. Regular brushing For more information on your oral (at least twice a day) with a fl uoride toothpaste and daily fl ossing health, contact the Massachusetts are the two best ways to maintain good oral health, which means Dental Society at (800) 342-8747 that according to this survey, more Americans need to step up or visit www.massdental.org. their game. So, WORD OF MOUTH readers, where do you rate your oral health? If you follow the oral health tips you see regularly in this publication or on the MDS Web site, you should be well above average. o

10 word off mouthuth Bacon-Flavored Floss? Another Reason to Go “Green” For a few years now, toothpaste manufacturers have been expanding their The health benefi ts of drinking green tea have long product lines beyond the old standby mint toothpaste to include a variety of been promoted. Its health benefi ts have been fl avors—citrus, berry, grape, and bubblegum, to name a few—all in the interest linked to weight loss, heart health, and cancer of encouraging children and adults to brush their teeth more. So it may not be too prevention. And a recent study in the Journal of much of a stretch to fi nd fl avored dental fl oss on the market. But several new gag indicates that the tasty beverage gifts are being marketed as dental fl oss products that you may want to avoid. may help promote healthy teeth and gums, as well. A line of fl oss can now be found online in fl avors such as Researchers analyzed the periodontal (gum) health of bacon and cupcake frosting. While these fun fl avors may 940 men and found that those who regularly drank encourage you to fl oss more often, be warned that green tea had superior periodontal health to subjects neither contains fl uoride, the cavity-fi ghting ingredient who consumed less. The study’s authors believe that found in many dental fl osses manufactured by the secret weapon is the presence of an antioxidant oral health care companies. called catechin. Antioxidants have been shown to reduce infl ammation in the body, and it is suggested Don’t Get Diver’s Mouth that by interfering with the body’s infl ammatory Do you scuba? If so, you may want to see your dentist fi rst because this sport response to periodontal bacteria, green tea may can lead to jaw joint and/or tooth pain and gum tissue problems. “Diver’s mouth actually help promote periodontal health. syndrome” is a condition that is caused by the mouthpiece and the air pressure change involved in scuba diving, according to the Academy of General Dentistry. Divers may be initially unaware of the discomfort in their mouths that is caused by For Whiter Teeth, Stop “Wine-ing” an ill-fi tting mouthpiece, but when they fi nish their dive, they may notice jaw joint All you oenophiles out there may already know pain or gum lacerations. that drinking red wine can increase your risk for stained teeth. But is switching to white wine “Cankering” for Some Licorice? keeping your whites any pearlier? Not necessarily, according to a recent study by New York Canker sores can be uncomfortable and unsightly, but an unlikely root plant may University College of Dentistry researchers. The provide relief. A study published last fall in General Dentistry reported that study used two sets of cow’s teeth, whose surface licorice-laced adhesive patches given to 23 adults suffering from canker sores led closely resembles human teeth, soaking each for to a faster recovery. Seven days after application, sores grew signifi cantly smaller one hour in either water or white wine and then and less painful, while study members who’d received no treatment saw their immersing them in black tea. Researchers found sores increase by 13 percent. It’s believed that stress and hormonal changes often that the teeth soaked in white wine for one hour, cause canker sores, and licorice helps to knit the tissue back together and heal which the researchers say is similar to the effect the sore. Keep in mind that the licorice used in this study was in its more natural of sipping white wine with dinner, state, not the red twisty sticks you fi nd at the movie theater. Glycyrrhizin, one had signifi cantly darker stains than the of the main components found in licorice, is believed to contribute to the herb’s teeth soaked in water before exposure healing properties. Laboratory studies have reported that glycyrrhizin reduces to the tea. The acids in wine create infl ammation, according to the University of Maryland Medical Center. rough spots and grooves, which allow the chemicals in other beverages, such Chew Smart as coffee or tea, to penetrate deeper WORD OF MOUTH has previously touted the oral health benefi ts of . In into the surface of the tooth. a nutshell, the act of chewing produces saliva, which helps wash away harmful bacteria on the teeth. But a 2008 Australian study hypothesizes that chewing gum has other health benefi ts as well, including relief from stress and anxiety and an increase in alertness. The study’s gum chewers showed a reduction in anxiety compared to non-gum chewers by nearly 17 percent during mild stress and 10 percent during moderate stress, while 19 percent showed improvement in Red, white, or alertness over non-gum chewers. Just remember to chew sugar-free gum or gum whitening? containing , a natural sweetener that has been shown to dramatically reduce cavities.

word of mouth 11