Albuquerque-Bernalillo County Water Authority To End Fluoridation: What Does This Mean For Oral Health?

Attention, residents of Albuquerque and Bernalillo County:  You and your families will soon be at higher risk for tooth decay.   In a surprising move, the Albuquerque Bernalillo County Water Utility Authority Board in January voted to stop adding fluoride to the public water supply by the end of the year.

Although our water supply contains some naturally occurring fluoride, fluoride levels are too low in most of the county to prevent tooth decay.   The U.S. Department of Health and Human Services has determined the optimum level of fluoride in water to be 0.7 mg/liter.  Yet only 35% of Bernalillo County’s water distribution zones meet this level.   (See this map of ABQ-Bernalillo County’s naturally occurring fluoride levels.)

Fluoridating public water supplies and using fluoride dental products can improve oral health and produce several benefits:

• Fewer cavities and less severe cavities.
• Less need for fillings and tooth extractions.
• Less pain and suffering associated with tooth decay.

Thirty-four percent of New Mexico’s third-graders suffer from untreated tooth decay, compared to the national rate of 23%.  Hispanic and Black children and those living in families with lower incomes have more decay. Reducing water fluoride levels could make that worse.

The water utility board’s action recently was brought to the attention of the New Mexico Oral Health Advisory Council (NMOHAC), of which I am a member.  The NMOHAC includes dental health care providers, state officials and others committed to improving oral health and access to dental services. The NMOHAC is considering how to address this issue.

Under the federal Safe Drinking Water Act, public water supplies must contain no more than 2.0 mg/liter of fluoride.  There is no federal minimum for water fluoride levels.

For more information on fluoridation and the nationally recommended standard:

• Community Water Fluoridation: Questions and Answers:
  • http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#12
  • http://www.cdc.gov/fluoridation/guidelines/index.htm
• Press Release on HHS/CDC recommendation:  http://www.hhs.gov/news/press/2011pres/01/20110107a.html

Oral health news roundup

Here is a look at some recent news stories on dental health and dental access issues. I’ll regularly post news roundups like this. If you have any news stories you’d like me to highlight, let me know!

Palm Beach Post: Ignoring dental care, a popular way to economize, can come at high price

July 6, 2011

Sonja Isger talks about the dramatic and dangerous costs of putting off dental care. As the article explains, many people give up dental visits to cut costs when money is tight. Isger highlights some surprising dental access and cost statistics for both the nation and Florida.

Huffington Post: Why Oral Health Leads to Overall Health

July 5, 2011

Too often, dental care is viewed as a luxury or purely cosmetic. In this piece, Glenn Braunstein explains the connection between oral health and overall health and that there are links between dental disease and chronic disease. You can’t have a healthy body without a healthy mouth. That’s why access to dental care is so important – it’s critical to have routine exams to prevent problems and catch the signs of any infections or disease early.

Columbus Dispatch: Dental practitioner would benefit Ohio

July 4, 2011

In a letter to the editor, an Ohio resident says the state needs a midlevel provider to help meet the needs of people in Ohio. As I’ve said before, I also believe midlevel providers, particularly dental therapists, could help expand access to dental care in New Mexico. It’s interesting to see the Ohio perspective.

Los Angeles Times: Tooth decay is prevalent among poor children

July 1, 2011

In this article, Amanda Marscelli looks at the severe dental issues facing poor children in Los Angeles and across the country. The disparities are devastating. The piece includes some pretty shocking statistics; for example: one-fourth of the nation’s children have 80% of the nation’s tooth decay. As you’ll read in the article, poor children have the hardest time accessing dental care and they’re the ones who need it most.

Minneapolis Star Tribune: Students find a subject worth sinking their teeth into

June 27, 2011

Jeremy Oslon profiles a student from the first class of students to complete a dental training program at the University of Minnesota that introduces at-risk high school students to the field of dentistry and supports them in earning their diplomas. I’m impressed by this innovative program. It’s encouraging to see that the University of Minnesota is trying to expand access to care while introducing these teenagers to a promising and important career.

Integrating Medical and Dental Care Can Improve Access and Health of New Mexicans

Oral health is essential to overall health. Yet, for decades, the medical and dental professions have practiced in their own separate spheres, rarely working together to coordinate to improve care for their patients.

My hope is that may be changing – at least here in New Mexico.

Recently, at the New Mexico Health Resources (NMHR) annual provider retreat in Taos, I was struck by how many presenters — medical and dental professionals alike — focused on opportunities for medicine and dentistry to work together in diagnosing and treating patients. I’m encouraged that we will see more action among healthcare professionals, provider groups, payers and others to collaborate on improving the health of all New Mexicans and expanding access to these necessary healthcare services.

Following is a quick summary of several key presentations from the retreat.

Diabetes Management & Treatment at the Dentist’s Office - According to Gary Cuttrell, MD, DDS, JD, University of New Mexico division chief for dental services, 60% of Americans see a dentist once a year. For many people, this is more often than they see their primary care physician. This presents a unique opportunity for dentists, hygienists and other dental professionals to use their training and education to provide basic non-invasive diabetes screenings for diagnosing, referring and helping patients manage diabetes.

Application of Fluoride Varnish In Primary Care Settings – Many presenters suggested that, with some additional training, health professionals in primary care medical practices could apply fluoride varnish to patients’ teeth to prevent further tooth decay and ultimately avert the long-term health problems of obesity, cardiovascular disease and diabetes that can be caused by poor oral health.

Perinatal Dental Care Coordination between Obstetricians and Dental Practices - Irene Hilton, DDS, MPH, presented compelling reasons for obstetrical and dental professionals to collectively reach out to and treat women early in their pregnancies. From the start, a pregnant woman passes on whatever dental disease she may have to her child. Ideally, a woman will have seen a dentist before she is pregnant, but, if not, she should see one within the first 10 weeks.

According to Dr. Hilton, pregnant women are more open to seeking care and following a care plan. This is a good opportunity, for the obstetrician and dentist to collaborate on reinforcing good oral health habits for the mother, who hopefully will instill them in her child. Unfortunately, some women may not see a dentist until the end of their pregnancy and, as a result, they may fail to get all the treatments they need. This is particularly problematic for women covered by Medicaid, because once they give birth, they no longer have their own dental coverage.

I am encouraged by these discussions, and I’m sure there are other opportunities for medical and dental professional to work together for the benefit of their patients.  Let’s break down those silos, so that all New Mexicans can enjoy good health!

When a “B” Isn’t Good Enough: Dental Scorecard Shows NM Children Not Receiving Care

A new scorecard from the Pew Center on the States downgraded New Mexico from an “A” to “B” since last year for its efforts to improve children’s oral health.

Some may think a “B” is just fine, even if it is a step down.  But the Pew scorecard assigns grades based on policy efforts to improve oral health – not the results of those policies.  Unfortunately, if grades were based on results, New Mexico would get a much lower mark, because too many of our kids aren’t getting the dental care they need.

As the report shows, just over half our Medicaid-enrolled kids received no dental care whatsoever in 2009.  That’s over 100,000 New Mexican children in low-income families – kids who are already at high risk for poor oral health – not getting any dental care at all.  (American Academy of Pediatrics, Children’s Health Insurance Status and Medicaid/CHIP Eligibility and Enrollment, 2008, State Reports.  Sept.2009. p10.)

We are doing these children a terrible disservice.

Good oral health is critical to kids’ overall health, as well as to their ability to learn.  Failure to get routine oral health care services early in life can set kids up for a lifetime of poor oral health and increase their risk of developing serious conditions like heart disease and diabetes.

We need policies that will bring needed dental care services to all kids as quickly as possible – and to do that, those policies must address our state’s severe dental care shortage head-on.  Some 40 percent of our population – more than 780,000 New Mexicans – live in federally designated dental health professional shortage areas where there just aren’t enough dentists.

These communities need more frontline providers so that people can get routine, affordable dental care before their dental problems turn into dental emergencies.

One promising solution that I mentioned in my first post involves bringing in dental therapists to expand the reach of the dental care team, so that everyone can get affordable dental care when they need it, where they live.

A dental therapist is trained to work with a dentist, usually at a different location, to provide preventive and routine dental services such as cleanings, fillings and simple extractions.  Because they don’t have to work in the same office with the dentist, dental therapists can help bring some of the most commonly needed dental care services to children and families who currently can’t get them.  However, dental therapists are supervised by dentists, and many independent evaluations have shown that dental therapists provide the same quality of care as dentists for the routine services they perform.

Dental therapists can help save the system money, too.  Because they don’t provide all the services a dentist does, their training is highly focused on performing a narrow scope of routine services, which they do over and over.  This approach allows them to provide care at a lower cost to the system.  Obviously, this is very important at a time when the state is strapped for cash and is considering cuts to Medicaid and other programs that provide dental care for children of low-income families.

As I reported last week, the state legislature this past session considered – but did not pass – a bill that would allow dental therapists to practice in New Mexico.  I’m hopeful that our lawmakers will reconsider this proposal next year.

Too many of our poorest, most vulnerable children aren’t getting the dental care they need.  Bringing in dental therapists could help us solve that problem – and earn us an “A,” not only for effort but results, too.