Cent4dent Blog

I will be on Fox News Tonight at 5 to discuss this issue. Here are the notes I’ve prepared for the broadcast:

Decay Story:

• Tooth decay in primary teeth of children aged 2 to 5 years increased from 24 to 28% – a 16% increase from the 88-94 period vs the 99-04 period
• Significant disparities along racial, ethnic and economic lines – Hispanics 6-11 showed 31% fill rate in permanent teeth vs 29 % non-Hispanic/white kids
• Three times as many children living below the poverty line ages 6-11 had unfilled cavities compared with those with incomes above the poverty line.
• Adults 20-64 showed a 4% decrease in dental visits at least once a year when comparing the same 88-94 vs 99-04 date parameters – tie into oral/systemic link

Causes of increased decay

• Access to care issues, and the fact that so few dentists participate in Medicaid system, which is frought with problems:
o Payment is very small
o Patients don’t keep appointments
o Limited numbers of procedures – eg Hg vs composite
 Talk about California and Maine, and soon, other parts of the US
• Entitlement mentality
o If I don’t have dental insurance I don’t go to the dentist
o Boss is responsible for whether my family and I keep my teeth – this is a quality of life decision, not a quality of job decision
• The managed care system
o Babies don’t come with owner’s manuals – baby bottle syndrome used to be a precautionary lesson, I think today it’s glossed over
o Baby teeth are not expendable.
o Parental and grandparental coping mechanisms are not in place, priorities are misplaced, many mothers out in the workplace and therefore cannot control the diet children are getting during the day.
• A nation of over-indulged children and adults – check out love and logic.com
• Misplaced dollars – toys (child and adult), consumer debt, pampering (nails grow back, teeth don’t).
• Study faulted bottled water – this IMHO is not the case. Fluoridation has not been shown to be effective. In many areas water is not fluoridated. Osteosarcoma in adolescent males. Fluoride needs to be applied topically, not taken systemically.
• Baby teeth decay very rapidly
• Spaces between baby teeth are there so that there’s room for the larger permanent teeth. Sticky candies, like jelly beans get stuck between, and start the decay process. Also get stuck in grooves of teeth. This is something that is seldom taught to parents – How to brush your child’s teeth.

Effects of increased decay
• Invasive treatment on infants is scary both for the child and the dentist.
• Creates dental anxieties that can take decades, even a lifetime to overcome
• Budgetary changes which can lead to a lack of care, or undercare.
• Lack of access to care led to the death of a 12 year old in Maryland, so this simply isn’t only about teeth, it is a life and death issue.
• Many children’s decay is so severe that the children need to be treated under sedation or general anesthesia. This poses a substantially added risk to a situation that could have been avoided, had the proper nutritional and preventative information been given the parents.

What can parents do?

• The causes of decay in children must be understood. The cause of rampant decay like we see here in this child was baby bottle syndrome – there should be nothing but water in a bottle in the child’s mouth when it goes to sleep or for a nap. Sugar is present in juices, formula. It lays on the teeth and if not removed, starts the decay process. Once the decay starts, it gets deeper in the enamel and then it hits the underlying layer, the dentin which is 60 times softer than the enamel. From there it spreads like wildfire to the nerve of the tooth.
• Too many sweets that are sticky lock into the grooves in the top of teeth, and between spaces in the teeth, and again, spread like wildfire.
• Soda and fruit juices with sugar are major culprits – children should be encouraged to rinse and spit after ingesting these foods.
• Jellybeans and other sticky candies should never be used as rewards without an immediate toothbrushing by the parent.
• Children should not be entrusted to their own toothbrushing until around age 8 or 9.
• Parents should sit cross-legged on the floor so that they have visual access to all tooth surfaces and brush them. This position also trains the child for their first dental visit which will be in a dental chair, with them lying down.
• As soon as the teeth begin to erupt into the mouth, parents should start at least wiping the erupting teeth down with a gauze square.
• Children’s first dental visit should be around age 1 or 2.
• Dietary information and a whole lot of other information about this is available on our website at: http://www.cent4dent.com/html/treatment/kids_teeth.html
• If there is an older sibling who is a good dental patient, bring the younger sibling in, to observe the procedures and gain trust, take a ride in the dental chair.
• Sealants on permanent molars as soon as they erupt into the mouth.

When I first started practice, in 1976 I set up next door to a pediatrician so I saw a lot of child patients. The parents of these patients were well educated by the pediatrician, and it was backed up by the preventative procedures we used on them. I thought that we’d make life really easy for these kids, by providing them with regular, preventative services. Many of those children are now bringing their children into the practices, and understand what it takes to keep their teeth.

However, parents whose parents didn’t place these priorities on them while growing up are now facing large dental and financial problems because the knowledge was not passed forward. Hoping that the access to care for patients below the poverty line is going to get better is not going to eliminate this problem. Many dentists simply will choose, as we have, not to participate in a program where they are not being reimbursed and patients do not respect our time. Many of us get involved in various charity programs to assuage our guilt of not participating in government programs. In our office, we often will provide treatment for our patients of record who have fallen on hard times and cannot afford the treatment their children need. We do not do this for people outside the practice, because I get at least 3 emails a week from people searching for a dentist to treat them for free.

You see, when I originally started this website, it was to educate the innocent public about the hazards of managed care, as I saw it, and the dangers of mercury fillings (the “silver” fillings in your teeth are really 50% mercury, the most toxic naturally occurring substance on earth. Today, I got this email from Charlie Brown, the attorney for many citizens’ anti-mercury concerns. This is very exciting, because for the first time, those of us who have been concerned for a long time, are thinking that we’re going to see a dramatic turnaround on the parts of the FDA and the ADA. Here is Charlie’s email:

Court declines to rule on merits in Moms Against Mercury v. FDA –

but suggests road map to victory

The U.S. Court of Appeals ruled that it lacks jurisdiction (the statutory authority to rule) in Moms Against Mercury, et al. v. FDA, adding the decision is not a ruling on the merits of our cause and implying a remedy could lie in the U.S. District Court. (Full opinion at www.cadc.uscourts.gov — on right side click “All Opinions”; see Apr. 13, 2007, 4th case).

To win this round, FDA paid an enormous price. To achieve credibility with the court, FDA abandoned its long-time role of cheerleader for amalgam, five times admitting in its court brief that it FDA doesn’t know if mercury fillings are safe or unsafe. (Those 5 admissions at www.toxicteeth.org/natcamp_fedgovt_fda_admits_Mar07.cfm)

That a federal agency continues to allow untrammeled sales of a mercury-based device to pregnant women and children while conceding “the lack of definitive scientific evidence” and “intense disagreement about the scientific evidence” is reckless, contemptible, and immoral. FDA must be hoping that no one outside the Capital Beltway finds out. Or perhaps some of FDA’s protectors of mercury fillings (see next paragraph) intend to disavow those admissions before the ink is dry on the court decision. Suspecting just that, I sent a warning letter to FDA counsel advising that any statements by FDA returning to the status quo ante constitutes a Fraud on the Court. (Letter at www.toxicteeth.org/natcamp_fedgovt_fda_brown_Apr07.cfm)

FDA’s hard-line protectors of mercury fillings include Associate Comm’r Norris Alderson, who presented the “white paper” apologia for amalgam in September, a position soundly rejected by two Scientific Advisory Committee position; Center for Devices Director Dan Schultz, MD, and Dep. Director Linda Kahan, Esq., who together uphold the outrageous “professional courtesy” stand to allow self-interested dentists ignorant of toxicological issues to make the decision, hence giving primacy to dental economics over children and fetal health; Division Director Chiu Lin, who used an unauthorized substantial equivalence test to OK an application for mercury fillings, even though the applicant himself advised Lin that mercury fillings aren’t allowed for pregnant women and children in its home country, the U.K.; and Dental Devices Branch Director Mary Susan Runner, the initiator of the notorious BETAH-LSRO contract and the ADA’s fifth columnist inside FDA.

The astonishing gap between FDA’s position (doesn’t know if it’s safe) and its policy (may be implanted into anyone without even warnings) is setting off a grassroots firestorm. Ken Stoller, M.D., filed a sworn complaint to the New Mexico Board of Pharmacy asking that mercury fillings, no longer certified as safe by FDA, be banned in that state (want to help?–write Ken, hbotnm@netzero.com). Philadelphia Councilwoman Blondell Reynolds Brown plans hearings in early May (want to help?–write Freya Koss, frekoss@aol.com). The latest example of a reckless dentist leaving bottles of mercury for children to get exposed happened in West Virginia; this time, we have a plan to fight back (want to help?–write Sandy Keech Esq., sandraK@toxicteeth.org). In Ohio, the movement is growing to add a mercury-free dentist to a dental board whose policy is to block from consumers disclosures that “silver fillings” aren’t really silver (want to help?–write Jessica Kerger, Esq. JessKerger@aol.com). Congresswoman Watson is closely monitoring these developments in consultation with Members of the House Government Reform Committee (want to help?–write Elizabeth Wright, elizabeth@toxicteeth.org)

Here’s the good news about the Court opinion: It appears to suggest an ongoing violation of law. The Court holds that FDA may not approve mercury amalgam by using a “substantial equivalent” test. But that is exactly what FDA is doing when it approves mercury amalgam applications.

In the days ahead (stay tuned to our web site), we will announce our next step to reign in an FDA bureaucracy that exhibits both contempt for the law and reckless indifference to the health, and very lives, of America’s born and unborn children.

Charlie Brown, 4/14/07

Charles G. Brown, National Counsel

Consumers for Dental Choice

1725 K St., N.W., Suite 511, Washington DC 20006

Ph. 202.822-6307; fax 822-6309

charlie@toxicteeth.org, www.toxicteeth.org