I'm certainly not saying that environmental factors aren't a big piece to the puzzle, but to eliminate genetics as a contributing factor to disease and health is unfathomable.
You're really skeptical of how genetics could play a role in health issues? I can't imagine how they couldn't. Total anecdote here: I am religious about taking care of my teeth. Brush 2-3 times a day, floss daily, I'm not currently using fluoride but have in the past, see the dentist twice a year for cleaning. I rarely drink soda and try to limit sugary snacks. And I have a mouth full of fillings. DH, however? Brushes once a day, never flosses, eats all the things and has had one speck of a cavity in his entire life. You can't tell me that genetics don't play a role in that.
Genetics play a role in health issues to varying degrees. But much of our degenerative diseases (metabolic derangement, diabetes, heart disease, autoimmune disorders, etc.) are largely influenced by environmental factors. I don't think I've come across a single piece of research that suggests our genes control the decay process. If you've seen something like that, please share.
With hygiene and sugar consumption being equal, interesting factors to look at are the microbes living in the oral cavity and on tooth surfaces (partly influenced by diet and hygiene), salivary flow, hormonal factors that influence dentinal fluid transport & salivary pH (influenced by diet/glucose control, stress), status of fat-soluble vitamins (especially A, D & K2) and I'm sure there's more.
Here you go- I'm not a dentist, but from a quick read of the abstracts just on the first search page, both genetic and environmental factors appear to play a role in tooth decay.
I'm really skeptical of the genetics argument. I've never seen any evidence for it; but lots of evidence for environmental issues leading to dental disease. For me, thinking "woe is me, I just have bad teeth" led to lots of stress from feeling helpless, money wasted and worst of all tooth wasted. Thanks to that myth, DD also had a rough start.
When you have problems I see mainstream dentistry basically giving the equivalent of "eat less exercise more" advice as overweight people get from their docs. Just brush and floss more. Not working? Here's extra-strength fluoride and/or you must not be doing right.
There may very well be factors we don't have practical influence on, like poorly formed enamel or medications that lead to decreased salivary flow. But they're not insurmountable. Almost anyone can improve their oral health but it may take extra work for some people to right the ship. Out of tens of thousands of dollars I've spent at dentists, the most valuable information I ever got was in a $10 paperback book that took a weekend to read. Ridiculous.
But anyway, that applies to normal people and has little to do with this story since these parents seem incapable of caring for their kid properly. True, decay can spread rapidly in baby teeth and it can get bad fast. You can see it doesn't take neglectful parenting to land there. But that's all the more reason to be vigilant and get abscessed teeth treated without delay. Once a tooth is dead there's no bringing it back to life.
I don't know if kids' teeth are different in this regard, but I had one tooth die and it was the worst pain I've felt in my life. Unmedicated childbirth doesn't shake a stick at it. At the time, it looked barely suspicious on an xray and it was a good 4-5 months before an abscess even appeared. I can't even imagine a mouthful of dying teeth :? How was this poor kid functioning??
You're really skeptical of how genetics could play a role in health issues? I can't imagine how they couldn't. Total anecdote here: I am religious about taking care of my teeth. Brush 2-3 times a day, floss daily, I'm not currently using fluoride but have in the past, see the dentist twice a year for cleaning. I rarely drink soda and try to limit sugary snacks. And I have a mouth full of fillings. DH, however? Brushes once a day, never flosses, eats all the things and has had one speck of a cavity in his entire life. You can't tell me that genetics don't play a role in that.
Agreed. More anecdotes! H goes to the dentist every three months, and brushes 2x a day/flosses agree every meal. He has had cavities and ends up needing a deep cleaning annually.
I had developed a fear of the dentist and didn't go for 5+ years. Never flossed. Finally went to the dentist last fall and had zero cavities. I did need a deep cleaning, but at my most recent checkup last month there was absolutely no tartar to scrape. The dentist flat out said I had gotten lucky due to my genes/enzyme production. Others in my similar situation would've had many cavities and/or needed a root canal.
Are there people who are told, "Well, it's a good thing you came in for your routine visit and screening. You have cancer, but we caught it early." And then say, "Okay, doc. I feel fine right now, though. I'll just come back in for treatment as soon as I'm in a lot of pain." Because really, that is what a LOT of people basically do when they are told they have a cavity.
Using cancer as an example really isn't a good choice although yes, they do. How many women do not get regular mammograms? Ignore signs of disease?
70% of people do not take their meds as prescribed. Within in that 70%, 30% do not take them at all. How many people are walking around with undiagnosed diabetes? High blood pressure? How many people do not get regular check-ups? It is exactly the same thing.
A $200 filling is out of reach for many, many people.
Yes, but how many people are told "you have cancer," and then say, "Well, I'm just not going to do anything about this until I'm hurting." That's what I'm getting at.
I know a $200 filling is out of reach for many people, but I am telling you that there were countless patients with insurance who just would not get fillings done, even thought they would basically be free. Even if the filling could be done that very day, they would just say, "Well, it doesn't hurt. I'll just wait and see." That happened ALL the time. And so many people with insurance wouldn't come in for their free cleanings at all.
Then you have the whole issue of what needs to be done to fix a tooth, and what extra work needs to be done to make it look really nice. If dental insurance becomes rolled into regular medical insurance, I doubt plastic fillings are going to be covered when amalgam (silver) fillings last longer and cost less. The people who can afford it will pay OOT for all the cosmetic stuff (like plastic fillings), and you're going to have tons of dentists converting their practices to cosmetic dentistry practices.
I'm not saying that people shouldn't have dental insurance, or that I don't think it's necessary, or that rising dental costs aren't a problem. I'm just saying that I do think that the challenges presented are different from the rest of the body.
Those prescribed medicine numbers are pretty scary. Are those figures just for within your field, or is that in general, out of all medicines prescribed by all doctors?
You're really skeptical of how genetics could play a role in health issues? I can't imagine how they couldn't. Total anecdote here: I am religious about taking care of my teeth. Brush 2-3 times a day, floss daily, I'm not currently using fluoride but have in the past, see the dentist twice a year for cleaning. I rarely drink soda and try to limit sugary snacks. And I have a mouth full of fillings. DH, however? Brushes once a day, never flosses, eats all the things and has had one speck of a cavity in his entire life. You can't tell me that genetics don't play a role in that.
Genetics play a role in health issues to varying degrees. But much of our degenerative diseases (metabolic derangement, diabetes, heart disease, autoimmune disorders, etc.) are largely influenced by environmental factors. I don't think I've come across a single piece of research that suggests our genes control the decay process. If you've seen something like that, please share.
With hygiene and sugar consumption being equal, interesting factors to look at are the microbes living in the oral cavity and on tooth surfaces (partly influenced by diet and hygiene), salivary flow, hormonal factors that influence dentinal fluid transport & salivary pH (influenced by diet/glucose control, stress), status of fat-soluble vitamins (especially A, D & K2) and I'm sure there's more.
And you don't think any of these factors could be influenced by genetics?
Oh you guys didn't know? Mr+mrs has all sorts of conspiracy theories about the teeth.
I'd love to know what my "conspiracy theories" are, lol.
I've struggled with tooth decay since the ripe old age of 5 and after 25 yrs of my teeth crumbling away (sometimes literally), racking up credit card debt from dental work and then seeing my baby developing the same problem led me to being really, really fed up. And so it's a topic I have researched a lot and found success in applying what I learned.
All I'm saying is that the vast majority of the time you are here, it's to discuss oral health. Sometimes I wonder if you have a google alerts set up or if you're just an AE. But you could be a lurker from another board. IDK.
I'd love to know what my "conspiracy theories" are, lol.
I've struggled with tooth decay since the ripe old age of 5 and after 25 yrs of my teeth crumbling away (sometimes literally), racking up credit card debt from dental work and then seeing my baby developing the same problem led me to being really, really fed up. And so it's a topic I have researched a lot and found success in applying what I learned.
All I'm saying is that the vast majority of the time you are here, it's to discuss oral health. Sometimes I wonder if you have a google alerts set up or if you're just an AE. But you could be a lurker from another board. IDK.
Wait hasn't she been around since the old Nest days?
All I'm saying is that the vast majority of the time you are here, it's to discuss oral health. Sometimes I wonder if you have a google alerts set up or if you're just an AE. But you could be a lurker from another board. IDK.
Wait hasn't she been around since the old Nest days?
Yes and discussing oral health back then as well. lol
I really didn't mean it as a bad thing. Just that it's mr+ms's "thing" as it were.
Those prescribed medicine numbers are pretty scary. Are those figures just for within your field, or is that in general, out of all medicines prescribed by all doctors?
I get your point but still disagree. I see the same thing in medicine all the time. I do agree that people do not realize the health ramifications of poor oral health or visa versa.
The numbers I posted were for all meds, not just psych meds.
Well now I feel dumb for telling a friend about pediasure.
But it also seems like there are a lot of parents who are made to feel like their kids aren't heavy enough when the kids is just naturally small.
I think I have good dental genes considering my crappy habit past, but I'm wondering about the fluoride factor.
Dd doesn't get fluoride in the water here and we don't do drops cuz they make her sick, but we do use fluoride toothpaste. We'll see what this next checkup for her shows.
Ugh, those horrible parents and that poor child. I have to agree with whoever it was upthread that said that dental stuff should be covered under medical insurance. Hello, problems with your teeth can SEVERELY impact your health. Stupid insurance.
Side question: what age do you start taking kids to the dentist? M is 15 months now, has maybe three molars (he hates it when we look in his mouth, so hard to tell) and 7 regular teeth. We brush them regularly. I don't see him sitting still very well for the dentist though... and he'd probably freak out if he tried to look in his mouth.
Make sure they are on your dental ins even if they only have a few cuz things change fast and if they injure a tooth from falling or whatever you are all set.
Ugh, those horrible parents and that poor child. I have to agree with whoever it was upthread that said that dental stuff should be covered under medical insurance. Hello, problems with your teeth can SEVERELY impact your health. Stupid insurance.
Side question: what age do you start taking kids to the dentist? M is 15 months now, has maybe three molars (he hates it when we look in his mouth, so hard to tell) and 7 regular teeth. We brush them regularly. I don't see him sitting still very well for the dentist though... and he'd probably freak out if he tried to look in his mouth.
DD's pedi said to start taking her at 3 unless there were any problems.
So much of that is genetic, though. Some people are really susceptible to cavities and others aren't. I have always been a huge sugar addict and eat WAY too much sugar, but I've never had a cavity. Just complete genetic luck.
I'm really skeptical of the genetics argument. I've never seen any evidence for it; but lots of evidence for environmental issues leading to dental disease. For me, thinking "woe is me, I just have bad teeth" led to lots of stress from feeling helpless, money wasted and worst of all tooth wasted. Thanks to that myth, DD also had a rough start.
When you have problems I see mainstream dentistry basically giving the equivalent of "eat less exercise more" advice as overweight people get from their docs. Just brush and floss more. Not working? Here's extra-strength fluoride and/or you must not be doing right.
There may very well be factors we don't have practical influence on, like poorly formed enamel or medications that lead to decreased salivary flow. But they're not insurmountable. Almost anyone can improve their oral health but it may take extra work for some people to right the ship. Out of tens of thousands of dollars I've spent at dentists, the most valuable information I ever got was in a $10 paperback book that took a weekend to read. Ridiculous.
But anyway, that applies to normal people and has little to do with this story since these parents seem incapable of caring for their kid properly. True, decay can spread rapidly in baby teeth and it can get bad fast. You can see it doesn't take neglectful parenting to land there. But that's all the more reason to be vigilant and get abscessed teeth treated without delay. Once a tooth is dead there's no bringing it back to life.
I don't know if kids' teeth are different in this regard, but I had one tooth die and it was the worst pain I've felt in my life. Unmedicated childbirth doesn't shake a stick at it. At the time, it looked barely suspicious on an xray and it was a good 4-5 months before an abscess even appeared. I can't even imagine a mouthful of dying teeth :? How was this poor kid functioning?
It is a genetic problem, but not the way that you think.
Decay is an infectious disease, and children normally get their oral flora from their parents (mom normally). If mom has a lot of decay, it is very likely her child will. Decay is cause by Strep mutans and not all strains are equal, there are some that are more destructive than other (thus the genetic component). If your normal flora contains these (and you have well over 400 strains of bacteria in your mouth, once you get teeth), then you have a whammy against you.
Secondly, there ARE journal reports of people who have defective enamel. This is another line of defense against decay. So if you are hit with this problem too, you have a double whammy.
Thirdly, if you have a parent who does not give a crap, then you get a perfect storm. It is recommended that you NEVER put a child to bed with a bottle, or if you do, only water. It is not only Mountain Dew that causes baby bottle mouth, but milk and juice do as well as both of these contain sugars that are broken down by saliva to be utilized by the bacteria. The bacteria munch on the sugars, produce acid and cause decay.
Most dentists recommend that you move from a bottle as quickly as possible. Drinking from a cup does not allow the fluid to pool behind the teeth like a bottle does.
I've seen a lot of kids (been in dental research for 30 years) and have friends who are working on vaccines for tooth decay. I've seen a lot of very bad mouths.
Side question: what age do you start taking kids to the dentist? M is 15 months now, has maybe three molars (he hates it when we look in his mouth, so hard to tell) and 7 regular teeth. We brush them regularly. I don't see him sitting still very well for the dentist though... and he'd probably freak out if he tried to look in his mouth.
Our kids see the same dentist. Bug didn't go until she was two and already had a cavity. (Weak enamel) I'm glad we went with a pediatric dentist, the rapport they have with kids is incredible.
For the boy they said just to bring him along around a year old. They popped him up on the table next to his sister and let him play with the squirter and sucking straw. Once he was giggling and happy, she asked if she could count his teeth. They did this at Bug's regular check ups until he was about three and was old enough to sit through a cleaning. At that point he was already thrilled to go to dentist visits.
They didn't charge anything until they started doing cleanings, but I don't know what they do for families who aren't already established.
Yeah, but IIRC, finding a dentist who takes medicaid is like finding a prostitute who takes credit cards.
When we lived in Chicago and were on medicaid, it was really hard to find a dentist that didn't terrify me. A lot of the offices were filthy and in questionable areas that I didn't feel safe walking or taking transit to by myself. I was able to find a dentist for my daughter that wasn't like that, but adult dental care via medicaid is a different story. The coverage is minimal for adults, too.
Post by statlerwaldorf on Jun 30, 2014 0:17:22 GMT -5
I will never forget when I went to a sliding fee scale dental clinic that also accepts Medicaid. There was a woman next to me that was probably in her 20s. She needed a couple root canals, but Medicaid would only cover root canals on certain teeth. Since she couldn't afford the root canals, they were going to pull her teeth and give her partial dentures.
Yeah, but IIRC, finding a dentist who takes medicaid is like finding a prostitute who takes credit cards.
All dental schools associated with medical centers accept dental Medicaid.
Finding dentists that accept Medicaid is easier now than it was a decade ago as many states have really made strides to entice more dentists to do so.
Don't states have leeway in terms of what they cover? Medi-cal only covers root canals on front teeth, for example. Or with the ACA, are there requirements for adult coverage?
Yeah, but IIRC, finding a dentist who takes medicaid is like finding a prostitute who takes credit cards.
I'm not sure if this is the same as Medicaid, but I had MassHealth 15 years ago for about two years, and it covered dental for me and DS. More than basic care, I got four impacted wisdom teeth removed as well as regular cleanings and maybe a filling.
I will never forget when I went to a sliding fee scale dental clinic that also accepts Medicaid. There was a woman next to me that was probably in her 20s. She needed a couple root canals, but Medicaid would only cover root canals on certain teeth. Since she couldn't afford the root canals, they were going to pull her teeth and give her partial dentures.
This has, sadly, become more prevalent even with non Medicaid patients.
That is just awful! Poor kid, I cannot imagine the pain & she couldn't have been eating well.
My experience with pediatric dentistry...I was told DD1 needed 8 crowns at like 4yrs old due to cavities between teeth. Of course to the tune of several thousand OOP & a hospital bill. I got a second opinion...1 tiny cavity between 2 teeth we should watch. Almost 6yrs later still has all those same teeth without incident. Dentistry is subjective and being super aggressive isn't always necessary...I'm so glad I didn't take Dentist 1 at his word. Also DD4s teeth literally grew in needing fillings! She had enamel hypoplasia in her 2 front teeth likely due to circumstances revolving around her birth. Nothing like taking your 8mo old to the Dentist to get you the side eye...and every couple months I take her back since to check out that the patches are holding (they are so far). There are definitely factors well beyond our control (brushing flossing).
All dental schools associated with medical centers accept dental Medicaid.
Finding dentists that accept Medicaid is easier now than it was a decade ago as many states have really made strides to entice more dentists to do so.
Don't states have leeway in terms of what they cover? Medi-cal only covers root canals on front teeth, for example. Or with the ACA, are there requirements for adult coverage?
Most states Medicaid does not cover adults, only children. There are a handful of states that cover adults, I don't remember which off the top of my head.
I do know in an emergent situation for children, just about everything is covered (at least in KY). However, I do know that there is a very high requirement for MEDICAL need for orthodontia so that ortho is not done to merely move a crooked tooth. I believe the ortho person told me that for every 100 requests for orthodontics on Medicaid, the vast majority of them are declined for lack of medical need. I also suspect that this has to do with compliance issues too, as Medicaid patients are more likely to cancel appointments. This becomes an issue when you need to see the dentist regularly for treatment.
Ok, I don't really see what any of that has to do with our own DNA; I meant human DNA when referring to genetics. I'm very familiar with the theory you describe.
Defective enamel is a genetic issue, so it very well does have to do with your own DNA.
But speaking of bacterial DNA, one of my current questions/thoughts on the topic is who is figuring out what constitutes a health-promoting oral flora? Even a healthy mouth has cariogenic strains of bacteria. How do we explain people who are able to maintain good dental health despite providing plenty of sugars for those bacteria to eat? Are they just awesome tooth-brushers? Then how do we explain people who had healthy teeth before the age of toothbrushes and floss (pre-agriculture)?
There's a lot of focus on eradicating s. mutans and other bacteria through various methods. But in other areas of medicine we're learning that simply killing off bacteria doesn't always work over the long term and they can become resistant to our efforts. I kind of think some people may be missing species or sufficient diversity that is vital to maintaining a balanced flora - where cariogenic strains are not able to bloom. I've seen news about caries vaccines that sort of tinker with this balance but I'm thinking a treatment that is truly lasting will involve re-establishing an ecosystem that remains stable with a reasonable diet and adequate saliva.
Also, the whole focus on bottles, juice, etc. is kind of misleading for parents, I believe. The numbers of people that give their kids obviously sugary things like that is decreasing but plenty of seemingly innocuous foods that kids typically eat provide substrate for bacteria all the same. The snack-y carb-y stuff may be worst of all because it tends to stick to teeth unlike liquids (crackers, cereals, goldfish, pretzels, "fruit" snacks etc). I found it really difficult to avoid this stuff when socializing, especially.
There are healthier bacteria to have in your mouth than others. Not all oral disease is a function of bacteria only, but external factors.....some of which you have no control over. For instance, you can have the microbes for periodontal disease in your mouth, but not have disease. The second prong of getting disease is how your body deals with the microbe because most of the destruction from perio is not only the bug, but of your body's inflammatory response to the bug....think friendly fire.
The vaccine that is being tested (which appears to work great in the animal model) does NOT get rid of all the bacteria. The vaccine elicits a secretory immune response to the carbohydrate strands on the bug. I don't think that there is ever the intention to get rid of the microbe entirely, but to replace it with one that is not so much so.
Finally, with bottles in children, milk/juice tends to pool in the floor of the mouth, behind the lower front teeth when you drink reclining. This is where caries are seen in those young children who are put to bed with a bottle. To drink from a sippy cup requires that you sit up more, which allows the liquid to flow down the throat rather than pool. When you see caries in the front 2 bottom teeth in an infant, it is a very distinct picture as to what mechanics cause the problem.
My gut feeling is that all the caries in children these days is largely due to the continual snacking that is done.....not necessarily WHAT is eaten. It seems that kids (or their parents) are never without a bag of Cheerios these days. If you are continually eating, even something that is not sugary, the carbs are still broken down into sugar in the mouth. Saliva can only go so far to wash it away. When I was a kid, I very rarely remember getting a snack. We ate breakfast lunch and dinner and if we didnt eat a meal, it was going to be several hours before the next one. I'd love to see this study done, but as I'm out disabled, not going to be done by me. I still have a few studies that still need to be published, but have put paid to this part of my life.
Don't states have leeway in terms of what they cover? Medi-cal only covers root canals on front teeth, for example. Or with the ACA, are there requirements for adult coverage?
Most states Medicaid does not cover adults, only children. There are a handful of states that cover adults, I don't remember which off the top of my head.
I do know in an emergent situation for children, just about everything is covered (at least in KY). However, I do know that there is a very high requirement for MEDICAL need for orthodontia so that ortho is not done to merely move a crooked tooth. I believe the ortho person told me that for every 100 requests for orthodontics on Medicaid, the vast majority of them are declined for lack of medical need. I also suspect that this has to do with compliance issues too, as Medicaid patients are more likely to cancel appointments. This becomes an issue when you need to see the dentist regularly for treatment.
How does that jive with the ACA - more states are covering adults through medicaid or in our case Medi-Cal. Is that because they are required to do so - loosely interpreted?