A recent article, printed in the Journal of Dental Research caught the attention of the prestigious New York Times and consequently the attention of the American Dental Association. Although the article brought forth no information not known to those in the profession who are abreast of outcome analysis, it caught public attention because it challenged advice deeply ingrained in the public’s minds.
Namely: Brush your teeth twice a day and see your dentist twice a year.
The brushing twice a day is a relatively new mantra, having been part of a marketing campaign for Ipana toothpaste in the late 1940s. Actually toothpaste manufacturers would like you to brush when you wake, after each meal, and before you go to bed, but twice a day had a nice ring to it because dentists, even today are preaching “brush twotimes a day for two minutes” to instill a habit from the time you are a child.
The public tends to believe that the reason for brushing is to remove plaque and the bacteria that live in plaque, and in fact that does happen. But plaque comes back with remarkable speed, so brushing is limited in its role to prevent decay and maintain healthy gums. It does provide an efficient mechanism to deliver fluoride to the teeth to make them decay resistant and it will lengthen the time for plaque to mature, which means the dangerous bacteria are not around to convert sugars and starches into acid and it lessens the likelihood that plaque will gravitate below the gums to break down the collagen in the gum tissue.
The article, which surveyed some 5,000 patients, concluded that unless a patient had one or more of three risk factors for periodontal disease: smoking, diabetes, or interleukin-1 genotype, there was no value in having a professional cleaning more than once a year. Furthermore it concluded that those patients with one of more risk factors should have their teeth professionally cleaned more than twice year.
The ADA couldn’t agree more.
This points out some interesting changes in the delivery of dental services. The ADA is struggling with the best way to identify patients by risk: for caries, periodontal disease and oral cancer. And third-party payers are designing benefits to encompass personal health management in both general and oral healthcare. There is even one non-profit (The Continua Alliance) dedicated to embracing developing technology to improve this system.
For several years the ADA has been preaching prescriptive use of services; e.g., x-rays, recall intervals, and staging of treatment plans. However, hungry dentists, public expectations and benefit design have often impeded acceptance of this philosophy. There is hope that the adoption of an electronic Health Record, and the need to better allocate limited healthcare dollars and providers, will force better acceptance and move compensation for health services from Volume to Value.
In the meantime we should all get to know our bodies better and seek remedies consistent with our needs and desires.
While I am on a roll about health, I think my next post will be about a friend and columnist, David Whiting who wrote a piece telling of his bout with cancer. I think you will find it interesting.