Are We Flossing Yet?

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Sorry to keep nagging you, but a new study shows that dental care also saves money (in addition to improving overall health). People with diabetes who got regular gum treatments lowered medical costs by $2,483 per year, on average, compared to people who did not.

Of course this is America, where the health-care question isn’t “What will help?” but “What will insurance pay for?” For many people with diabetes, taking more drugs to bring down glucose is paid for, but dental care is out of reach. This is unfortunate, because professional gum treatment has been shown to significantly reduce A1C levels and may reduce risk of strokes.

Severe infection and inflammation in your gums (called “periodontitis”) often spreads through your whole body, increasing insulin resistance and damaging blood vessels. And it’s hard to get the germs out of those tight places in your mouth.

Dental care for periodontitis can get expensive. It may involve deep cleaning, long-term antibiotics, and frequent follow-ups. It appears that the Affordable Care Act (“health-care reform”) passed last year will not provide dental care for many more people, except preventative care for children under 21.

Medicare and Medicaid will probably not offer dental coverage any time soon. According to National Healthcare Reform Magazine, “Cuts to Medicare payments have raised concern that Medicare Advantage plans will eliminate extra benefits, like dental coverage.” And when it comes to Medicaid, they say, “No provisions allow for an adult dental benefit for existing or new enrollees in Medicaid.”

Perhaps this new report will encourage employers and government to make dental insurance available, and make the rest of us more likely to buy some.

The report was not a clinical study. Using data from the insurance company Cigna, it was a review of over 46,000 people’s insurance records. Cigna has long recognized the importance of oral health and includes it in their plans more often than most other insurers.

The researchers looked at people who got dental care and people who didn’t and compared their diabetes-related medical expenses. To qualify for the survey, they had to have a diagnosis of diabetes and at least one dental treatment for periodontitis. Patients were divided into two groups — those who had complete gum treatment and regular follow-up, and the others who had only a few treatments and no regular follow-up. The well-treated group had 21% lower diabetes costs.

The researchers didn’t control for income level, which could be a major problem with the study. Seems like poorer people would be more likely to skip dental treatments, and low income is one of the biggest risk factor for diabetes complications.

I’ve written about gum self-care here and here. But there’s more to it, according to University of Maryland Medical Center (UMM) writers. Their Web page has detailed advice on how to brush, floss, and other good things. Here are few of their tips:

• Brushing: Brush after as many meals as possible, with a soft-bristle brush. Brush your tongue, too, to get rid of bacteria. If you can’t brush, rinsing your mouth after meals may reduce bacteria by 30%.

• Flossing: Again, more often is better. Don’t use floss that is too thin or too hard; it may cut gums. Get something softer and wider. A floss threader might be easier than holding the floss around your fingers. Run the floss around each tooth and across the gum line.

• Toothpicks can help but do not replace flossing. According to UMM, picks such as a Stim-U-Dent pick are good, but standard wooden ones aren’t safe.

• Tiny brushes that can go in between teeth and around false teeth might help. One is called a Proxabrush.

• Antiseptic mouthwash twice a day: The best ones are Listerine or a prescription mouthwash containing chlorhexidine. Next best are those containing cetylpyridinium, such as Cepacol and Scope. Keep them in your mouth for 30–60 seconds to let the germs die. UMM says to wait at least 30 minutes after brushing before using mouthwashes that contain chlorhexidine, but I don’t know how realistic that is.

• Drink water, because hydrating increases saliva, which reduces gum inflammation.

Again, see the UMM Web site for more details.

Last time I wrote about this, readers suggested taking Vitamin C and coenzyme Q10 to stop gum bleeding. Although I don’t know what CoQ10 actually is, it does seem to help gums, and vitamin C is always good.

Self-care is a huge part of dental care, but if you already have symptoms of gum disease — like swelling, bleeding, pain, bad breath, or loose teeth — you probably need to see a dentist, and probably more than once. You might want to get on doxycycline or another antibiotic that only a doctor or dentist can give. And their deep cleaning techniques can definitely give you a good start towards gum health.

But how to pay them? One way is to find the nearest dental college. Local public health departments can sometimes refer to low-cost dentists. Try a Google search for “free dental care.” In talking with prospective dentists, don’t be afraid to negotiate prices. You’re the customer after all. Any hints from readers will be appreciated.

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