[00:00:00]

Listen up. When it comes to dental and oral health, Americans may not have all that much to smile about. For those wondering, cavities are only the start of the problem, but they're a pretty big issue. About 60 percent of adolescents 12 to 19 have had at least one cavity, and an estimated 90 percent of adults 20 and older have suffered from the same fate.

If that's not bad enough, it's estimated that a quarter of all adults 20 64 are walking around with an untreated [00:01:00] cavity. If this doesn't bring a frown to your face, think about gum disease, technically known as periodontal disease. This disorder undermines the hard and soft structures that support teeth, leading to tooth loss and possibly a lot of other potentially more serious issues.

How rampant is gum disease? Well, about half of Americans 30 and older show some signs of the problem, including a whopping 10 percent who face serious issues. The list of dental health threats go on and on. Individually or combined, they can undermine a person's social standing, professional position, physical health, and mental well being.

All of this seems pretty confusing for a nation obsessed with having a perfect smile. 4 billion annually on toothpaste alone. You This doesn't count extra money set aside for whitening strips and procedures, dental veneers, and invisible liners. So what gives? Our upcoming guest is here on behalf of the American Dental Association to set us all [00:02:00] straight on the threat of poor dental and oral health, why it's so bad, and what we can do to improve it.

I'd like to welcome everyone to the main section or the most important section of our podcast in every episode of our podcast is when we interview an authority on a critical issue and healthcare is critical, but if we dig deeper and go a little more precise, oral healthcare and dental healthcare is important, but it's something we think is probably overlooked an awful lot. So that's why we've asked Dr. Erinne Kennedy Kansas City University and the medical college, the, I'm going to screw that up. Dr. Kennedy, welcome. And you please tell me what the exact name of, you're the assistant dean of the give it to me.

Absolutely. Hello everyone. I'm Erinne Kennedy. I'm the Assistant Dean for Curriculum and Integrated Learning at Kansas City University College of Dental Medicine. We are a new dental school in Joplin, Missouri, and we're serving the Four Corners region in that area. And I'm super excited to be here today with you, John.

Okay. Thank [00:03:00] you. So let's start off with, we have been told we're hammered from the time we can remember to brush your teeth. Did you brush your teeth? Did you not brush your teeth? And we've been handed by our parents, by our grandparents, by dentists, by oral hygienists. What's the status of dental health, in America in 2024?

Are we doing a good job? Are we doing a bad job? Is it getting worse? Is it getting better?

John, that's a great question. And actually, we recently had an oral health in America report released. And so we have a lot of updated information about what's going on with oral health across different regions of the United States and different groups. And the big answer that I can give you is that it's improving for some groups, but it's not improving for all.

And we have Oral health care challenges for some groups that make it incredibly challenging to continue to receive or receive care for the first time. And I'm going to give you an example why. Our demographics have changed. We are an aging population. It still blows my mind today that we will have more older adults age 65 and older in [00:04:00] 2035 than will have children.

We are a more diverse population and we are a more digitized population, which can have advances but also challenges for patients. Older adults, 65 to 74, only 13 percent are a dentalist, which is absolutely fabulous because in 1960, about 50 percent of this age range of adults were completely a dentalist, meaning they were wearing dentures.

However, we still have patients who are having challenges in certain demographics accessing dentures. And why has this happened? Well, for many adults, prevention has increased. Prevention may be community water fluoridation or having access to healthy food. Also, prevention that they might receive when they're in a school based system or through their dentist, right?

Our restorative materials have improved. We, I'm blown away by the profession of dentistry because we continue to advance how we restore teeth. And we even have new options we've had dental implants for a long time, but they're becoming more and more [00:05:00] available to many different adults, which has changed access to care for patients who are a dentalist.

However, 13 percent of the population is still completely a dentalist. They're facing. multiple extractions. They're trying to access dentures. Many adults will go without teeth in certain areas. And so, have we made advances? Absolutely. But maybe I'm a public health dentist. I am a public health dentist, but maybe I have a goal of an ideal world where would actually not have any adults that are a dentalist.

So, which are the groups that seem to be falling behind or not keeping pace with the advantage. And is that just a matter of access to dental care or are there other factors involved?

There's a couple of different factors involved. So, the American Dental Association Health Policy Institute puts out tons of amazing infographics, and we can link that resource down if it's helpful for people. But there are certain demographics, like, if you are in a lower socioeconomic status, it is likely that you are not seeing a dentist regularly because of [00:06:00] financial challenges.

You may not have insurance. So, that allows you to, afford certain aspects of dentistry, or you may not be able to find a clinician that accepts your dental insurance. The American Dental Association has created a resource called Find My Dentist, and it's been really helpful.

And so, uh, we can link that too, but it's something that can help you if you are struggling to find a dentist in your area to receive care. That can be really helpful. There are certain racial and ethnic groups that are undisturbed, and this depends on the oral health outcome that you're looking at, whether you're looking at untreated caries in children or untreated caries in older adults, but we continue to have health equity disparities when it comes to everyone receiving health care on a regular basis and by health care I include oral health care.

So given what we're seeing on the landscape of dental care and what people can do for themselves. Obviously insurance is a big part of that because it's going to cover expense for you. They're more likely to go. What do we see as dental care coverage in terms of insurance in this country now, and is it getting worse or better?[00:07:00]

Well, there are some challenges when it comes to dental insurance. It's different for adults versus Children. So in Children, about 50 percent of the population have private dental benefits, typically through their parents, their employer. Another about 38, almost 40 percent have Medicaid or chip.

That's the Children's health insurance program. And then there is a group about 10 percent that have no dental benefits and their children in the United States for adults. That landscape is very different. About 59, almost 60 percent have private insurance. Those are adults who are employed with an employer that provides dental benefits.

Not every employer provides medical and dental benefits. About 7 percent have Medicaid dental benefits. About 6 percent of adults have Medicaid coverage, but they do not have dental benefits with that. So that means that they have health insurance through Medicaid, but they do not have a dental benefit And then about 27 percent of those adults are currently without coverage. So that means one in three [00:08:00] adults that you encounter when they go to a dental visit, they are paying cash. They do not have a dental benefit. coverage. And so as you can imagine, that could be a barrier for some adults receiving care.

If you don't have that dental insurance benefit, it may be challenging for you to access care and to be able to work through a payment plan. Since you don't have an insurance coverage that would be helping you go to those preventive or regular consistent visits.

You just, you'd wind up just saying, well, I'm going to skip it this time. I'm not in pain. I don't see a cavity, my teeth aren't falling out. Yeah. That's

And that can actually, be really challenging because the more you wait in between visits, instead of receiving that minimally invasive preventive care that I talked about the next time that you go in 3, 4, 5, 10 years later, you are having tooth pain, you may have swelling, and then the procedures that will solve the challenges that you're facing are incredibly expensive.

The preventive services are not necessarily expensive but oftentimes regularly when you're paying cash for something it may feel, challenging or it may be, [00:09:00] expensive, you know, for you but relative to the procedures that would help with tooth pain and swelling, those preventive procedures are much more cost effective.

And so that can be an incredible challenge for many adults and it's something that I hope in the profession of dentistry we continue to work towards solving.

Yeah. Well, it's part of the whole medical issue in the States, whether it's proactive or reactive and trying to get around that. Is there a difference between dental care and. Oral health or it's sort of they're sort of used interchangeably, but I suspect there may be Something else involved or deeper nuances there.

You bet. The way that I explain this to dental students, I have the privilege and honor to teach in our College of Dental Medicine and help our first year dental students, but we were recently talking about this as a group and the way that I explained using the term dental care is it's really focused on your teeth.

That's why the word dental is used, right? But my focus and our focus as a profession is really to shift to oral health care [00:10:00] because that focuses on the human being attached to the dentition, right? The oral cavity is the start of your digestive system. And so not only is your mouth connected to the rest of your body, but the way that we educate our students is to treat you as a whole person.

So looking at your medical history, looking at your social history, helping you identify challenges and receiving great. oral health care when you're outside of the dental office, right? And it also shifts the focus to medical management of disease. In the last 40 years the profession of dentistry has changed.

We have become more minimally invasive. We have focused on less surgical treatment and more medical management of disease. And, In turn, we've shifted our focus and our focus was always prevention, but we have new resources and new data that allow us to practice preventive dentistry even more minimally invasive ways.

And so I really think that the term oral healthcare helps us realize and helps [00:11:00] us remember we're treating and looking for your whole oral cavity. We are looking at you and helping you achieve your oral health care goals, and we are treating you with kindness and respect and practicing person centered care, which ends up, including other family members.

When you come in, and you have a mother, I always loved private practice, because when I was working at the hospital, I would have a mom come in and she would be the 1st person in her family to kind of vet out the practice. And once she felt comfortable, It would open up the practice to her children and to, her partner and to her extended family and to her cousins and her nieces and her nephews.

And so when I got to know a family, I typically started there. And once they realized that it was focused on person centered care I quickly got to know the whole herd. Mhm.

Let's go back to oral care how it's related when they think of cavities, they may think of gum problems, cracked teeth, it could be root canals. But oral care, from what we've written about and seen, really has a wider impact on your health that I think is [00:12:00] just now becoming tied to heart disease, diabetes, or pregnancy risks. We write all the time about the impact of poor oral health care on dementia or cognitive abilities as you get older. Are there other issues, and how are they all connected?

Why does it integrate to the rest of our system?

Absolutely. So, there are two things. What we have to understand about our oral cavity is that the inflammation that might be seen as a result of tooth decay or periodontal disease. the inflammation that's there that contributes to inflammation systemically. And that is often the connection between oral healthcare and how healthy your oral cavity is and the rest of your body.

In addition to inflammation, we are learning more and more about your oral microbiome. There's nothing I get more excited than talking about the good bugs and the bad bugs and your oral cavity and how your saliva contributes to this microbiome. And so Everything that you said is exactly true in diabetes.

When [00:13:00] you have gum disease that is left untreated and those pathogens or bacteria are below the gum surface and they are, they've not been treated either non surgically or surgically. We found that exacerbates diabetes. And when you have your blood glucose levels under control also known as like your sugar levels, when you have this blood glucose levels under control, it actually allows your body to have less inflammation and it contributes to the healing of periodontal disease.

And so what does that mean for a patient? It means that controlling your blood glucose and working with your endocrinologist to control your chronic diabetes is incredibly important. alongside working with your dentist to make sure that the microbiome of your oral cavity and your gum disease is treated as well.

For Alzheimer's, the same thing's true. We know that periodontal disease contributes to Alzheimer's. We've also found that some of these same bugs contribute to heart attacks and strokes. They have found oral bacteria that are pathogens for caries and gum disease, and some of the plaques that cause heart attacks and strokes.

And [00:14:00] so, When you think about how this all contributes they've even found connections when it goes to children with asthma. So, understanding the inflammation in your body and more importantly the microbiome that's contributing to that inflammation is what's so important. I say all of this as a tee up to say, that's why it matters that we clean our teeth every day, brushing, cleaning in between our teeth maintaining that oral cavity by eating healthy foods.

I don't know about you, but at the end of the day when I've brushed my teeth and I'm getting ready to clean in between my teeth, whether I'm flossing or whatever, there are some nights where I think Oh, am I going to do it? Am I going to floss my teeth? Like, do I have two more minutes of energy in me when I've had a really busy day?

Even I think of that. And what I always think of is everything that it's contributing in my body and honestly, it tips the scale for me. I'm thinking. Great. I don't want chronic disease. I want to live this healthy happy, well [00:15:00] balanced life. And I know that it's going to contribute to that. And so I think sometimes when you're thinking about all of the health behaviors that we have to maintain for me, it's helpful to see the magnitude of that impact.

And I know that when you take care of yourself, you're taking care of your whole body.

Is there a growing awareness of the greater impact of dental care, oral health on people? Are they aware of this? I mean, it's, coming up, but if you ask the average person, why is it important to brush your teeth, they'll say, well, you don't get cavities, but do you see a greater understanding of what's out there?

I do. I see a greater understanding and I'll kind of give you a broader picture of where I see it happening. I'm working in a college of dental medicine and I, We've changed our curriculum in the last couple of years to include a more broad, systematic approach. And when we train dentists differently, we're also training our College of Medical students differently.

And in the process of doing this, we've learned about all of the community partners that are helping. [00:16:00] So today there's a new oral health education that's in schools that helps children understand the impact their oral health has on their overall body. We have oral health education that's in community centers and with community events.

We have oral health education that's in long term care facilities. And so is this completely widespread is every corner of the United States, which is the population that we're referring to today. Have they all received this information yet? No. But do I see the start of this grassroots campaign?

And do I think in three to five years, It is going to be common knowledge that the benefit that you have when you have good oral health is that your whole body will be healthy. Yes, I do see that. I just think that we're kind of in the front of the grassroots campaign.

It kind of begs the question as to whether internist or other medical professionals are aware of that or is focused on that connection. Do you see that connection growing or is it there? Or do you wish it were higher? I assume you wish it [00:17:00] were higher,

I always wish it were higher again. I'm aiming for that ideal. But I will share with you a couple of examples of what I see working. One, we're starting to include oral health education into so many different health professions, curriculums, and programs. Two most health professions, universities have something called interprofessional education, meaning they're training.

These health professionals together. And in the case of oral health you may have a college of dental medicine student and a college of medicine student. Working together to perform an head and neck evaluation simultaneously so that they can see that in practice. So I see education changing. And then I also see practice changing before I was at the College of Dental Medicine.

I worked in a department at Massachusetts General Hospital. Where I worked alongside about 10 other dentists at the time, but we worked closely with pharmacists and primary care professionals and behavioral health clinicians, and we were all working together. So, we didn't just learn or interprofessional education.

We practiced [00:18:00] it the best example that I've seen so far. Honestly, in my opinion, and this is just my opinion is a lot of OBGYN obstetrics and gynecologists. These women's health centers and federally qualified community health centers are often placing a dentist and the office so that they are able to care for expecting mothers and women.

Prenatal, perinatal, and postnatal, and then they're also able to care for children that are born very quickly. It's recommended today that you have an exam for your child by their first tooth, or their first birthday, so it's easy to remember because it's the firsts. But I think these OBGYN offices are such an excellent example of education and practice, and it's working.

At 1st, they just started collaborating together and then they realized that they needed to be physically close so that they could further this collaboration.

Why is it so critical for women in terms of prenatal, postnatal and in general?

I'll give 2 examples. [00:19:00] 1 is that we know that women who care for their oral cavity during pregnancy. It's 1 of the ways to care for their baby, and we know this because there's years, decades of literature that show that if you have periodontal disease. and you're carrying a child, you are at risk for a low birth weight baby and which can put your child at risk when they're recovering and you're recovering after birth .

The second piece is that we know that the child, it receives the majority of their microbiome from their closest caregiver. And so when a child is birthed, they are exposed to bacteria through the birthing process, whether it's a cesarean section or whether it's a natural birth or delivery. And after that, their microbiome diversifies or gets more complex and has a bunch of different bacteria mostly between zero and three.

And it's because they are being exposed to bacteria, which are good. We want bacteria in our mouth. We just want them to be good bacteria. From their mother, their closest caregiver, and then also from their environment. You see [00:20:00] children picking up and putting things down and, eating all sorts of different foods which fuel your microbiome.

And so if we want children to have the best leg up or the best success for a healthy oral microbiome that they can maintain throughout their entire life, They're going to receive that from their closest caregivers. And so I say closest caregivers because I teach two hours on this topic in our College of Dental Medicine.

And I remind students that the closest caregiver is different in every family. That child may spend a ton of time with the mother. They may spend a ton of time with the father. They may spend a lot of time with their grandparents or an aunt or an uncle or a nanny. And so encouraging and promoting healthy oral health behaviors is really for the village or the group that's caring for that child.

Certainly during the pandemic. We, saw a lot of video healthcare, and it certainly has continued. How has that impacted dental healthcare, oral healthcare? I guess it's a positive in some way that it's easier to get to a professional, [00:21:00] but there's no hands on approach or less of a hands on approach, physical approach, perhaps.

Yeah, you know, John, it's actually improved oral health care, I think. So now there we use, I was one of the first adopters of teledentistry in my practice when I was in Massachusetts in the pandemic. And so I was a teledentist. For about, every day for a while and we used it for a couple of different things.

We were able to triage. If there was an urgent or, a pain or swelling with for a patient, we were able to triage that urgent condition and either, provide medication or get them scheduled for an appointment. We were also able to do oral health or oral hygiene coaching. So we were able to provide some preventive resources and health education using tele dentistry platforms, which really helped with access to care.

Especially for anyone who is traveling from great distances during that time. And since the pandemic that's exploded now, there are entire companies that have dental hygienist come that come in and provide preventive services. They also take a ton of collective ton of information [00:22:00] during the exam, using photos and videos and charting that they are able to share with Dennis that they're able to then do it a teledentistry exam.

So that care. Is able to be received at the place of work or at the community location. It's not always a place of employment but the place that I think has actually been so incredibly revolutionary is one that I've seen while I've been here in Missouri. It is a telehealth program through Freeman hospital, and this telehealth program uses these telehealth stations to go into, schools K through 12 schools where if a child comes and they have an earache Or some sort of condition they're able to use this telehealth resource to communicate during the school day with the clinician that's most appropriate for treating that condition or triaging that condition.

If a medication is needed, they're able to communicate and have consent with the parent. They're able to call that medication into a pharmacy so that the child doesn't have to miss school. The parent doesn't have to miss work and that child can either meet their parent at [00:23:00] home if they go home on the bus that day.

and ensure that they, get home at an appropriate time. Or, if that parent is going to come pick their child up and stop by the pharmacy, it kind of makes that process completely flawless. And so that's, in my opinion, a great example of telehealth telemedicine that, that has really addressed some of the barriers to care that have historically prevented, children, older adults from receiving care.

And the people who are benefiting most from this, are these people who wouldn't have benefited in the past, or does it really just cut across the entire spectrum?

It depends on the program. I've seen a couple of different types of programs in Missouri. There are some that target, children in schools. Some that target long term care facilities. Those are examples of programs where a child may not have received care before or an older adult may not have received care for.

So that is addressing the vulnerable population. I have also seen practices in Missouri, when one practice comes to mind, and they actually integrated teledentistry into their workflow. [00:24:00] So it was with patients who are already coming in and receiving care regularly, but they made it even more efficient and more effective for that patient population.

And so I think that's one of the remarkable components of teledentistry is that it's addressing the entire population in many ways.

So the other aspect I want to get into is that Americans spend 4 billion a year on toothpaste alone. And I'm not saying there's anything wrong with that. I feel like a Seinfeld not that there's anything wrong with that, but you think of toothpaste, you think of whitening, you think of veneers, is the emphasis on having beautiful teeth. sort of misguiding people as to what dental health care should be or is it fine? It's just a component and it's a good thing.

Well, this is something that a mentor told me, and I think it helps answer this question and then I'll give two examples. There is nothing more beautiful than your own enamel. I tell that to every single patient. Your enamel is such an incredible, [00:25:00] material. It's the hardest substance in your body. It can be completely remineralized if a lesion like a curious lesion or a cavity is caught early enough.

And it's translucent. It's beautiful. So it's okay to want to improve the aesthetics of your own enamel. In any way, but I always remind my patients the enamel that you've been given is absolutely beautiful and it's my job to help you protect and preserve it. So the reason I say that is because there are some things that are aesthetic that also help prevent disease.

And I'm going to give the example of whitening. If you go to your dentist and you have whitening trays created and you put the gel in to whiten your teeth in the evenings this active ingredient for most of those whitening products is carbamide peroxide. Okay. which has actually been shown in studies to help increase the pH of your oral cavity, which shifts the microbiome.

And it helps prevent caries and it helps also prevent gum disease. And so that's a really great example of something that, yes, it's an aesthetic treatment but it's also helpful in shifting your microbiome [00:26:00] and improving disease long term. And so I have a lot of patients who are actually in my office for being treated for caries.

We're tooth decay and periodontal disease or gum disease, and I'm using different resources and some of them have a positive aesthetic outcome. And so I think I, I love your question because I don't know if we've got to done a great job of explaining that as a profession. It's like, yes, this is an aesthetic resource and it's helping improve your systemic health by shifting your microbiome and potentially reducing inflammation by not having those

Okay. All right, so That brings us to another question. What do we need to do personally to maintain oral health care. Obviously, you need to visit your dentist or you need to have a teledev. But beyond that, is it just brushing your teeth and flossing? Is it more than that?

What are the keys to keep your teeth and your your whole oral cavity in pretty good shape?

I put it in three buckets. [00:27:00] Habits Treatment, and Diet and Nutrition. And so the treatment bucket is exactly what you were talking about, John. It's important to establish a dental home, see a dentist regularly. The interval at which see a dentist is based on your risk for various diseases.

So if you're at a higher risk for developing tooth decay, your dentist may request to see you more frequently so that they can provide some of those minimally invasive treatments that I talked about. And then there's the habits portion. This is what you're doing every day. So brushing is really important, but it's important because we're aiming to reduce and shift the microbiome and harness the active ingredients that are in toothpaste.

It makes me laugh how much we spend on toothpaste, but it's because there are so many good ingredients in toothpaste that you might want to look for. So one of the things I look for in my toothpaste is something called arginine. It's an amino acid. That's naturally found in your body, but we can put it in arginine or we can put it in arginine.

That's how much I love it. We can put it in toothpaste and what it does is it actually fuels [00:28:00] the good bacteria in your mouth and helps them grow. And when those commensal bacteria, those good bacteria grow, they basically are in a competition with the bad bacteria and those bad bacteria are not going to thrive in that environment.

So arginine is this really healthy way to boost your microbiome. All of course, look for fluoride. I maybe should have started with fluoride first, but I'm just on such an arginine kick. I couldn't help myself. But looking for fluoridated toothpaste is helpful. Remember when I said enamel is the most beautiful thing in your body.

I mean, it's just absolutely gorgeous. Fluoride helps reinforce and strengthen your enamel to prevent tooth decay in the future. Fluoride also impacts. your microbiome. It actually makes it really challenging for pathogenic bacteria to thrive when you have fluoride. And then there's other two other things that are helpful in toothpaste.

Sodium bicarbonate, which is just baking soda. Baking soda raises the pH of your mouth and helps your microbiome stay really healthy. So anything that has baking soda in it is always a good thing. And then xylitol [00:29:00] is a really good example of a non fermentable sugar. So you may see this in sports drinks packets.

You may see it in Little packets that you may put in coffee. Sometimes it's in candies gum even, but Xylitol can also be in your toothpaste and it gives a sweet taste to the toothpaste, but more importantly bacteria called streptococcus mutans or strep mutans, they cause tooth decay. It's one of the bacteria that caused tooth decay.

There are more but Xylitol basically kills off those bad bacteria because they cannot digest it. This sugar and so Xylitol is something that can be really helpful in toothpaste. Now I'm going to give you a tip that a fabulous mentor of mine, Dr. Brian Novy, taught me. And it is to leave the foam alone.

So when I teach kids mainly kids, but when I teach kids in practice how to brush their teeth, we usually do it together and we use the circle motion and we point the bristles up towards our gum tissue so that it really massages the gum tissue and [00:30:00] helps. remove the plaque or the microbiome that's on your teeth.

And then afterwards, when you spit your toothpaste out, you know, if you smile, you would have little bubbles that look like they're bubbling. Like you just did a chemistry experiment in your mouth. You want to leave those there. You don't want to rinse them off because all of the good ingredients that I just shared with you are now doing their good work in your mouth.

ah,

And so you want to leave those on as long as you can.

Okay. Alright.

So, uh,

go

what about cleaning in approximately? Were you going to ask me what about cleaning in between your teeth?

absolutely. Absolutely. That was my next question.

So, when you clean in between your teeth, there are a lot of different options you might have received throughout your healthcare career in dentistry. I don't know, when you're working with your dentist, someone likely told you to floss. There are different ways to clean in between your teeth today, and I think we're really acknowledging that your oral hygiene habits are personalized.

So with my patients, I give them [00:31:00] a bunch of different options. I let them know that they can floss in between their teeth daily. They can use interdental picks or the little brushes because sometimes that makes it a little bit easier depending on how your teeth are rotated or how close they are together, how far they are apart or different restorations you might've received.

And then the fourth is a water flosser or a power flosser. These are filled with a liquid that can be kind of that can irrigate in between your teeth. Any of these will work. It just, you want to consult with your dentist and your dental home and your dental hygienist on what might work best for you based on some of the challenges that you're facing with oral health.

And so that's so important because when you brush, there are areas in between your teeth that cannot be accessed by a toothbrush. And so if we want to disrupt that microbiome, and then we want the toothpaste I typically tell patients to clean interproximally first, because then you remove that microbiome and now there's space for that toothpaste to flow in between the [00:32:00] teeth and for those active ingredients to get into what we call all the nooks and crannies, but is in between your teeth and around your gum tissue.

Is there anything else we should be doing in terms of what we can control?

So I will say this, if you play a lot of contact sports, if you have young children who play contact sports, I highly encourage you to see a dentist and ensure that you have a mouth guard. I think that's really important. I don't think we talk about that enough. mouth guards have been shown to reduce the impact of concussions and to really help prevent certain levels of damage.

And so I encourage anyone, if you're in a pickup basketball league, if you play volleyball on the weekends, if you have kids that play contact sports, ensure that you have them doing that. Many times people talk about using mouth rinse as well. Mouth rinse is helpful, but you want to make sure that it's a pH neutral mouth rinse.

And so you can ask your oral healthcare team to help you identify one of those, but we have to be careful with broad [00:33:00] spectrum antimicrobial mouth rinses. There are bacteria on your gum on your tongue that actually help regulate the blood pressure in your body. They release nitric oxide and they are fed when we use things like arginine or green leafy vegetables or lean proteins.

And it actually helps us maintain our blood pressure. If we use broad spectrum mouth rinses, it's been shown to kill this bacteria on the tongue or get rid of them. And we don't want to get rid of all the good bacteria. And so that's why I always tell my patients to leave the foam alone. And if you do want to rinse at the end of brushing and flossing, if you're like, I have to be a person that rinses, one of the things I always recommend is a little bit of baking soda water or a pH neutral mouth rinse.

I share the baking soda example with a little bit of water, because if you have a sensitive mouth and. Sometimes we have ingredients that make something taste good or feel good. Right. Sometimes there are some patients that are incredibly sensitive, but having a little bit of baking soda water, where you take one piece, teaspoon of baking soda and a cup of [00:34:00] water, mix it around, and then you can swish with it.

Don't swallow. But using that can be really helpful.

Right. was just at my dentist recently. I've tried to be better about going and great oral hygienist who was working with him. And she said she often, she was recommending certainly flossing, but she said, use an electric toothbrush. use a water pick too.

And I said, okay, that's great. And then she said, we were just talking and she said, a lot of people get really insulted when I tell them what to do, because they assume that means they're not taking care of their teeth. It was an interesting comment. I wouldn't have thought of that because I defer to people who know more than me about whatever they know more than me.

So do you experience it or are patients likely to say, well, I've been brushing my teeth forever. I don't need it. Your advice. I mean, my chip a tooth or have a cavity. It might be different. Do you see resistance in patients?

I do not, but I also approach it a little bit differently. So when I meet with patients and we kind of go over what next steps are, I have a menu in my practice [00:35:00] of all of the different things that you can do. I do. It's like, it looks like it's not quite a cheesecake factory menu which is, a ton of pages, but it's a one page menu.

And we sit down and we say, I say, here are all of the different things that you can do to improve your oral health. I think from my, experience with different patients and what I see during the exam and in the data that I have, I think these top three may be the best for you.

And here are some reasons why, but then I say, what would you like to do? What would you like to do to improve your oral health? And then the, my patient would select what they're going to do between now and the next visit. I only ever made one change at a time. So I found that patients, when they have one thing to focus on.

And they may spend the next three to six months building that one habit that is much more successful. If I focus on one thing and then six months from now, if maybe you're not flossing, I'm not focusing on flossing the first time. If you select use a new toothpaste, I'm going to have you use that new toothpaste.

I'll evaluate you in three months or six months. We'll see [00:36:00] how you're doing. And then I'll say, what else do you want to do? What more can we do to improve your oral health? And then you pick another thing. And I would actually have my patients write on a little slip of paper when they walk out of the office what their goal was for the next visit. And then they take that with them because changing an oral healthcare behavior is the exact same as changing any other healthcare behavior. and it takes a lot of effort. And it takes such a commitment and there are stages to behavioral change. And so I really tried to harness my patient's motivation and their desire to change and what they cared about instead of maybe prescribing.

you see more progress that way

I

Or more game. Yeah. Just as I forget, do you recommend organic or natural dental care products? And I'm not going by a particular brand. Some people swear by them, but then they swear by everything organic. So is there a significant difference in picking a organic toothpaste or something like that?

I don't focus necessarily on the organic [00:37:00] label. But I do focus on the ingredients that I shared with you earlier. So there are many organic products that would actually have some of the important ingredients like arginine, fluoride, xylitol, sodium bicarbonate. So I always go by the ingredients and then I educate patients and we actually read the nutrition labels or the little healthcare labels together.

And then we select a, a choice that works for them. I also would make recommendations. Some of my patients were vegan or they had certain allergies. And so I would help them navigate the product market on an individual basis to make sure that whatever product was selected worked for their own preferences and for their own beliefs and values.

how often should we be seeing a dentist and does it change with age?

Okay, great question. So historically patients have been seen about two times a year. And so I would always start with, if you haven't seen a dentist in a while, now's the time, engage, find a dental home and then listen to your [00:38:00] oral health care team member. When we look at patients risk factors, for something.

The frequency of visiting a dentist has changed over the last couple of years, even with caries or tooth decay. There are recommendations where I've had some patients that were at such high risk that I needed to provide preventive treatments that could only be provided in office every month. So when I started their treatment plan, I may see that patient every month for the first few months to help them navigate the initial stages of controlling their tooth decay, right?

There are other patients who maybe have never had a cavity or a tooth or tooth decay in their entire life. They may be at such low risk that a dentist based on the risk management resources that we have as clinicians, they may recommend that they only come once a year, right? And so now we are understanding that your frequency of visit is linked to your risk category for different diseases.

And so I would definitely work with your dentist on navigating that, but if you're [00:39:00] having challenges you at least want to be going if you haven't had an exam in a while, as quickly or as soon as possible, because it's always important to start care early. And as a default, oftentimes your insurance will recommend that you have a visit twice a year.

Do we see? Any projections in terms of age or people more focused on their teeth when you're a kid growing up Your parents are usually bashing you to take care of your teeth But let's say when you go to college or high school college or your 20s are people more focused on their teeth in those Years or not necessarily?

It depends. Sometimes they're often on their parents health insurance during that time. And so they may be accessing care at the same frequency that they were before. But sometimes that can be challenging where we are finding a little bit of a difference. is when there are certain populations from 20 to 40 that they may be employed in a place that provides health insurance, but they also may not be employed in a company or in a job that provides health insurance.

And so what we find is [00:40:00] that there's actually a large group between 20 and 40, whether they're unemployed, or they're employed in, let's say, a service industry job. That's not providing health care or dental care. We often see. a decrease in those young adults accessing dental care.

Ah, interesting. All right, we could go on and on. I've never known anybody so enthusiastic about dental care But what are the misconceptions people have or you want to correct? So then people walk away. They say okay. Yeah, I really need to think about that or be aware of that

One thing I want to make sure that everyone understands is that your oral health is essential to your body operating optimally, your overall health. And so focusing on caring for your oral health daily is incredibly important. And then bringing in more people into your team in person centered care, you, the patient are the center of that team.

And so you may have different team members that are on your team. You may have a dentist, a dental hygienist someone who's helping you with therapy, whether you have headaches or a sore jaw. You may have a primary care [00:41:00] doctor that's a part of that care team. You maybe have an OBGYN that's helping you manage components of your pregnancy or menopause that's contributing to how you're managing your overall health and your oral health. And so I think it's important to realize that the patient is really the center. You're the quarterback. And it's important to have a bunch of people on your team that can help care for you because we all want you to be healthy. And we all want you to have a long life with a really high quality of life.

And so I think for me, I just, I want patients to know that they have this opportunity to engage a team, to help them reach their oral health goals. The second thing that I think is super important to understand is that dentistry is changing. The practice of oral health care is changing. We're constantly adapting new information and new evidence.

And so engaging and asking important questions to your dental team is really important. Because what was true five years ago may have changed today. And so if you have questions, [00:42:00] if you want to learn more, I think it's so important. Your dentist wants to hear from you.

Your dental hygienist wants to hear from you. The dental assistant that you engage with wants to hear from you. And so I think it's really important to realize that information changes and asking whatever questions you have to your dental team is incredibly important so that you get the best care possible.

I

Kennedy Thank you very much.

Just wanted to say thank you, John. It was a pleasure to be here today. If there's, anything that comes up or any more resources that can be of help to you and your team, the American Dental Association is here to help you.

Okay. Dr. Aaron Kennedy Thank you very much for your time. We look forward to talking to you again

Before we dish out some health hacks, we want to again remind everyone of the hundreds of exclusive discounts members of our WellWellBeing community enjoy. These include everything from fitness and athletic equipment, to personal care products, organic foods and beverages, and more.

Now joining our WellWellBeing community is easy and free. [00:43:00] Just visit WellWellUSA. com. Go to Milton's Discounts on the pull down menu and you'll see the sign up sheet. Signing up takes seconds, but the benefits can last for years. Enjoy. Okay, ultimately, our dental and oral health may be in better shape than ever, but it still faces a lot of challenges.

As Dr. Kennedy noted, perhaps one third of American adults don't have insurance to cover their dental care. This, of course, doesn't prevent all these people from visiting dentists, but it obviously doesn't encourage them either. That's nothing to smile about, because dental and oral health fits closely into a person's overall well being.

Don't take care of your teeth, gums, or oral cavity, and all sorts of deadly serious health issues and diseases can emerge. Protecting yourself is surprisingly clear cut. Admittedly, small, personalized approaches may be needed, but the proactive [00:44:00] fundamentals remain the same for everyone. Key points include Brush and floss your teeth daily and use a water pick if necessary.

Leave the foam alone after brushing. It's doing you a lot of good. Get the right toothpaste that includes the ingredients necessary to protect your teeth and oral cavity. Connect to a dentist. And at a minimum, schedule biannual appointments. Work to create a personal oral care treatment plan with your dentist that provides sound support and steady improvements.

Most of all, remember that oral health equates to body health. So make sure all your doctors and practitioners are working together, no matter what their specialty is. That's it for this edition of What the Health. We'd like to, of course, thank Dr. Kennedy, Assistant Dean at Kansas City University's College of Dental Medicine, for all her insights and information.

We'd also like to thank the [00:45:00] American Dental Association for their help in connecting us to Dr. Kennedy. The ADA is a great source of information, and we'd recommend visiting the ADA site at ADA. org, that's ADA. org, to learn more. So thanks again for listening. We hope you'll connect again soon. to one of our upcoming episodes of What the Health.