Creating Healthy Smiles, One Smile At A Time

Monthly Archives: July 2013


I was recently asked an interesting question by one of our patient’s mother. Her 9 year old daughter had just been in for her routine 6 month preventive visit and was diagnosed with 5 cavities.  She had never had a cavity before, and concerned, this mother asked, “Can asthma or her inhaler cause cavities?”  Since her last visit, this young patient had been diagnosed with asthma and was now using a nebulizer.

Turns out there are a few scientific studies which suggest that there is an increased risk of dental cavities and gingivitis for individuals with asthma.  A well researched 2011 study from dental researchers in Sweden (the Swedes are obsessed with the study of cavities) strongly examined asthmatics – ages 3, 6, 12-16, and 18-24 – and a control group of healthy youths of similar age and geographical background. The results were interesting.

  • Only 5% of tested asthmatic teens were cavity-free, compared to 65% of “healthy teens.”
  • Teens with “long-time moderate or severe asthma” had more gum inflammation than the control group.
  • The 3-year-old asthmatics showed more dental caries than 3-year-olds in the “healthy” control group. This trend still existed in a follow-up exam three years later, when the kids were 6 years old.
  • Adolescents with asthma had lower plaque pH than the control group, meaning their mouths were more acidic, making their teeth prone to decay and their gums vulnerable to inflammation.

Researchers think low saliva levels contributed to the gum irritation and tooth decay. Saliva washes food particles from teeth and minimizes the growth of bacteria that contributes to decay.

When an asthmatic child exercises or sleeps, he often will breathe through the mouth to get enough air. Subsequently, the mouth dries out. Medication (such as nebulizers) used to control asthma dries the mouth even more. In addition, some nebulizers use fructose in their delivery mechanism, increasing sugar exposure.

One usually drinks water when thirsty, however, interesting enough, children with asthma have been found to drink more sugary beverages than non-asthmatics.  This combination can lead to a greater incidence of cavities.

There have also been studies showing that asthma, or even the use of nebulizers, does not increase one’s risk of cavities or gingivitis.  In fact there continues to be some debate within the dental community about whether or not there is a true correlation between asthma and cavities. For another point of view, check out this article:

That being said, there are some common sense precautions one can take if you have asthma.

  • Brush and floss on a regular basis
  • Stay well hydrated. Drink plenty of water and avoid sugary or acidic drinks
  • After using a nebulizer, make sure you drink some water to eliminate any dry residue that may stick to your teeth.
  • See your dentist every 6 months and inform him/her of your concerns.

Happy Brushing and Flossing!


ImageWith the implementation of the Affordable Care Act (aka “Obamacare”) set to start in 2014, we thought it would be an opportune time to discuss what impact this will have on Pediatric Dentistry and dental insurance plans.

When the Affordable Care Act (ACA) was first signed into law in 2010, there was  a lot of hope that this would lead to an improvement in access to dental care for children.  One of the provisions of the law was that any medical insurance plan to be offered on the State exchanges had to provide coverage for 10 essential health benefits.  One of those ‘essential health benefits’ was pediatric dental coverage.

What we all thought this meant was that every medical insurance plan (be it Blue Cross/Blue Shield, Harvard Pilgrim, Aetna etc…) being offered on individual State exchanges would have to include dental coverage (preventive cleanings and fillings etc…) for children.    This would have been a win-win scenario for all: for parents who would probably pay less for premiums, for previously uninsured children who gain access to quality care, and for dentists who would now be able to treat the millions of previously uninsured.children.

Unfortunately, that is not the case.

Recent rulings by the commission charged to come up with detailed rules on the Affordable Care Act state that Pediatric dental insurance can be offered as a stand alone plan on the State exchanges, BUT does not need to be included as part of a medical insurance plan. Furthermore, individuals are not required to purchase the dental plans, and no income weighted federal subsidies are available for these dental plans. It’s available for purchase  if an individual’s workplace does not offer dental insurance.

To put it simply, if you want to have pediatric dental insurance, (and you currently don’t have it), you’re going to have to buy it yourself instead of having the government mandate that ALL medical insurance plans include pediatric dental insurance.

Now, medical insurance plans can decide on their own to start offering pediatric dental coverage as part of their overall medical insurance policy.  However, to date very few have done so, and it’s unlikely that without a big ‘push’ from the federal government that they will do so.  Image

We suspect, that in Massachusetts, the  State Health Connector will soon be providing some of these stand alone pediatric dental plans, foremost among them Delta Dental.  It remains to be seen how much those premiums will cost, what the deductibles will be, and exactly what will be covered.  We don’t  hold out much hope that it will be as comprehensive as it should be.

So, unfortunately, when it comes to dentistry, what we are left with is a promise that falls well short of it’s intended goals. The ACA despite it’s initial hoopla, does little to ensure that all children will have affordable, comprehensive and accessible dental care.

Quite disappointing.

NOTE: The ACA in most cases, does not effect most people’s current medical and/or dental insurance.  It only applies to those who are currently uninsured. Furthermore, the income eligibility requirements for those who qualify for medicaid will be expanded from 58% to 133% of the Federal Poverty Level, increasing the numbers of those who will be eligible for pediatric dental coverage under medicaid.

Wacky Picture of the Day

While not entirely approving of the technique, we did find this sand sculpture to be absolutely amazing. Rest assured, we’d never extract teeth in this manner.