Archive for the ‘Oral Systemic Health’ Category

Cavity Management by Risk Assessment Improves Access to Care

Monday, October 1st, 2012

By Dr. V. Kim Kutsch, DMD

Recently PBS broadcast a Frontline special report entitled “Dollars and Dentists”. The report presented a “broken dental system” in the US, amidst a rising epidemic with decay. PBS actually did a very good job describing the current issues facing dentistry today: rising healthcare costs, increasing decay rates in children and adults, limited access to care, an entitlement system that doesn’t adequately reimburse private practitioners, and corporate America seeing a profit opportunity in treating (mistreating) these children, and the concept of mid-level providers to help solve the access issue. However, the report failed to examine the real issues at play, and missed a huge opportunity to report the truth.

Here are the facts: the decay rate in our small children is rising at epidemic proportions, there is limited access to care, but the focus of the system is still in the wrong place. The Medicaid system will reimburse for crisis care for a child in a hospital setting to the tune of $12-18,000, and again when the same child needs the same procedure 20-24 months later, but won’t adequately reimburse a private practicing dentist to provide the necessary preventive management to avoid the crisis in the first place. What part of this expensive, out-dated system should we consider successful?

Corporate America got involved and suddenly there is an increase in the number of stainless steel crowns being placed on these children and less preventive services. Is anybody really surprised by that? The system rewards placements crowns but doesn’t adequately compensate a private practitioner to provide real preventive care and counseling. What might happen if the system paid $300 for fluoride varnish, professional therapy products, and nutrition counseling and $30 for a stainless steel crown?  There would be a lot fewer stainless steel crowns and there might also be fewer $18,000 crisis scenarios and better treatment outcomes.

Organized dentistry provides a lot of free care to help with the epidemic, take the success of the MOM program for example, or Donated Dental Services. Or consider the fact that individual dentists routinely provide pro-bono care to people in need. This was never mentioned in the report, but we all donate care as best we can. Unfortunately it still isn’t enough for the crisis we’re in.

Dr. Bob Barkley summed it up pretty accurately over 40 years ago. The problem we have is the house is on fire, and we’re trying to solve the problem with carpenters. We need to send in the firemen. The bottom line is dental caries is a multifactorial, complex, pH-specific biofilm disease. Too late we’ve learned that the drill has little to do with actually treating the disease. Increasing the number of Pediatric Dentists, operating suites, corporate dental practices, or mid-level practitioners isn’t going to solve this epidemic. We can’t drill and fill our way out of this crisis, regardless of who is running the drill. We don’t need more carpenters. We need to put the fire out.

To solve the healthcare crisis we face in dentistry today, we need to move from a treatment model to a healing model. CAMBRA, or caries management by risk assessment identifies and addresses the cause of the disease for each patient. By understanding the cause of dental caries we can focus on targeted strategies and effectively manage it. Armed with this knowledge we can coach patients back to long-term sustainable health. Through real preventive management of this disease we can provide the treatment outcomes we are looking for. The system we’ve got is truly broken and not functioning. The decay epidemic is direct evidence of that. But the solution won’t be found incarpenters, we need to change the “system” so that it fairly rewards firemen. That would reduce the decay epidemic, reduce the cost burden, improve access to care, and provide a genuine long-term solution. We need to fix the system. That’s the real story, and Frontline missed it completely!



Dr. Kutsch received his undergraduate degree from Westminster College in Utah and then completed his DMD at University of Oregon School of Dentistry in 1979. He is an inventor, product consultant, internationally recognized speaker, in past president of the Academy of Laser Dentistry, and WCMIID.  He has also served on the board of directors for the WCLI and AACD.  As an author, Dr. Kutsch has published dozens of articles and abstracts on minimally invasive dentistry, caries risk assessment, digital radiography and other techonologies in both dental and medical journals and contributed to several textbooks. He also acts as a reviewer for several journals.  Dr. Kutsch also serves as CEO for Oral biotech, as a clinician.  He is a graduate and mentor in the prestigious Kois Center and maintains a private practice in Albany, Oregon.

The Truth about Fluoride – Debunking the Myths

Monday, August 27th, 2012

By Dr. Weston Heringer, Jr.

Fluoride is natures cavity fighter with small amount present in all water sources such as lakes, rivers and wells. Communities fluoridate their water supply as a cost-effective public health measure to help prevent tooth decay and cavities in both children and adults. According to the best available scientific evidence, water fluoridation is safe and effective. Thousands of studies and more than 65 years of experience tells us that water fluoridation is effective in preventing tooth decay and is safe for children and adults. Even with all the science, there are still a lot of misconceptions about community water fluoridation so let’s talk through them.


1. Fluorosis. Fluorosis can occur before teeth erupt from the gums if teeth are exposed to too much fluoride. The vast majority of fluorosis is very minor, barely detectable white spots on the teeth, that does not affect how they function or a person’s overall health. There are studies that suggest that fluoride occurs more frequently in African American children, however more research is needed on the topic. Fluoridation is implemented because dental decay is widespread, the burden of which falls unfairly  among some  population groups.  The National Dental Association, representing African American dentists, and the Hispanic Dental Association both endorse community water fluoridation as safe and beneficial.

2. IQ. According to the best available scientific evidence, there is no association between fluoridation and brain development or lower IQ. The studies often cited are from China, India, and Mexico where environmental conditions are significantly different than those in Oregon. The vast majority of these studies have never been published in peer-reviewed journals and the quality of these studies does not stand up to scientific scrutiny.

3. Osteosarcoma. In 2011, a team of researchers from Harvard University, the Medical College of Georgia and the National Cancer Institute published a study that analyzed hundreds of bone samples from nine hospitals over an 8 year period from patients with osteosarcoma and a control group to measure fluoride in levels in the bone. Considered the most extensive study to date, the results indicated NO CONNECTION between fluoride levels and osteosarcoma. All the other organizations and agencies that have looked at this issue – including the FDA, National Cancer Institute, California EPA Office of Environmental  Health Hazard Assessment – have concluded the same thing.

4. Infant Formula. Although we encourage all parents and caregivers to talk to their dentist of physicians about their child fluoride intake, community water fluoridation has been proven to be safe for children, including babies. Babies who are fed powdered or liquid concentrate infant formula mixed with optimally fluoridated water might develop mild enamel fluorosis, which is a cosmetic condition and has no effect on how they function.


Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C. Community water fluoridation saves more than it costs. Studies show that community water fluoridation prevent at least 25 percent of tooth decay.

Want more information on fluoride? You can find extensive information in Fluoridation Facts, the ADA’s comprehensive publication with facts from over 350 scientific references.


Dr. Heringer is a retired pediatric dentist and has served on 19 overseas dental trips. He operated a private practice in Salem for 30 years with a satelite office in Lincoln City for 26 years. For the last two years of his career he was the full time dentists on the Tooth Taxi, a mobile dental van providing free care to children in Oregon. Dr. Heringer is a past president of the Oregon Dental Association and is a board member of the Dental Foundation of Oregon.