Category Archives: Mouth & Teeth

Gonorrhea (Photo: Bill Schwarts/CDC)

Sexually Transmitted Infections: Part 1 Gonorrhea

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By Yolanda Evans, MD, MPH
From Seattle Children’s Teenology 101 weblog

Part of normal adolescence is the development of new relationships. Teens have strong ties with peers and also began to have romantic relationships.

Many teens also choose to start having sex. In fact nearly half (47%) of all high school students have had sex before. With sex comes consequences: intense feelings, possible heart break, as well as the risk of pregnancy and sexually transmitted infections.

Unfortunately, 15-24 year old’s account for almost half of the 19 million new sexually transmitted infections (STI) that occur each year (even though this age group is only a quarter of the US population), but I want to be clear that any person who has sex is at risk for an STI. In this post, I’ll focus on gonorrhea.

Gonorrhea

Gonorrhea CDC-Bill Schwarts

Gonorrhea bacteria amongst white cells. Photo by Bill Schwartz/CDC

Gonorrhea is an STI caused by a bacterium. The CDC estimates that about 700,000 people are infected each year. It’s spread by having sex; that means oral, anal, and/or vaginal sex and can also be spread from an infected mother to an infant (leading to serious illness in the baby).

The symptoms can vary. Most women have no symptoms at all or they may have pain or burning with urination, vaginal discharge or bleeding. It might be mistaken for a urinary tract infection.

Men are more likely to have pain or burning with urination and white/yellow/green discharge from the penis.  People with an infection of the throat may have sore throat or no symptoms at all and rectal gonorrhea infection could cause painful bowel movements or itching, burning, and discharge.

Untreated gonorrhea can cause a painful infection called epididymitis in males and can lead to an infection of the fallopian tubes called pelvic inflammatory disease (PID) in females.

PID can cause scarring of the fallopian tubes that leads to infertility or a life threatening pregnancy outside of the uterus called an ectopic pregnancy.

In both males and females untreated gonorrhea can also lead to a life threatening infection that affects the joints.

Screening for gonorrhea is relatively easy. Anyone with symptoms, a partner who has been diagnosed with gonorrhea, or anyone diagnosed with another STI should be screened. There is now a test that looks for the bacterial DNA in urine, so a person only needs to provide the urine.

Depending on the situation, a medical provider may still obtain a swab from a woman’s cervix (the entrance to the uterus or womb) or a man’s penis but the ability to detect the bacteria in the urine has made screening something that is not painful or uncomfortable. To look for infection in the rectum or throat, a medical provider will need to obtain swabs of these areas.

Fortunately, gonorrhea can be cured if treated appropriately, but antibiotic resistance is increasing. If your teen is diagnosed with gonorrhea or any treatable STI, they should take all the medication provided and should not share medication or take another person’s dose.

The good news is that gonorrhea can be prevented!  Not having sex is the only way to prevent any STI 100% of the time, but knowing the status of your sexual partner and using latex condoms with every sexual act (including oral and anal sex) also reduce the risk of getting gonorrhea.

About Yolanda Evans, MD, MPH

Yolanda-Evans-MD-MPH_avatar-100x100My work is a ‘dream come true’ and it’s what I’ve wanted to do for as long as I can remember. I have the privilege of getting to know some amazing teens and hearing things about them that they may not have told anyone before. When I’m not working, I like trying new foods, traveling around the world, spending time with family and friends, and enjoying the fresh Washington air (though not quite as fresh as Alaska where I grew up, but very close!) – Yolanda Evans, M.D., Adolescent Medicine at Seattle Children’s

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Soda Pop Top

King County health officials say consumption of sugary drinks contributing to obesity among the young

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Photo: Alessandro Paiva

Close to a third of high school students, or 26,000 youth, drink soda daily in King County, and 8,000 students drink two or more sodas per day, according to a new “Youth consumption of sugary drinks in King County” report.

Sugary drinks are the largest single source of calories in the U.S. diet and account for almost half of all added sugars that Americans consume.

With 1 in 5 youth in King County is either overweight or obese “reducing the amount of sugary drinks our children consume is a key strategy for improving health,” said Dr. David Fleming, Director & Health Office for Public Health – Seattle & King County.

A person who drinks two 20-ounce regular colas per day consumes 4.7 cups of sugar per week — or 243 cups of sugar per year — from soda alone. The consumption of sugary drinks has been linked to risks for obesity, diabetes, heart disease, stroke, and hypertension.

According to the new “Youth consumption of sugary drinks in King County” Data Watch Report:

  • Two out of three King County middle and high school students report drinking sugary drinks, including sodas, sports drinks or other flavored sweetened drinks, at school.
  • Of those youth who drink sugary drinks at school, 43% bring them from home, 9% get them from friends, 29% buy them at school, and 20% obtain them in other ways
  • Among high school students, daily consumption of at least one soda is highest among American Indian/Alaskan Native youth (40%), Hispanic/Latino youth (39%), Native Hawaiian/ Pacific Islander youth (38%) and African American youth (37%) versus 30% for white, non-Hispanic youth.

Sugary drinks are beverages with added sugars, such as regular sodas (or “pop”), energy drinks, sports drinks, sweetened fruit drinks, and sweetened coffees and teas.

On average, a 20-ounce bottle of regular soda has more than 16 teaspoons of sugar and 240 calories. This is double the total amount of added sugar allowed for an entire day based on a 2,000 calorie diet.

During the last two years as part of Communities Putting Prevention to Work (CPPW), a one-time federal stimulus-fund initiative, King County organizations have been taking steps to decrease access to sugary drinks and offer healthier options, such as water or low-fat milk.

As part of CPPW, the Childhood Obesity Prevention Coalition launched Soda Free Sundays, a community level campaign to take a break from sodas one day a week.  Over 1,000 individuals and 55 organizations took the pledge to go soda free on Sundays.

“This report demonstrates that sugary drink overconsumption continues to be a real problem in King County,” said Victor Colman, Director of the Childhood Obesity Prevention Coalition. “We know that with action at the individual, organizational, and community-wide levels we can see real progress and make healthier beverage choices within reach for everyone.”

Steps families and organizations can take to cut down on sugary drinks:

  • Purchase, serve and enjoy low-sugar options like water, low-fat milk, unsweetened tea and coffee drinks, and small portions (4 ounces or less) of 100% fruit juice.
  • If you do have a sugary drink as an occasional treat, cut calories and save money by ordering a small size and saying “no thanks!” to refills.
  • Ensure easy access to cool, fresh water at work, in organizations that serve kids and in public spaces.
  • Use the King County Board of Health’s Healthy Vending Guidelines to make sure that your vending machines offer the healthiest beverage options
  • .Limit the availability of sugary drinks at your workplace or organization by using the King County Vending Guidelines to identify the types of healthy drinks to make available.

To learn more about sugary drinks and what you can do, visit:

  • Public Health’s sugary drinks webpages, includes new  “10 things parents should know about sugary drinks” and “10 things families and organizations can do to cut down on sugary drinks” fact sheets
  • Soda Free Sundays, a community-wide challenge to take a break from soda and other sugary drinks for just one day out of the week.

Story photo and thumbnail photo courtesy of Alessandro Pavla.

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Breastfeeding

Ten things you didn’t know were in the Affordable Care Act

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By David Schultz and Christian Torres

So you think the Supreme Court upheld a law that requires most people to buy health insurance?

That’s only part of it.

The measure’s hundreds of pages touch on a variety of issues and initiatives that have, for the most part, remained under the public’s radar.

Here’s a sampling:

Postpartum Depression (Sec. 2952)

Urges the National Institute of Mental Health to conduct a multi-year study into the causes and effects of postpartum depression. It authorized $3 million in 2010 and such sums as necessary in 2011 and 2012 to provide services to women at risk of postpartum depression.

Abstinence Education (Sec. 2954)

Reauthorizes funding through 2014 for states to provide abstinence-only sex education programs that teach students abstinence is “the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems.” Federal funding for these programs expired in 2003.

Power-Driven Wheelchairs (Sec. 3136)

Revises Medicare payment levels for power-driven wheelchairs and makes it so that only “complex” and “rehabilitative” wheelchairs can be purchased; all others must be rented.

Oral Health Care (Sec. 4102)

Instructs the Centers for Disease Control and Prevention to embark on a five-year national public education campaign to promote oral health care measures such as “community water fluoridation and dental sealants.”

Privacy Breaks for Nursing Mothers (Sec. 4207)

Requires employers with 50 or more employees to provide a private location at their worksites where nursing mothers “can express breast milk.” Employers must also provide employees with “a reasonable break time” to do this, though employers are not required to pay their employees during these nursing breaks.

Transparency on Drug Samples (Sec. 6004)

Requires pharmaceutical manufacturers that provide doctors or hospitals with samples of their drugs to submit to the Department of Health and Human Services the names and addresses of the providers that requested the samples, as well as the amount of drugs they received.

Face-to-Face Encounters (Sec. 6407)

Changes eligibility for home health services and durable medical equipment, requiring Medicare beneficiaries to have a “face-to-face” encounter with their physician or a similarly qualified individual within six months of when the health professional writes the order for such services or equipment.

Diabetes & Death Certificates (Sec. 10407)

Directs the CDC and the HHS Secretary to encourage states to adopt new standards for issuing death certificates that include information about whether the deceased had diabetes.

Breast Cancer Awareness (Sec. 10413)

Instructs the CDC to conduct an education campaign to raise young women’s awareness regarding “the occurrence of breast cancer and the general and specific risk factors in women who may be at high risk for breast cancer based on familial, racial, ethnic, and cultural backgrounds such as Ashkenazi Jewish populations.”

Assisted Suicide (Sec. 1553)

Forbids the federal government or anyone receiving federal health funds from discriminating against any health care entity that won’t provide an “item or service furnished for the purpose of causing … the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.”


This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Toothbrush

Do I have to go to the dentist?

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By Kelly Malcom, HBNS Editor

Many of us have vivid memories of tying a thread to a loose tooth and wiggling it back and forth with our tongue all the time hoping for a profitable visit from the Tooth Fairy.

Facebook is full of school and family photos of kids with cute, gap-toothed smiles. But increasingly, children are losing their baby teeth not due to the budding of their permanent teeth but to the ravages of early decay and cavities.

“Pediatricians refer kids to us all the time who are underweight or malnourished. You look in their mouths and you can see why immediately: it’s because they have these extensive cavities and infection,” says Allison Cavenaugh Eggleston, DDS, a pediatric dentist in North Carolina.

“The parents who say to me that baby teeth aren’t important because they’re going to fall out anyway are the same parents who ask how their child will eat when I tell them I may need to extract all of their teeth.”

There are a number of reasons kids and adults don’t make it to the dentist regularly. For some parents, it’s a lack of understanding about the importance of oral health, even at an early age.

Eggleston tries to reach them early by educating pregnant women about the importance of seeing a dentist, not just for themselves but for their babies.

“There is hard evidence to show that reducing the cavity-causing bacteria in a mother’s and father’s mouth will reduce the cavity-causing bacteria in your child’s mouth. Many don’t think of it this way, but oral disease is an infectious disease that can be spread to your baby, even via something as simple as kissing them. That’s why it’s important to go to the dentist regularly, have your cleanings, and understand what you can do to help prevent these cavities.”

Barriers to Dental Care

For many people, just getting to a dentist can be difficult. This may be because the dentist is too far away. Eggleston will soon start her dental practice in an area of rural North Carolina where previously the closest dentist for many residents was 60 miles away. Roughly 47 million Americans live in areas that are recognized by the government as having a shortage of dentists.

Or it may be too difficult to get time off of work to take your child to the dentist.  “If you have someone who can take the kid to the dentist, that’s fine. But many families don’t have that caretaker,” says Jay Friedman, DDS, a dental consultant and author. To get around this, Friedman and many other experts suggest treating kids in schools using licensed dental therapists.

However, one of the greatest barriers to access to dental care is a lack of insurance and cost of care. “The most recent figures are that there are close to 130 million people without dental insurance, which is eye-popping,” said Shelly Gehshan, director of Pew Children’s Dental Campaign.

How to Pay for Dental Care

Dental care is essential but many people put it off because of cost. There are a few steps you can take to ease the pain of sticker shock:

  • Check to see if your employer offers dental insurance or flexible spending accounts for health care needs. You can use these to set aside a portion of your paycheck before taxes to help cover dental care.
  • Shop around if possible. Before agreeing to an expensive procedure, see whether another dentist will perform the same procedure for less.
  • Many dental offices will work with patients when it comes to bills. Offer to pay cash in exchange for a discount or ask about setting up a payment plan to stretch payments into smaller installments over time.

Local Resources:

Even for those with dental insurance, actually seeing a dentist can cause a big hit to one’s pocket book. Cait Goldberg is currently shopping around for an orthodontist for her daughter.

“We knew she’d eventually need braces because she’s sucked her thumb her whole life,” she explains. “The first dentist we saw is a Harvard grad and has this incredibly slick office, with iPads in the waiting room and everything. He told us he’d wait until she lost her last few baby teeth before applying braces at $8000 over the two or three years she’d wear them. In the meantime, we could purchase a $1,500 appliance to help her stop sucking her thumb.”

Another dentist had no iPads and zero bedside manner, but would cost $3000 less, she said. Her insurance would cover just $2000, either toward the appliance or the braces.

She’s going to keep looking but the extreme difference in price has made her skeptical. “I’m not even sure if one is better than the other or if it matters.”

Preventing Dental Problems

You can get your child off to a good start by beginning oral hygiene rituals early:

  • Wipe your infant’s gums after eating to get them used to you being in their mouths.
  • Brush your child’s baby teeth with a soft brush and a tiny amount-no larger than a grain of rice-of fluoride toothpaste.
  • Take your child to their first dental visit by age 1.
  • Ask about and consider sealants, which have been shown to reduce cavities.

The American Dental Association recommends that kids and adults:

  • Brush your teeth twice a day using fluoride toothpaste.
  • Use floss or an interdental tool to remove plaque and food particles from between the teeth.
  • Mouthwash can be used to reduce the amount of bacteria in the mouth and may cut down on tooth decay.
  • See a dentist once a year for a professional cleaning.

Asking Questions

One of the best things anyone can do is ask questions about treatment recommendations. Like medical care, dental care costs have been rising partly due to the use of unnecessary tests and procedures. In fact, Dr. Friedman spearheaded a campaign against the prophylactic removal of wisdom teeth, of which, he says up to 70 percent are unnecessary. (See below)

Do You Need Your Wisdom Teeth Out?

Many people believe having your wisdom teeth taken out is a rite of passage. Yet, if they aren’t causing pain or other problems, you may be able to leave them alone.

Dr. Jay Friedman, DDS, a dental consultant, estimates that up to 70 percent of wisdom teeth extractions are unnecessary-a big deal considering the procedure can cost thousands of dollars plus recovery time.

A recent review from The Cochrane Library, considered the gold standard for determining the relative effectiveness of different interventions, found no evidence to support the prophylactic removal of impacted wisdom teeth (impacted meaning the tooth is wedged between another tooth and the jaw).

Talk to your dentist about the risks of watching and waiting versus removing them to prevent potential future problems.

 

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Toothbrush

Millions in the U.S. going without dental care — report

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By Jenny Gold

Millions of people each year are skipping out on their annual trip to the dentist. And it’s not because they’re afraid of the drill.

Many people just can’t find a dentist or can’t pay for a visit: 33.3 million Americans live in a region with a shortage of dental professionals; kids, seniors and minorities are particularly vulnerable.

And because dental care usually isn’t provided as part of a standard health insurance package, even under Medicare, many Americans simply can’t afford it.

In 2008, 4.6 million kids skipped their dental checkups because their families couldn’t pay, and in 2006, only 38 percent of retirees had dental coverage.

But a new report from the Institute of Medicine has some ideas on how to improve dental access, including recruiting more dental students from minority, low-income and rural populations to serve the neediest areas.

The IOM also recommends investigating ways to expand Medicaid dental coverage for adults (Medicaid currently only requires dental coverage for kids) and increasing reimbursement rates for providers.

Dr. Frederick Rivara“The consequences of insufficient access to oral health care and resultant poor oral health — at both the individual and population levels — are far-reaching,” said Dr. Frederick Rivara, professor of Pediatrics at the University of Washington School of Medicine, Seattle, and chair of the committee that wrote the report. “As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health.”

According to a second study by the CDC’s Sandra Decker, in today’s Journal of the American Medical Association, paying more increases the number of kids who get regular teeth cleanings.

But some players in the world of teeth may be unhappy with the IOM report.

That’s because the IOM also recommends that states change their laws to allow dental hygienists, assistants and other professionals to take on a greater role in treating patients.

Right now, the laws dictating what types of procedures dental hygienists and assistants are allowed to provide varies greatly by state.

Restrictive laws, the IOM writes, may result in states missing “critical opportunities to serve greater numbers of individuals in need of care” where there are not enough dentists to meet the needs of the local population.

But advocates for dentists, including the American Dental Association, have warned for years against allowing anyone except dentists to extract teeth and fill cavities.

In Alaska, for example, a program to train ordinary citizens as “dental therapists” to reach the small villages scattered throughout the sparsely populated state was met with harsh criticism.

The ADA even sued to block the program, saying therapists could end up doing harm to patients. The case was later dropped.

The new health law passed by Congress also includes a $60 million program to expand the services dental hygienists and aides can provide in rural areas, including pulling teeth and filling cavities.

The program, however, has not yet been funded. The ADA isn’t complaining. “We didn’t want this concept to get a foot in the door,” an ADA spokesman told Kaiser Health News last month.


This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Healthy Smile

Survey finds wide gaps in dental health among King County’s children

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Overall, children in King County had fewer cavities and better dental health than children living elsewhere in the state, but children in the county’s low-income families were more than twice as likely to have untreated dental disease and four times as likely to have rampant tooth decay than King County children from higher-income families, according to a new survey.

The Washington State 2010 Smile Survey studied the dental health of a statewide sample of 5,733 kindergarten and third grade children, including 4,000 living in King County.

The survey found that King County children are more likely to have no tooth decay and fewer fillings than children living in other parts of the state with 60 percent of elementary school children have no decay compared to 51 percent of children statewide.

King County children were also less likely to have rampant decay, defined as having decay on seven or more teeth, than children living in the rest of the state.

One reason: 80 percent of King County residents have access to fluoridated water, which likely contributes to children having healthier teeth and less decay than in other parts of the state.

The County’s school-based dental sealant program also likely contributes to the County’s better results. This program specifically target schools with children at higher risk for dental disease, and among the County’s third graders 63 percent had been treated with dental sealants compared to 51 percent for the rest of the state.

Nonetheless, the study found that within the County there were wide disparities in dental health:

Compared to higher-income children:

  • Students eligible for free/reduced lunch programs in King County are almost twice as likely to have experienced dental decay;
  • twice as likely to have treated decay, at least twice as likely to have untreated decay;
  • and almost four times as likely to have rampant decay as student who are not eligible for free/reduced lunch programs.
Bar graph showing differences in dental health between income groups

Compared to non-Hispanic White children:

  • Children of color have one-and-a-half times the rate of dental disease (caries experience and treated decay),
  • twice as much difficulty in accessing dental care (untreated decay)
  • and three times the rate of dental disease (rampant caries) as White Non-Hispanic children.
Compared to children who speak English at home:
  • Students whose primary language is not English are more likely to have caries experience and treated decay;
  • almost twice as likely to have untreated decay;
  • and three times as likely to have rampant decay.
Bar graph showing differences in dental health between language groups

The researchers noted that these disparities exist despite a variety of dental programs the county offers low-income families, including community dental clinics, Public Health dental clinics, and the University of Washington Dental School and other dental programs.

“Despite these opportunities for care,” the researchers note, “children from low-income families continue to have elevated rates of untreated dental disease compared to the general population. This suggests that barriers to child dental care extend beyond finding a provider.”

To learn more:

  • Visit the Public Health – Seattle & King County’s Oral Health Program’s webpage where you can find links to the report as well as other information about dental health and dental care resources.
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