I wrote an essay...

      I wrote an essay...

      Hello all!
      I wrote an essay this morning, and in the spirit of its topic, I am sharing it with you ;)

      Fair and Equal Access to Oral Health Care

      Since I began my journey into dental hygiene, I had my mind opened to a world I could never have imagined that I, a poor country girl, would ever experience. Had I not discovered dental hygiene, I could not have imagined ever becoming a dental hygienist because I had never even had a cleaning. I could never have realized the risks involved with poor oral hygiene other than such basics as cavities and bad breath because my only exposure to this information had been TV commercials for tooth paste and rinse. My tiny school, at about 350 people including students and staff K-12, put little to no effort into oral hygiene education for students at any age group.
      At age 24, looking for a meaningful career, I was influenced by someone of privilege who said, “why not be a dental hygienist? They make loads of money”. In seeking this famed fortune, I gained vital knowledge pertinent to oral and general health; I was pulled from a life of struggle towards what I perceived to be a better life, but it turned out to be a better way to live. A way to give to others that which I never had, an education in dental hygiene.
      One could theorize that the disparity in diversity within members of the dental hygiene profession directly reflects the disparity of accessible oral healthcare to people of low income, under-served rural locations, and ethnic minorities.
      Is the profession prepared to work in community and health care settings?

      The profession of dental hygiene and dentistry in general are more than prepared to work in community health care settings, we are already capable of doing so and states have created programs such as Mission of Mercy to serve at a statewide level. Consistent oral health education in schools of all socioeconomic status, at least once per grade level, should be prioritized and possibly even made mandatory for schools to provide. Placing DHs in school settings as both educator and care giver would be a major benefit for students as they grow.
      These underserved populations are now where we must, as ethical professionals, focus our attention. The article “Dental Hygiene at the Crossroads of Change” mentions the use of “telemedicine technology” (Rhea, Beetles) as a way for a dental hygienist to work independently with the supervision and communication with a dentist. With the use of intraoral cameras, live video communications, portable x-ray units, and portable operatory systems, dental hygienists could serve far flung rural areas using a mobile setup.
      The simple provision of preventative services such as education and clinical screenings would enrich this population and help to identify those who need to seek further help from a dentist. A mobile system would also be helpful for serving people of low income and ethnic minorities who may lack access to care based on financial and/or transportation related needs.
      How can the profession increase its diversity and improve the cultural competency of existing members?
      Outreach to diverse populations, providing volunteer work, and participating in events which serve these populations is a great way to expose oneself to a diverse population. By encouraging people of all cultures to learn about dental hygiene and see the field as a possible career opportunity, we open the way for a more diverse population of hygienists.
      Increasing the diversity of students entering the college is also a stumbling block to improving diversity in the field. The CDC presents information which shows that “Adults aged 35–44 years with less than a high school education experience untreated tooth decay nearly three times that of adults with at least some college education” (CDC); from this we see that college plays some role in oral health. Many of those adults who do not go to college are also of ethnic minorities, the US census shows that 63% of non-Hispanic white people attained some college or more, while 52.9% black people and only 36.8% of those with Hispanic heritage had attained the same level or better (US Census). Nativity status as well as disabilities play a role in college attainment as well, with people of foreign birth and people with disabilities falling behind those with native status and able body.
      Improving the cultural competency of existing members could mean changing the basic DH education curriculum to include courses in cultural competency. Students could work with diverse populations in various ways, if not in person then via the internet or through reading or watching informational videos. We as people tend to fear that which we do not understand, and so learning about other cultures is vital to being able to treat people with compassion and provide equal quality of care. We need to get out of our comfort zones and try to see the world from the perspective of other people, only then can we understand their needs.
      Who are the potential partners in health care, government, business and the non‐profit sector that can help ADHA expand access to good oral health care?
      In introducing dentists and hygienists to hospital settings, we close the gap in oral to general health. Doctors partnering with dentists could provide all-inclusive healthcare for patients which equally addresses the health of the entire body. Dental professionals also have the ability to lobby, through ADA lobbyists, in favor or against various legislation in the advancement and betterment of our profession. The ADA Engage Legislative Action Center “uses Engage to send out action alerts, inform dentists on critical public policy issues, and put our members in contact with their legislators. Most importantly, Engage allows your voice to be heard in Washington” (ADA ELAC). It takes all of us pulling together to put our plans, hopes, and dreams into motion. The collective effort of DHs along with their dentists and offices, and with the help of volunteers, will shape what we want the profession to become.
      There exists a disparity in oral health as well as in diversity of our oral health professionals and by educating people equally, as well as providing opportunities, we can possibly improve diversity in both areas of concern. Greater diversity in college means better opportunities for increasing cultural competency for all students. By unifying dental professionals with general health professionals, we can provide quality all-inclusive care to all; this would broaden the horizons for many up-and-coming dental hygienists and dentists as it would likely create more jobs and possibly new specialty focuses. By serving the public at a higher level and reaching out as many people as possible, giving care to people who for whatever reason cannot obtain oral health care on their own, we are truly serving all people and enriching our profession.

      ADA ELAC. cqrcengage.com/dental/home
      CDC. www.cdc.gov/oralhealth/oral_health_disparities/
      Rhea, Marsha. Bettles, Craig. “Dental Hygiene at the Crossroads of Change” ADHA. Environmental Scan 2011‐2021. Print.
      US Census. www.census.gov/content/dam/Census/library/publications/2016/demo/p20-578.pdf
      "Doing nothing for others is the undoing of one's self" - Horace Mann

      Post was edited 1 time, last by “Zephez” ().

      I wrote another essay! Public service announcement regarding the risks of electronic cigarette use (took me about 15 total hours to write this).
      Electronic Cigarette Effects on Oral Tissues: Risks and Efficacy as Nicotine Cessation Therapy
      Electronic Cigarettes, also known as e-cigs and other slang terms, are an alternative method of nicotine consumption which involves the use of an atomizer. The atomizer heats the liquid, containing the nicotine and other agents, producing vapor which is inhaled. Vaping, what users call the smoking of the e-cigarette vapor, has become quite popular in recent years as an alternative to traditional combustible cigarettes and as an aid to quit smoking. There are few studies to prove the efficacy of using e-cigs outweighs the efficacy of other nicotine replacement therapies. Formulating a PICO question, I will strive to discover how we as oral health care professionals can help advise our patients. For patients who use electronic cigarettes, what evidence based advice can we give as to oral health risks they face in comparison to other nicotine replacement therapy products and going forward safely with tobacco cessation?
      I worked with my PICO question, forming some keywords for database searches. I searched PubMed, the online Metropolitan State University library, and researched sources from these articles as well as attended a CE course during the 57th Annual Dental Reviews which was presented by David D. McFadden, M.D. entitled Tobacco and e-cigarettes: Helping patients make healthier choices. My PubMed searches were worded as follows: “electronic cigarettes oral health”, “e-cigarettes effective for smoking cessation”, “e-cigs dental health”, “vaping effects on oral health”, and “vaping effective for smoking cessation”.
      My first conclusion drawn was from an article written by Bullen, Howe, Laugesen, McRobbie, Parag, Wilman, and Walker (2013) which was titled Electronic cigarettes for smoking cessation: A randomised controlled trial. The conclusion of Bullen et al was that “E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events. Uncertainty exists about the place of e-cigarettes in tobacco control, and more research is urgently needed to clearly establish their overall benefits and harms at both individual and population levels.” The theory and focus of the research concerned the potential for electronic cigarettes as a device for use in smoking cessation. Dr. Bullen’s team conducted randomized controlled trials to determine if their theory was correct, the study was stratified by ethnicity, sex, and level of nicotine dependence. This article is relevant to my PICO question and is quantitative in nature, so it applies through statistical analysis.
      From the article written by Javed, Kellesarian, Sundar, Romanos, and Rahman (2017), titled Recent updates on electronic cigarette aerosol and inhaled nicotine effects on periodontal and pulmonary tissues, we can draw the conclusion that e-cigarettes do have a deleterious effect upon oral tissues. Jayed et al (2017) states, “This mini-review summarizes the recent perspectives on e-cigarettes including inhaled nicotine effects on several pathophysiological events, such as oxidative stress, DNA damage, innate host response, inflammation, cellular senescence, profibrogenic and dysregulated repair, leading to lung remodeling, oral submucous fibrosis, and periodontal diseases”. The article illustrates well the connection between the exposure to e-cigarette aerosols and the reaction of tissues to those agents. The focus of this article is on the effect of electronic cigarette aerosols on the health of periodontal and pulmonary tissues, key information I pulled from this article is their finding that e-cig aerosols have a detrimental effect on the ability of myofibroblasts to repair injured tissues. Jayed et al (2017) specify that aerosols are the culprit, “direct exposure to e-vapor has been shown to produce harmful effects in periodontal ligament and gingival fibroblasts in culture. This is due to the generation of reactive oxygen species/aldehydes/carbonyls from e-cig aerosol, leading to protein carbonylation of extracellular matrix and DNA adducts/damage”. This is a recent study and the article was published February 2017, it is heartening to see more research done to determine the effects of e-cigarettes upon the oral tissues.
      After attending the 57th Annual Dental Reviews, and watching Dr. McFadden give his presentation, I learned from the information gathered by McFadden and Leischow (2017), titled Tobacco and e-cigarettes: Helping our patients make healthier choices. Dr. McFadden spoke on e-cigarette background, medical implications, the safety and contents of the devices, and touched briefly on their use in smoking cessation. The conclusion of this presentation was that we do not know enough about the safety, contents, and efficacy in NRT to recommend electronic cigarettes over FDA approved medications for tobacco cessation and behavioral therapy. FDA approved methods should be tried first before resorting to replacement therapy with e-cigs. This presentation provides valuable information about e-cigarettes and how we can inform our patients about the risks involved with their use. From this presentation, I took away some important strategies for consulting my patients on the use of e-cigs. McFadden and Leischow (2017) offer this list of what to tell patients:
      • We do not know:
      –If ENDS are safe
      –Which chemicals ENDS contain
      –How much nicotine users are inhaling
      –If ENDS are effective for smoking cessation based on controlled studies
      • Advice for Smoking Cessation?
      –Use FDA-approved medication
      –Behavioral treatment to improve medication adherence and address addiction challenges (p.65)

      In the Standards for Clinical Dental Hygiene Practice document, reading the first paragraph of the section titled ‘Dental Hygiene Process of Care’, what stood out to me was how our process of care truly is all-encompassing in being attentive to each individual patient’s needs. I enjoy being able to tailor each session I have with my patients to meet their needs; identifying the variables which determine their conditions so that these factors can be, as noted by Eklund et al., “reduced, eliminated, or prevented by the dental hygienist” (p. 5). I want the patient’s oral health needs to be the forefront of my EBDM. It is ultimately up to the patient to form their own decision, but it is our responsibility to provide all the necessary information for them to make an informed decision. As clinicians, we have the duty to continue our education in matters concerning oral health, as electronic cigarette use has been on the rise we must educate ourselves so that we will be ready to appropriately advise our patients.
      Putting this information into practice, I will use it in three different ways; first I will educate and inform my colleagues as to the new information and how we can, as a team, impart that knowledge to our patients who smoke. When providing tobacco cessation counsel, I will suggest that the patient first try FDA approved methods of nicotine replacement and treatments for addiction. If my patients are using e-cigs and do not intend to quit, we will know what we need to in order to fully inform our patients. My follow up will include standard intraoral charting and monitoring, including intraoral photos will also help the patient see any changes which may be clinically evident. I will continue to educate my patients as I continue my own education in the up and coming research regarding e-cigarettes.
      Broaching the topic of smoking cessation with our patients can be a difficult one, but it is ultimately imperative for their health that we adequately inform them as to their periodontal status and how smoking effects their health both systemically and orally. I have personally met smokers who thought smoking only yellowed the teeth and had no notion of how smoking is related to periodontal disease.
      In conclusion, I feel that the question of the safety of the e-cigs would prevent me from recommending this product to my patients. I do feel more confident in my knowledge of e-cigs and their effects on oral health and that I can convey this information to any patient in a way that is understandable and beneficial to my patients. If my patient informs me that they use an electronic cigarette I will, just as likely as with combustible cigarette users, ask if they would like to talk about quitting for their health. Providing this information to a variety of people will require that it be presentable in various languages.
      "Doing nothing for others is the undoing of one's self" - Horace Mann

      Something else I wanted to add, but couldn't find any peer reviewed articles on, was the battery source of the e-cigs. If the device has a lithium ion battery charger, it may pose risk of explosion. Anyone who uses this device should use only the charger and cord that came with it, do not use chargers and cords that did not come with the device as these may be the cause of malfunction.
      "Doing nothing for others is the undoing of one's self" - Horace Mann

      I wrote another paper, this one is significantly longer. I don't plan to publish it anywhere else, so I was hoping to share it with you guys...
      Community water fluoridation (CWF) has been hailed as a cheap, effective, and safe method to prevent cavities for over 70 years. Efficacy of fluoride in public drinking water is regarded by the Centers for Disease Control and Prevention (CDC) as one of ten great public health achievements of the 20th Century, placing CWF among medical advancements such as control of infectious diseases and reduction of heart condition related fatalities. State and local programs across the nation, in response to recommendations made by the U.S. Public Health Service, have been enacted to ensure optimal fluoridation of public drinking water. Optimal fluoridation refers to meeting dosage requirements as recommended by the U.S. Public Health Service, “a fluoride concentration of 0.7 mg/L (parts per million [ppm]) to maintain caries prevention benefits and reduce the risk of dental fluorosis” (p.319). Optimization is accomplished by either filtering the water to lower fluoride content or raising fluoride ppm content artificially. Dental caries rate across the lifespans of many Americans has been reduced dramatically by CWF, thus money spent on tooth restoration and time lost due to school/work absences related to tooth pain has also decreased.
      Despite the benefits for teeth, studies have unveiled some concerns regarding the side-effects of ingesting fluoridated water. Studies performed on non-human mammals and cells have shown negative effects related to fluoride ingestion, while other studies have concluded ingestion of fluoride may be linked to current pandemic concerns such as attention deficit hyperactivity disorder [ADHD], diabetes, and other physiological and neurological maladies. (Malin & Till 2015; Fluegge, 2016; Peckham & Awofeso, 2015). CWF has shown significant potential for both benefit despite the potential negative side effects, having it remain but improving optimization would better serve the public as a whole. There is a need for movement towards topical application of fluoride, rather than ingested, and the need for accessible preventative dental health care so that fluoride treatment can be managed on an individual basis. Community water fluoridation needs to be extensively evaluated to determine the rate of adverse effects caused by overexposure and exposure to artificially fluoridated water. Efficacy and economic benefits are positive effects of community water fluoridation; however, dosage is not regulated in response to other sources of individual fluoride consumption, topical effect is more beneficial than ingested effect, and well-founded concerns about adverse health effects have surfaced.
      Efficacy and economic benefit
      CWF is effective in caries prevention as well as an economical strategy to avoid the costs of restorative dentistry. The intent of community water fluoridation is to protect against dental caries via strengthening the teeth with fluoride, a mineral salt found naturally in almost all water sources, either raising or filtering the concentration to the recommended level. Efficacy of CWF was recently studied by the U.S. Health Service (2015), they determined the intended effect of reducing caries prevalence has been successful (p.319). As reported by McLaren, L., Singhal, S. (2016), caries rate increases with cessation of CWF, “Overall, published research on CWF cessation and dental caries points more to an increase in dental caries postcessation than otherwise” (p.6). With the long term effects of CWF, studies have shown the decrease of caries incidence as well as the correlated economic benefit of caries decrease. Economic benefits from CWF involve the reduction of caries and therefore the decrease in restorative work needed for caries treatment (U.S. Health Service, 2015, p.320; Ran & Chattopadhyay, 2016, p.790). As community water fluoridation has been successful in reducing caries, it would be counter-productive to completely cease CWF programs. Fluoride has been effective in reducing caries in a way which inexpensively reaches a large population of the nation.
      Dosage and optimization regulation
      The amount of fluoride consumed by the public is far greater than that expected to be derived from public drinking water. Fluoride source, content in processed foods and beverages, and rate of consumption effects the amount of fluoride ingested daily in addition to fluoridated water. Peckham and Awofeso (2015) argue that fluoridation of water has caused an increase in non-water fluoride sources such as foods processed in areas with fluoridated water (p.3). The U.S. Public Health Service (2015) argue that the additional fluoride consumed in foods and beverages prepared with fluoridated water increases the benefit to teeth as consumed fluoride exerts effect on teeth through the saliva; the maximum allowable received dose per day must be below “4.0 mg/L to protect against severe skeletal fluorosis” (p.319-320). Over-fluoridation has the proven effect of causing fluorosis of bones and teeth. Skeletal fluorosis is quite rare in the U.S., but dental fluorosis is more widespread if only in very mild to mild form (U.S. Public Health Service, 2015, p.323-324). Considering it is generally accepted that we should drink eight 8oz glasses (2 liters) of water per day for hydration and health, a person following these guidelines would get at minimum 1.4mg of fluoride per day from water fluoridated at 0.7mg/L. Peckham and Awofeso (2015) reference CDC data in determining that, “where water is fluoridated between 0.7 and 1.2 ppm overall fluoride, total fluoride intake for adults was between 1.58 and 6.6mg per day while for children it was between 0.9 and 3.6mg per day and that there was at least a sixfold variation just from water consumption alone” (p.3). The CDC data shows the amount of daily ingested fluoride exceeds the safe dose which was recommended by the U.S. Public Health Service (2015) to avoid severe skeletal fluorosis with 4.0mg or less daily (p.319). The resultant negative effects of fluoride overexposure create an ethical issue; in fluoridating the water of the public, there can be no accounting for individual consumption of fluoride from other sources.
      Topical vs. ingested fluoride effect upon teeth
      Topical fluoride is more effective in caries prevention than ingested fluoride. Topical fluoride provides the direct benefits of caries prevention while ingested fluoride ranges from effects of minimal benefit during tooth formation to adverse reaction in all stages of life. The U.S. Public Health Service (2015) observed notable benefits which can be related to CWF, but acknowledges that even though CWF has been successful in reducing caries overall, “…it remains one of the most common chronic diseases of childhood” (p.319). Topical fluoride, fluoride applied directly to the tooth surface through professional treatment or saliva, gives the benefit of fluoride protection and not by ingestion (Fluegge, 2016, p.2; Peckham & Awofeso, 2014, p.2). As logically concluded by Peckham and Awofeso (2014), “Given that most of the toxic effects of fluoride are due to ingestion, whereas its predominant beneficial effect is obtained via topical application, ingestion or inhalation of fluoride predominantly in any form constitutes an unacceptable risk with virtually no proven benefit” (p.6). The superiority of topical application over internal raises questions as to whether we should fluoridate water at all for the purpose of ingestion; however, as we have established, caries rate will increase with complete cessation so a topical solution must be found before discontinuing CWF.
      End of part 1, see part 2 for conclusions
      "Doing nothing for others is the undoing of one's self" - Horace Mann

      Part 2
      Adverse health effects may outweigh the benefit of CWF
      The potential of fluoride playing a role in the rise of systemic disorders is a chief concern for many researchers. Studies have been conducted which focused on the correlation between fluoride’s effect on maladies such as diabetes mellitus, attention-deficit hyperactivity disorder [ADHD], and excessive intake which leads to fluorosis. CDC hosted state water fluoridation reports have been used for collection of data in showing the link to diabetes and ADHD (Fluegge, 2016, p.6; Malin & Till, 2015, p.6). Neurological disorders may also have a link to fluoride overexposure. Malin and Till (2015) note an increase in ADHD prevalence nationwide, correlating the excessive intake of fluoride with consumption of processed foods, beverages, and swallowing of dental products such as toothpaste and mouthwash (p.2). This overexposure, combined with the prevalence of artificial fluoridation, could be a contributing factor to raised incidence of ADHD in areas of artificial fluoridation (Malin & Till, 2015, p.4). Chemical reactions between fluoride and blood glucose are a possible link between fluoride exposure and incidence of diabetes. Fluegge (2016) references increases in diabetes nationwide, a quadrupled amount of diagnosed individuals over the course of 32 years (p.2). A possible environmental cause for this could be, as reported by Fluegge (2016), the inhibitory effect of fluoride on glycolysis (p.2). Fluorosis is a disease which causes clinically visible evidence in teeth. With fluorosis, the teeth become stained splotchy white and in severe cases stained brown and pitted on the surface (U.S. Public Health Service, 2015, p.320-321). Peckham and Awofeso (2014) state that fluoride water concentration “…levels exceeding 0.3 ppm have been associated with teeth mottling and discolouration”; illustrating the symptoms of fluorosis and going on to report daily fluoride intake upwards of 2mg (p.5). The fact that fluoride has the capacity to interact with other materials and potentially cause health problems is a cause for concern and caution in fluoridation of public drinking water.
      Community water fluoridation has been an economically sound and successful solution to reducing rate of dental caries; it will always be viewed as a major milestone in preventative dentistry. According to studies, daily intake of fluoride is greater than what is intended for safe and effective fluoride exposure. Fluoride is most effective when applied topically to the teeth, in response to this the daily intake of fluoride should be reduced to balance and further optimize the benefits of fluoride while avoiding the risks. Some forms of artificial fluoridation have potentially increased risk for adverse health effects, further studies should be conducted and safer means of delivering CWF should be explored.

      Centers for Disease Control and Prevention. (1999). Ten great public health achievements -- United States, 1900-1999. Morbidity and Mortality Weekly Report, 48(50);1141. Retrieved Oct 22, 2017: cdc.gov/mmwr/preview/mmwrhtml/mm4850bx.htm
      Fluegge, K. (2016). Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health, 14(5) 864–877. doi: 10.2166/wh.2016.012
      Malin, A.J., Till, C. (2015). Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: An ecological association. Environmental Health, 14(17). doi: 10.1186/s12940-015-0003-1
      McLaren, L., Singhal, S. (2016). Does cessation of community water fluoridation lead to an increase in tooth decay? A systematic review of published studies. Journal of Epidemiology and Community Health, 70(9) 934–940. doi: 10.1136/jech-2015-206502
      Peckham, S., Awofeso, N. (2015). Water fluoridation: A critical review of the physiological effects of ingested fluoride as a public health intervention. Scientific World Journal, 293019. doi: 10.1155/2014/293019
      Ran, T., Chattopadhyay, S. K., the Community Preventive Services Task Force. (2016). Economic evaluation of community water fluoridation: A community guide systematic review. American Journal of Preventive Medicine, 50(6), 790-796.
      U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation (2015). U.S. public health service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Reports 130, 318-331.
      "Doing nothing for others is the undoing of one's self" - Horace Mann

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