Vitamin D and Dental Health

Karen

Karen Kelley RDH

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I recently read two articles, the first by Dr. Richard Kim, a dentist who practices in New York City, and the second on the website doctorshealthpress.com. They both have information from a Boston study about the correlation of Vitamin D and Dental health. I was interested to learn that so many people have a deficiency of Vitamin D and how it can affect dental health.

This is a portion of Dr. Kim’s article:

“Medical researchers have long known that Vitamin D has many oral and overall health benefits, but there is growing concern that deficiency of this critical nutrient is more common than once thought. Understanding the benefits of Vitamin D, where it comes from and who is at risk for deficiency could make an important difference in your general and oral health.

Somewhere along the way you can probably remember being told to have plenty of calcium in your diet to build strong bones and teeth. Fortunately calcium is everywhere – readily available in many of the foods we all love like milk, cheese, ice cream and even commercially added to orange juice, breads and cereals. Perhaps you didn’t know that without Vitamin D, the body can’t absorb that calcium… no matter how much of it you swallow!

A diet lacking or low in vitamin D will contribute to a phenomena known as “ burning mouth syndrome”, symptoms of which can include dry mouth, a burning sensation of the tongue and oral tissues and a metallic or bitter taste. The condition is most common in older adults who, coincidentally, are frequently found to have a Vitamin D deficiency! Oral Health scientists have found that in addition to many general health benefits, Vitamin D helps to reduce inflammation in the body, which is widely known to have a direct impact on the development and severity of periodontal (gum and bone) disease. As a matter of fact, according to a study published in the Journal of Dentistry (1) among 6700 research participants, those who had the highest blood levels of Vitamin D were about 20% less likely to have gum disease.

Vitamin D is produced naturally by the human body when skin is exposed to sunlight, but more often than not people choose to protect themselves from the harmful effects of ultraviolet rays. Sunscreen and protective clothing may prevent getting enough vitamin D from the sun; and deficiency is common among people who live in northern latitudes or other areas that receive limited sunlight. Up to 50% of older adults have inadequate Vitamin D levels, perhaps partly due to decreased outdoor activity and sun exposure.

Although it is a rule of thumb that the best source of nutrients is a natural one, Vitamin D supplements are readily available over the counter and routinely recommended to individuals at risk for deficiency. Do you have unexplained body or mouth symptoms? Could you be at risk … or have you been recently diagnosed with low Vitamin D levels? Your doctor and dental professional can advise you about the benefits of a supplement, and a recent discovery of Vitamin D deficiency is a good reason to schedule your regular dental checkup.

1. Journal of Dentistry (2005), 33:703–10.”

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From the doctorshealthpress site:

Vitamin D isn’t just for your bones anymore.

This versatile vitamin is now showing promise in the fight against gum disease as well. According to a new study, vitamin D has both anti-inflammatory and immunomodulatory properties. (This means that it can reduce inflammation and boost your body’s ability to fight off infections.) It appears that people who have more vitamin D in their bodies run a lower risk of contracting gum disease.

The Boston-based study looked at 6,700 people who had never smoked before. They examined the gums and teeth of these people and compared their vitamin D status to the health and inflammation of their gums. Adjusting for age, previous dental work, dental hygiene, and other factors, it was found that people who had a higher intake of vitamin D also had overall healthier gums.

In fact, those who had the highest levels of the vitamin in their body reduced their risk of bleeding during oral examination by 20% when compared to patients who had the lowest intake of vitamin D.

So, if you thought this power-packed vitamin was only good for helping your bones, you were wrong. The evidence speaks for itself — vitamin D plays a double role. It acts as an anti-inflammatory and it may just help you walk out of your next dental appointment with less pain and bleeding.

So ensure that you allow your body to produce enough vitamin D. It’s a good reason to get just a few minutes of sun at least three times a week. Make sure you don’t overdo it, unless you are wearing sunscreen. If you can’t get outside, at least try taking a supplement in order to help you get all you need of this wonderful nutrient.

http://www.doctorshealthpress.com/food-and-nutrition-articles/vitamin-d-is-good-for-your-gums-too

After reading these articles, I started doing some of my own ‘research’. I began asking my patients who generally had good overall brushing and flossing habits, not stellar, but good, who’s gums generally looked healthy, but when I was scaling (cleaning) their teeth, they bled more than they should if their gums were truly healthy. (Healthy gums shouldn’t bleed!) Most of the patients that I asked told me they had been diagnosed with low Vitamin D levels! This was very interesting to me. I did some other reading about Vitamin D deficiency and found how common it is. It’s interesting to me that anyone living in the “Valley of the Sun” could be deficient in Vitamin D, but it actually is common.

I also found this article on Web MD entitled:

Keep That Smile! Calcium and Vitamin D Prevent Tooth Loss

“If you’re supplementing your diet with calcium and vitamin D to prevent bone loss, you may be more likely to hang onto your pearly whites, according to a report at this week’s meeting of the American Society for Bone and Mineral Research in Toronto. Even so, older adults need to floss their teeth and see the dentist regularly because with increased age come increased risks for losing teeth.

“Studies have shown that calcium and vitamin D decrease bone loss in the hip and forearm, but we weren’t sure if they had an effect on tooth loss,” says lead author Elizabeth Krall, MPH, PhD, a researcher at Boston University Dental School and Tufts University Nutrition Research Center. “Now we know that supplementation may also improve tooth retention, along with routine dental care and good oral hygiene,” she tells WebMD. To explore the role of supplementation on tooth retention, the researchers followed more than 140 older adults for five years. Participants took either a placebo or 500 mg of calcium plus 700 units of vitamin D daily for three years. Both during and after the trial, their teeth were examined periodically. For those who took supplements, the likelihood of losing one or more teeth was 40% less, even two years later.” ( http://www.webmd.com/oral-health/news/20000927/keep-that-smile-calcium vitamin-d-prevent-tooth-loss)

Anything that gives our patients a 40% less chance of losing a tooth and 20% less gums disease and bleeding during their dental visits is certainly worth looking into further. If a person is low in Vitamin D, it is an easy thing to implement a supplement or sun into a daily routine. The National Institute of Health recommends 10 to 15 minutes of outdoor activity two times a week to get enough Vitamin D. They also suggest for areas where they don’t have as much sun as we do, that vitamin D can be received by consuming milk, eggs, and fish. The Vitamin Council gives further instructions to individuals with periodontal (gum) disease. The Council says for someone with gum disease they may want to consider taking measures to raise their vitamin D blood levels to 40 ng/mL (100 nmol/L). They also suggest moderate UVB exposure (without sunburn) but additionally recommend oral intake of vitamin D and calcium supplements.

If you’re over 50 and have some symptoms of gum disease, ask your MD what your Vitamin D levels are now (they can do a simple blood test) and what you should be doing to raise your Vitamin D to an acceptable level.

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Keep smiling, Karen Kelley R.D.H.

 

 

Sources:

http://www.vitamindcouncil.org/health-conditions/periodontal-disease/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768179/

http://www.easy-immune-health.com/Vitamin-D-and-Teeth.html

http://www.doctorshealthpress.com/food-and-nutrition-articles/vitamin-d-is-good-for-your-gums-too

http://nydentallife.wordpress.com/author/nydentallife/

Photos:

www.hayleyhobsonblog.com

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Dental Insurance 101

Kim McCrady

Kim McCrady RDH BS

Dental insurance can be a confusing subject to even the savviest subscriber.  Why?  They make it confusing for a reason. Dental insurance companies are in business to make money for their stockholders and to pay out as little as possible on YOUR dental claims. Did you know, on average an insurance company has a goal to pay out less than 35% of your total maximum annual benefits?  That is roughly $350 per patient per year.  That covers routine exams, x-rays and routine dental cleaning twice in a 12-month period of time.   The good news is we are here to help you navigate the gauntlet and get your moneys worth from your plan.

1-     Know your dental insurance plan.  A common mistake is to assume your medical and your dental insurance are the same company.  Almost always, this is not the case.  Interestingly,  many dental insurance companies do not provide you with an ID card.  The solution is to ask your HR department.  They should be able to provide you with the name and the phone number of your dental insurance carrier. EX:

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www.deltadentalva.com

2-     Providing accurate information to your dental office is the first step to getting your claims paid.  You will need your subscriber ID number and the subscribers’ date of birth and the patients date of birth.  You should know many companies still use your social security number to identify you in their system.  If you are uncomfortable with them using your social security number you can request a unique ID number.

3-     Know your annual deductible.  Almost every dental plan has a deductible they require you to satisfy before they begin to pay out benefits on your dental claims.  This deductible can vary in amount.  There are usually individual and family deductibles.  Family deductibles are often three times the individual deductible. Deductibles can apply to any dental service billed to your insurance company.

4-     Many plans do NOT reset your annual benefits in January.  You should know your benefit year.  This is important so you do not leave unused benefits to the insurance plan.  By knowing your plan year, you can maximize your coverage.

5-     Your plan has a maximum amount of benefits they will pay on each family member each benefit year.  The average maximum benefit is $1500 per year.

6-     Although your plan has a maximum amount of benefits per year that are earmarked for your care, the insurance companies pay out your benefits on a percentage scale, NOT at 100% per claim until you have reached your maximum.   This scale usually has three categories for dental services:

1-Preventative

2-Basic

3-Major

Each insurance company places dental services into a category.  It is important to know how your plan categorizes services so you can better understand you estimated coverage from you dental plan.

7-     When your dental office estimates insurance coverage for the dental services you are receiving from the office, it is only as ESTIMATE.  Any time you or your dental office call your insurance carrier, the insurance company representatives often read a disclaimer to inform you a description of benefits is NOT a guarantee of payment.  It can be very difficult to provide an accurate estimate of insurance coverage.  You should expect a down payment for your care and a balance bill after your carrier has processed your claim.

8-     Once your dental claim has processed and your plan has paid their percentage of the services to your dentist, you receive an explanation of benefits (EOB).  Many people do not even open their EOB’s and read them.   They can be very complex, but very informative.  EOB’s include the fees billed to your plan for services rendered, payments made by the insurance company on your claim and the patient portion for the services.  Often, your plan will include any notes explaining adjustments to payments, including subjecting the claim to frequency limits for services, other exclusions including a feature referred to as down coding.

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www.bcbs.com

9-     Down coding is a loophole insurance companies have instituted that allows them to pay their contracted percentage on a lesser service.  The two most common down coded procedures are tooth colored crowns and tooth colored fillings on back (posterior) teeth.   For example, if a tooth colored filling costs $200 and you have 80% coverage on basic services, most plans will not pay the $160.  They will “down code” to minimize their responsibility for the services.   Therefore, the claim will be received at $200, subjected to your deductible, down coded to a fee for a lesser service, such as a silver filling at $140.  Assuming a $50 deductible, the insurance will pay their 80% on $90 instead of $200.  This nets a total insurance payment of $72 on your $200 claim and a $128 patient portion.

10- But what if you have a secondary plan to help with your dental claims? Be careful and DO NOT assume your secondary plan will pick up the patient portion for your primary claim.  You need to be sure you know if your secondary plan has a “non-duplication of benefits clause”.  This means your secondary plan will only pay the difference between what your primary plan covered and what they would have covered if they had been primary.  For example, if a claim is submitted for $1000 for dental services to your primary insurance company and your primary covers the service at 50% (assuming the deductible is satisfied and there is no down coding) the primary should pay $500.  If you have a non-duplication of benefits clause, the secondary will not pay the patient balance of $500 to complete the claim if, they too, would have covered the services at 50%.  But let’s say the secondary plan had 60% coverage for the services rendered and would have paid $600 on the claim.    Then they should make payment of an additional $100 so the total insurance payments received between the two plans is equal to the payment they would have made, had they been the primary plan.  Secondary insurance often is most beneficial when the primary plan has been maxed out and the secondary begins to pay benefits for care.

In plain English, dental insurance is very different than medical.  There are no set co-payments for each office visit.  Each visit is considered by your plan once it is received and processed according to the guidelines and limitations of your plan.  There are thousands of dental plans with thousands of loopholes and limitations.  And it seems the limitations are changing on a daily basis.

Your best bet to successfully utilize your dental insurance coverage is to join forces with your dental office administrators.   They spend hours obtaining breakdowns of benefits, applying this information to your care plan, sending the claim with all supporting documentation, following up on the claim weekly to assure payment on your behalf and will often have to repeat the process for you when the insurance company claims to have not received the information.  Be kind to them.  They are working for you to get you more than the average 35% of your benefits.

Want to learn more? Visit us at http://www.northstapleydentalcare.com/