Fluoride

Get Listerine fluoride for free with Obamacare – maybe

January 30, 2017 By Trish Walraven Leave a Comment

I feel very targeted right now.

It’s because I’m one of the 16% of Americans that everyone is fighting to either “guarantee insurance” for or “force insurance” upon, depending on which side of the aisle you stand.

You see, my family has Obamacare.

It’s not because we can’t afford anything else. It’s because there simply is no other major medical care available for small employers who either aren’t required to offer insurance to their employees or cannot obtain group insurance because of the size of the company. We privately purchase the exact same plan offered on the Marketplace; it’s off the exchange, though, so there are no subsidies.

Here’s the cool (mint?) reason for mentioning this on DentalBuzz. As part of a family that’s enrolled in a plan that was created due to Obamacare, I discovered by accident that there’s a way to get Listerine fluoride rinse for free.

What happened is that I was browsing through the 2017 drug formulary from my insurance company and found something called the ACA Tier. Almost every exchange-eligible plan has a No-Cost Preventive Drug List like this one from Blue Cross Blue Shield of Texas. It states in part:

Your health plan may include certain prescription and over-the-counter (OTC) preventive medicines, as a benefit of membership, at no cost to you when you use a pharmacy or doctor in your health plan’s network. There is no co-pay, deductible or coinsurance, even if your deductible or out-of-pocket maximum has not been met. Coverage for these medicines can vary according to the type of plan you are enrolled in…. Age limits, restrictions and other requirements may apply.”

So I’m going down the list and notice several entries for Listerine:

How can I get my free bottle, that’s what I said to myself when I read this. You want your free bottle too? Not so fast. All ACA-qualified plans are only required to cover fluoride for children under age 6. Which may mean that if you have children enrolled in Obamacare and they’re preschoolers, all you may have to do is to take your child’s bottle of Listerine up to the pharmacy window, present the insurance card, and they’re supposed to zero out the expense for you. I called my insurance company and this is what they stated. You’ll need to check your own benefit booklet first, though, because some plans only cover fluoride in other forms.

As a dental hygienist and mom, though, what’s a little perplexing is trying to figure out the label directions. We’ll go after this bottle of Listerine Smart Rinse, cause it’s cute and tough all at the same time.

Toddler-friendly? Check again.

There is a huge disconnect between the FDA and the ACA, and it shows on this label! The Food and Drug Administration says you shouldn’t give it to children under six without consulting a dentist or doctor, but the Affordable Care Act pays for its use only for children that age.

Anyway, we all realize that healthcare in the United States is a work in progress. In other words, it’s a mess, right? And most of us are very much out of our element when we’re trying to figure out what’s covered and what’s not. Did you know that even most dentists and hygienists are clueless about fluoride benefits and the ACA? The only reason that I know anything myself is because I did a bit of sleuthing, found a lot of the Obamacare plans in each state, read their Preventive Drug lists, and then compiled the research. Sure, this article starts off with a little Listerine click-bait (hah! Social Marketing 101 – make ’em look!) but I do want to offer some important education, too. Here goes.

• What do all ACA-qualified plans have in common with each other? At the very least, every insurance policy must include fluoride supplementation at no cost for children under age 5. Supplements are recommended mostly in areas where the fluoride level in water supplies are inadequate, and age five and below is the time frame when teeth can be protected most by the ingestion of fluoride. The supplements can be in the form of drops, chewable tablets, or as combination vitamins. All fluoride supplements require a prescription, either from a dentist or a physician’s office.

• Many health plans also pay for the in-office topical application of fluoride varnish. This is covered by the medical side of the plan, not the dental benefit, so you should either be savvy with using the medical code (CPT 99188) or leave it in the pediatricians’ sticky hands. Haha, sticky hands. If you’ve ever worked with fluoride varnish, it sticks to evvvverrrrry thing if you’re not careful. But hey, it’s why varnish can give up to six months of cavity protection, too. Some plans cover fluoride varnish applications as an unlimited benefit, however, I found that most plans pay for no more than two applications per calendar year.

• Some of the plans reviewed include prescribed and/or over the counter (OTC) topical fluoride gels, pastes, and rinses, such as the previously mentioned Listerine Fluoride, Act Rinse, Prevident, Fluoridex, Gel-Kam, Clinpro 5000, Phos-Flur, Omni Gel and others. A few of the plans even list brand-name toothpastes, although I wouldn’t count on those getting covered.

Although I reviewed somewhere in the range of 50-100 healthcare plans available, I can’t tell you specifically which fluoride products are covered by, say, Cigna versus Aetna, because they vary so much between states. You’ll have to read your plan, or better yet, call your insurance company. Be sure to share what you discover with your dentist, hygienist, or physician, so they can help your kids get the fluoride prevention that you’ve already pre-paid for.

Because, let’s face it, pre-payment is what preventive healthcare insurance is, anyways. You only “pay an ounce” for prevention, after all, so you should get at least that much back. Especially when a pound – 16 fluid ounces – of Listerine fluoride costs your insurance company only five bucks.

It sure beats the bill for a pound of actual cure.

Trish Walraven, RDH, BS is a dental hygienist from the Dallas/Fort Worth area who cropped out her lovely daughter in this photo because it’s very, very obvious that she’s older than five. She didn’t want the Obamacare Police to have anything on her if she did show up at the pharmacy begging for her “free” bottle of bubble-gum fluoride rinse.

References and resources

United States Census Bureau, Health Insurance Coverage in the United States: 2015 https://www.census.gov/library/publications/2016/demo/p60-257.html

Aetna Health Care Reform Preventive Care Drug List: https://www.aetna.com/content/dam/aetna/pdfs/formulary/2016_HCR_Preventive.pdf

American Academy of Pediatrics – Oral Health Coding Fact Sheet for Primary Care Physicians: https://www.aap.org/en-us/Documents/coding_factsheet_oral_health.pdf

Science-Based Medicine. Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers https://sciencebasedmedicine.org/preventing-tooth-decay-in-kids-fluoride-and-the-role-of-non-dentist-health-care-providers/

Kaiser Family Foundation. Health Insurance Coverage of the Total Population: http://kff.org/other/state-indicator/total-population/?currentTimeframe=0

United Healthcare. Topical Fluoride Treatment Dental Clinical Policy: https://www.unitedhealthcareonline.comTopical%20Fluoride.pdf

Humana Pharmacy Solutions. $0 Preventive Medication Coverage: http://apps.humana.com/marketing/documents.asp?file=2838979

Kaiser Permanente. Preventive Services Flier: http://apps.humana.com/marketing/documents.asp?file=2838979

Toothpaste can do more harm than good

December 30, 2014 By Trish Walraven 76 Comments

The next time a patient innocently asks me, “What’s the best toothpaste to use?” I’m going to unleash a whole Chunky Soup can of “You Want The Truth? You CAN’T HANDLE THE TRUTH!!!” Gosh, that’s such an overused movie quote. Sorry about that, but still.

If you’re a dental professional, isn’t this the most annoying question you get, day after day? Do you even care which toothpaste your patients use?

No. You don’t. Asking a dentist what toothpaste to use is like asking your physician which bar of soap or body scrub you should use to clean your skin. Your dentist and dental hygienist have never seen a tube of toothpaste that singlehandedly improves the health of all patients in their practice, and the reason is simple:

Toothpaste is a cosmetic.

We brush our teeth so that out mouths no longer taste like… mouth. Mouth tastes gross, right? It tastes like putrefied skin. It tastes like tongue cheese. It tastes like Cream of Barf.

On the other hand, toothpaste has been exquisitely designed to bring you a brisk rush of York Peppermint Patty, or Triple Cinnamon Heaven, or whatever flavor that drives those tubes off of the shelves in the confusing dental aisle of your local supermarket or drugstore.

Toothpaste definitely tastes better than Cream of Barf. And that’s why you use it. Not because it’s good for you. You use toothpaste because it tastes good, and because it makes you accept your mouth as part of your face again.

From a marketing perspective, all of the other things that are in your toothpaste are in there to give it additional perceived value. So let’s deconstruct these ingredients, shall we?

1. Fluoride.

This was probably the first additive to toothpaste that brought it under the jurisdiction of the Food & Drug Administration and made toothpaste part drug, part cosmetic. Over time, a fluoride toothpaste can improve the strength of teeth, but the fluoride itself does nothing to make teeth cleaner. Some people are scared of fluoride so they don’t use it. Their choice. Professionally speaking, I know that the benefits of a fluoride additive far outweigh the risks.

2. Foam.

Sodium Lauryl Sulfate is soap. Soap has a creamy, thick texture that American tongues especially like and equate to the feeling of cleanliness. There’s not enough surfactant, though, in toothpaste foam to break up the goo that grows on your teeth. If these bubbles scrubbed, you’d better believe that they would also scrub your delicate gum tissues into a bloody pulp.

3. Abrasive particles.

Most toothpastes use hydrated silica as the grit that polishes teeth. You’re probably most familiar with it as the clear beady stuff in the “Do Not Eat” packets. Depending on the size and shape of the particles, silica is the whitening ingredient in most whitening toothpastes. But whitening toothpaste cannot get your teeth any whiter than a professional dental polishing, because it only cleans the surface. Two weeks to a whiter smile? How about 30 minutes with your hygienist? It’s much more efficient and less harsh.

4. Desensitizers.

Teeth that are sensitive to hot, cold, sweets, or a combination can benefit from the addition of potassium nitrate or stannous fluoride to a toothpaste. This is more of a palliative treatment, when the pain is the problem. Good old Time will usually make teeth feel better, too, unless the pain is coming from a cavity. Yeah, I’m talking to you, the person who is trying to heal the hole in their tooth with Sensodyne.

5. Tartar control.

It burns! It burns! If your toothpaste has a particular biting flavor, it might contain tetrasodium pyrophosphate, an ingredient that is supposed to keep calcium phosphate salts (tartar, or calculus) from fossilizing on the back of your lower front teeth. A little tartar on your teeth doesn’t harm you unless it gets really thick and you can no longer keep it clean. One problem with tartar control toothpastes is that in order for the active ingredient to work, it has to be dissolved in a stronger detergent than usual, which can affect people that are sensitive to a high pH.

6. Triclosan.

This antimicrobial is supposed to reduce infections between the gum and tooth. However, if you just keep the germs off of your teeth in the first place it’s pretty much a waste of an extra ingredient. Its safety has been questioned but, like fluoride, the bulk of the scientific research easily demonstrates that the addition of triclosan in toothpaste does much more good than harm.

Why toothpaste can be bad for you.

Let’s just say it’s not the toothpaste’s fault. It’s yours. The toothpaste is just the co-dependent enabler. You’re the one with the problem.

Remember, toothpaste is a cosmetic, first and foremost. It doesn’t clean your teeth by itself. Just in case you think I’m making this up I’ve included clinical studies in the references at the end of this article that show how ineffective toothpaste really is.

• You’re using too much.

Don’t be so suggestible! Toothpaste ads show you how to use up the tube more quickly. Just use 1/3 as much, the size of a pea. It will still taste good, I promise! And too much foam can make you lose track of where your teeth actually are located.

• You’re not taking enough time.

At least two minutes. Any less and you’re missing spots. Just ’cause it tastes better doesn’t mean you did a good job.

• You’re not paying attention.

I’ve seen people brush the same four spots for two minutes and miss the other 60% of their mouth. The toothbrush needs to touch every crevice of every tooth, not just where it lands when you go into autopilot and start thinking about what you’re going to wear that day. It’s the toothbrush friction that cleans your teeth, not the cleaning product. Plaque is a growth, like the pink or grey mildew that grows around the edges of your shower. You’ve gotta rub it off to get it off. No tooth cleaning liquid, paste, creme, gel, or powder is going to make as much of a difference as your attention to detail will.

The solution.

Use what you like. It’s that simple. If it tastes good and feels clean to you, you’ll use it more often, brush longer, feel better, be healthier.

You can use baking soda, or coconut oil, or your favorite toothpaste, or even just plain water. The key is to have a good technique and to brush often. A music video makes this demonstration a little more fun than your usual lecture at the dental office, although, in my opinion you really still need to feel what it is like to MASH THE BRISTLES OF A SOFT TOOTHBRUSH INTO YOUR GUMS:

A little more serious video from my pal Dr. Mark Burhenne where he demonstrates how to be careful with your toothbrush bristles:

Final word.

♬ It’s all about that Bass, ’bout that Bass, no bubbles. ♬ Heh, dentistry in-joke there.

Seriously, though, the bottom line is that your paste will mask brushing technique issues, so don’t put so much faith in the power of toothpaste.

Also you may have heard that some toothpastes contain decorative plastic that can get swallowed. Yeah, that was a DentalBuzz report I wrote that went viral earlier this year. And while I can’t claim total victory on that front, at least the company in question has promised that the plastic will no longer be added to their toothpaste lines very soon due to the overwhelming amount of letters, emails, and phone calls that they received as a result of people reading that article and making a difference.

But now I’m tired of talking about toothpaste.

Next topic?

I’m bringing pyorrhea back.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She brushes her teeth every morning and night with a major-label toothpaste because she likes the way it makes her mouth taste but at lunch you never know. Sometimes it will be with a dry toothbrush, or dipped in her leftover coffee, one time she even brushed with a starlight peppermint out of desperation.

Resources:

PubMed.Gov: Role of dentifrice in plaque removal: a clinical trial.

PubMed.Gov: Clinical studies to determine the effectiveness of a whitening toothpaste at reducing stain

PubMed.Gov: Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes.

Vicky Flint RDH: The Truth about Toothpaste

DearDoctor.com: Toothpaste-What’s in it?

Trisha O’Hehir RDH: Dry Brushing -The Toothpaste Secret

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I got a potty mouth

July 21, 2008 By Trish Walraven 4 Comments

Hi. I’m a very sad American Indian. I am crying because I just learned that my children have Bisphenol-A in their dental sealants. BPA is bad. It means my boys might end up with man-boobs.

This is about dental pollution, people. It may be ignored by mainstream science, but this problem is real enough to sell newspapers, magazines, and make you read online articles.

What I’ve Heard About Dental Pollution

Everywhere I go I hear about how it’s not fair that the citizens of cities have no choice about the fluoride in their drinking water. Sure, it makes teeth stronger, but there’s a conspiracy of pollution! And it’s the people who are so poor that they can’t even afford cups, they have to tilt their heads sideways to drink under the sink faucet, they are the ones who get the most fluoride in their bodies.

Does fluoride save lives like chlorine does? Wait, I didn’t say that, because it’s going to sound like I am in favor of putting poisons in the water.

You dentists also are protecting the right to fix the holes in people’s mouths with evil substances. If you drill a tooth and put in a silver filling, you have to make the filling soft with toxic mercury. Why can’t you just heat up the silver and pour it in the cavity?

The high road dentists are no better, with their lady-man BPA-leaching plastic composites. I’d rather gnaw on a Nalgene bottle and take my chances with it than have an oil-slick wedged between my teeth 24/7. The recent petroleum price increases are nothing compared to the cost in human lives.

The other thing that’s polluting our mouths is lead. There’s been lead found in ceramic/metal crowns. They say these crowns come from China. We like to blame everything on China. But the real reason that there’s lead coming from the dental labs is because the cheap dentists have forced lab technicians to scavenge for scrap metal by secretly dumpster-diving for X-ray film packets.

My shaman tells me that all the metal he sees in people’s mouths is creating imbalance in their meridians. This pollution is caused by all the various metals sending out galvanic currents, which turns our mouths into electrolyte-driven batteries. It scares me even today when I see that trick with the guy who sticks the end of a lightbulb in his mouth and it turns on. I know he’s dying from galvanic currents just for a laugh.

One more pollutant that is caused by the well-meaning but unenlightened dentists of the world is when they leave a dead tooth in a living mouth. Would you leave a cadaver just laying around with living people? Well, this is just what is done when a dentist fills the root canal of a tooth and just leaves the dead shell of a tooth in place.

I’m no Navajo with my sand art, but I sketched out this modern flow chart to help us understand where all this pollution is leading:

The pollutants are circled in red. Only one treatment is circled in green because it doesn’t involve dental pollution.

With only two choices in life if we find that we need a dentist – a polluted mouth or the totally toothless gums of a baby – all we can do is pray to our ancestors to give us naturally strong, healthy teeth.

My life has been one of ignorance until now. I have been going to the dentist regularly, and have had various pollutants placed in my mouth. I still have all of my teeth and have no ill symptoms from the poisons. Should I be grateful, or should I be worried? Are teeth worth it, in the end?

Six Degrees Of Dental Pollution

Here are various tests that you can either do in your office or send home with patients to make sure that you aren’t polluting their mouths:

Fluoride: http://www.hach.com

Bisphenol-A: http://www.biosense.com

Mercury: http://www.heavymetalstest.com/_hgkit.php

Lead: http://www.zefon.com/store/leadcheck-swabs.html

Galvanic Currents: http://www.biomeridian.com/devices.htm

Root Canal Therapy: http://www.holisticdentist.com/articles/root-canal-treatment.html

I know that this isn’t Keep America Beautiful or any other grand public service announcement, but it’s important for dentists to understand the consequences of their actions. And sorry about the waterworks; you know how pollution is a touchy subject for me.