Anti-fluoride legislators cry 'local control' and 'forced medication;' dentists say it's been proven to reduce tooth decay for 70+ years

Centers for Disease Control and Prevention graphic; click to enlarge

By Deborah Yetter

Kentucky Lantern

As a dental hygienist working with low-income schoolchildren in Louisville, Jennifer Hasch said the untreated tooth disease she saw was shocking.

Some teens had decay so severe they had to have all their teeth pulled and be fitted with dentures. Middle-school kids reported being unable to sleep because of pain from infected and abscessed teeth. First- and second-graders required inpatient oral surgery under anesthesia because of the severity of tooth and gum disease.

“It was heart-wrenching,” said Hasch, who’s on the steering committee of the Kentucky Oral Health Coalition.

Adults don’t fare much better.

Kentucky ranks 49th in overall oral health and is among the top states in the number of toothless, older adults. And last year, a University of Kentucky oral health physician described to legislators patients being air-lifted to the UK hospital because of life-threatening infections from dental disease.

Yet a group of lawmakers led by Rep. Mark Hart, R-Falmouth, is pushing a bill to make fluoridation optional for local water districts, despite what Hasch and others, including the American Dental Association and the Kentucky Dental Association, say is overwhelming evidence fluoride safely helps reduce tooth decay.

“It’s a bill that will undo an unfunded mandate and return the issue to local control,” Hart said, speaking before the Feb. 7 meeting of the House State Government Committee in support of his House Bill 141.

Hasch and other oral health professionals are fighting HB 141, which would eliminate the fluoridation mandate established in 1954.

“There are kids that already are suffering,” Hasch said. “Water fluoridation protects that from getting worse.”

Dr. Stephen Robertson, executive director of the state dental association, urged lawmakers to reject HB 141, saying “Kentucky is not in a position to take a step backward in oral health.”

“Please listen to our professional advice and continue to provide consistent fluoride access to our patients in community water supplies,” urged Mary Ann Burch, representing the Kentucky Association of Dental Hygienists.

They didn’t.

Instead, the committee approved HB 141 by a vote of 16-1, framing it not as a public health issue but rather one of local autonomy. The bill now is pending in the House.

“This is a local control issue,” said co-sponsor Rep. William Lawrence, R-Maysville. His city was the first in Kentucky to add fluoride to its drinking water supply in 1951.

“Local control — that’s what this bill is about,” said Rep. Steve Rawlings, R-Burlington, also a co-sponsor.

“Let’s just leave it to local control,” said Rep. Kevin Bratcher, R-Louisville.

In all, six members of the committee cited “local control” as grounds for passing HB 141. Rep. Keturah Herron, D-Louisville, cast the only no vote.

Bill hasn't moved since Feb. 9

After getting out of committee, the bill went to the House Rules Committee, which is controlled by House leaders. It has been there since Feb. 9, which could indicate that its sponsors haven't yet rounded up the votes to pass it through the full House.

Meanwhile, though, the prospect of allowing local water utilities to eliminate fluoride from drinking water has Kentucky dental and public health officials frantic.

“Other than setting my hair on fire, there’s not enough words I can say that this is a critically important step, if Kentucky takes it, to harm developing teeth, children’s teeth and adult teeth,” Dr. Connie White, Kentucky’s deputy public health commissioner, said on a recent call with health advocates.

Fluoride reduces cavities by 25%, White said.

Not only will it lead to even more tooth decay than Kentucky already has, she said, it will drive up costs of Medicaid, a government health plan for low-income individuals that covers nearly half of Kentucky’s children.

Filling one cavity in a child costs Medicaid about $250, which could add million of dollars to the cost of the program, White said.

Already facing a shortage of dentists in the state, especially pediatric dentists, removing fluoride from community water supplies will mean longer delays in care, Hasch said.

“We don’t have the resources to handle that increase,” Hasch said. “All these dental providers are desperately trying to catch up with the current need.”

Dr. Bill Collins, a longtime dentist in Eastern Kentucky, said too many children in rural areas on well or cistern water already lack access to fluoridated water and suffer much more from dental decay as a result. Compounding the problem is high use of sugary sodas and lack of access to oral health care throughout the state.

He said he’s baffled about why lawmakers want to remove the fluoride mandate.

“They don’t see the need for fluoride because they haven’t experienced the decay that we have out in the rural areas,” said Collins, director of the Red Bird Mission dental clinic in Beverly, in northern Bell County. “If this happens, they’re going to experience it and they should be held responsible.”

‘Grounded in science’

Kentucky's statewide adoption of fluoridation, hailed as one of the major public-health advances of the past century by the U.S. Centers for Disease Control and Prevention, has made Kentucky a national leader, advocates said.

A naturally-occurring mineral, flouride helps strengthen tooth enamel and prevent decay when added to water in small amounts, Hasch said. It helps when children’s teeth are developing, but the main benefit is topical exposure to fluoride from drinking treated water.

The recommended level is 0.7 parts per million, which Hasch said is comparable to adding one drop of fluoride to about 11 gallons.

The Louisville Water Co., the state’s largest public water provider, has been adding fluoride to water it gets from the Ohio River since 1951, said spokeswoman Kelley Dearing Smith.

The river water already contains some natural fluoride and the water company adds enough to bring it to the recommended level, she said.

“We are grounded in public health,” she said. “Everything we do is grounded in science.”

The Louisville Water Co. joined insurer Delta Dental of Kentucky, the dental and dental hygienists associations, the Oral Health Coalition and the Kentucky Primary Care Association in a letter to legislators urging them to reject HB 141.

“Community water fluoridation is a safe, reliable cost-effective prevention measure to keep teeth strong and reduce cavities by at least 25%,” the letter said. “We are deeply concerned about any efforts to make water fluoridation programs optional in our communities.”

‘Forced medication’

Questions about fluoride’s safety and efficacy have persisted over the years, despite evidence to the contrary. 

Four rural water districts submitted letters in support of HB 141: the Grayson County Water District, Irvine Municipal Utilities, the Martin County Utility Board and the McCreary County Water District.

Craig Miller, division manager for the Martin County water utility.], wrote, “The facts are out there proving fluoridation of water is dangerous to human health.” He said eliminating fluoridation would save Martin County about $14,000 a year, which he said could be better spent upgrading the problem-plagued water system.

Nina McCoy, a longtime activist for better water in Martin County and a member of the utility board said she wasn’t consulted on HB 141 and the board didn’t vote on the matter. She suggested legislators defer to public health officials. “I don’t pretend to be an expert in this at all,” she said.

A letter from Stephen Whitaker, superintendent of the McCreary water district, cited potential “adverse effects of fluoridation” including thyroid, tooth and bone problems.

Lawrence, a co-sponsor of HB 141, called adding fluoride to water “forced medication.”

Hasch, with the Oral Health Coalition, dismissed claims of studies linking water fluoridation to health problems as “junk science” and said the overwhelming body of research supports it as safe and effective.

Collins, who has practiced dentistry in Eastern Kentucky for more than three decades, said he doesn’t understand persistent distrust of fluoride.

“I really don’t understand why they are so adamant about removing this,” he said. “It’s something that’s time-tested and shown to be a good thing and it’s safe. It’s just mind boggling.”

Kentucky water plants would no longer have to add tooth-protecting fluoride to water, under bill approved by a committee

By Liam Niemeyer
Kentucky Lantern

Kentucky water utilities would no longer be required to add or adjust fluoride in tap-water supplies — a state requirement since the mid-20th century aimed at improving dental health — under a bill a legislative committee approved Thursday, Feb. 8.

House Bill 141 is the latest effort by Rep. Mark Hart, R-Falmouth, to remove the state requirement for water utilities serving populations larger than 3,000 to add or adjust fluoride levels in drinking water systems to “protect the dental health of the people served.”

Rep. Mark Hart, R-Falmouth
(Ky. Lantern photo by Liam Niemeyer)

Hart, a legislator since 2017, was the only sponsor of making drinking-water fluoridation optional when he filed the first such bill in 2018. The legislation has gained Republican co-sponsors as it has been filed several times over past legislative sessions.

The House State Government Committee heard the proposal for the first time Thursday and approved it 16-1. The bill now goes to the House floor for consideration.

Republicans who voted for the bill, and advocates for the legislation who joined Hart, characterized the bill as providing “local control” for utilities to choose whether or not to fluoridate their water. Those advocating the bill included representatives of Morehead’s municipal utility, Irvine’s municipal utility and the Grayson County Water District.

Some advocates for the bill questioned the efficacy of adding fluoride to tap water and its potential side effects.

“Honestly, it is forced medication,” said Rep. William Lawrence, R-Maysville, a co-sponsor of HB 141. “Whether you’re for or against fluoride, this bill has nothing to do with that. This is a local control — let the local water districts decide what’s best for their district.”

The Centers for Disease Control and Prevention considers community water fluoridation to be one of the 10 greatest public health achievements of the 20th century. The federal public-health agency also has found no “convincing scientific evidence” linking fluoridation to “any potential adverse health effect or systemic disorder.”

Groups representing dentists, oral-health advocates and the dental insurer Delta Dental strongly opposed the bill, saying it would increae tooth decay, particularly among children. Kentucky already ranks among the highest for the number of adults with no teeth.

“We have reached the point where it’s not about the science, it’s about the emotion,” Stephen Robertson, executive director of the Kentucky Dental Association, told the Lantern after the committee approved the bill. “No matter what your position is, you can find something out there that’s going to validate your position.”

Jack Kall, a Louisville dentist and supporter of the bill, showed lawmakers cited graphs from a 2016 magazine article by the Harvard T.H. Chan School of Public Health that questioned the efficacy and safety of fluoridation. That article was strongly criticized by the American Dental Association, saying it relied on a report that was a “biased misinterpretation,” and the dean of the Harvard School of Dental Medicine at the time called for the article to be rescinded.

Kall, citing the graphs, asserted that countries that don’t fluoridate water have had a similar decline in tooth-decay rates as countries that do. He told the Lantern that fluoride can lower intelligence in children; a federal court case is litigating whether the mineral has an effect on brain development.

“It’s a hot topic and science continues to evolve,” Kall said. “We should constantly be reviewing things.”

Robertson said there are studies regarding fluoride that need to be verified and that improvements in nutrition and personal dental hygiene also could improve dental health in Kentucky. But fluoride in drinking water, he said, is a “program that works.” He asked, “Are we willing to take the risk of removing fluoride and seeing what happens?”

Sugar season has started, so brush your teeth twice a day, floss daily, and drink plenty of water, UK dental-school dean advises

Photo illustration by Viktoriia Hnatiuk, iStock/Getty Images Plus

By Jeff Okeson, D.M.D.

Professor and dean, University of Kentucky College of Dentistry

From Halloween through New Year's, holiday parties and family events are filled with gifts and delicious treats. Kids go trick-or-treating, pies are baked and cookies are decorated. It’s the time of year that brings everyone together.

But with all the sugary treats, increased potential for cavities can be a concern. Cavities are small holes in the teeth caused by tooth decay. Eating sugar without proper dental hygiene can lead to plaque buildup on teeth, which can dissolve the enamel on teeth and eventually cause cavities.

It’s important to pay attention to holiday favorites like sugary baked goods, candied nuts and candy canes that contain a lot of added sugar which can lead to tooth decay. It’s also easy to forget that holiday drinks like apple cider and cocktails can be acidic leading to tooth erosion.

While sweet treats can be enjoyed, as we head into the fall and winter months it is important to stay on top of your oral health to ensure your dental visits are cavity-free. Here's how to do that:

Brush your teeth properly. Adults and children alike should brush their teeth twice daily with fluoride toothpaste for a full two minutes. Divide the mouth into four sections, top right, top left, bottom right, bottom left and brush each section for 30 seconds. Gently rotate the toothbrush bristles in circles, being careful not to irritate the gums. Rinse the mouth to wash out all toothpaste.

Floss daily. Flossing is equally as important as brushing. Flossing cleans hard-to-reach areas between the teeth and below the gum line. One of the most common places for a cavity to form is between the teeth, which is why flossing is necessary when cleaning the entire mouth. Adults and children should floss their teeth at least once a day, ideally at night before bed.

Drink plenty of water. Staying hydrated is beneficial for overall health, but drinking water is also one of the easiest ways to help prevent cavities. Water containing fluoride strengthens teeth and prevents decay. Water also washes away leftover food and residue that can lead to cavity-causing bacteria.

Visit the dentist regularly. Adults and children should visit the dentist for routine check-ups every six to 12 months. Visiting the dentist regularly lets people know if they are at risk for cavities. Once a patient is seen, dentists can understand which treatments might be needed or what changes in oral hygiene or diet might help reduce their risk of tooth decay.

While these tips can help prevent tooth decay, even the most diligent brushers can still get a cavity. There are a few telltale signs that indicate a dental visit is needed. Contact a dentist or health care provider if you experience any of the following symptoms:

• Toothache or pain
• Sensitivity to heat or cold
• Tooth discoloration
• Swollen gums

Holiday sweets and drinks are something to look forward to and may be hard to avoid completely. Instead of worrying about what isn’t okay to eat, focus on consuming in moderation. Drinking plenty of water and keeping up on your brushing and flossing are some of the best ways to take care of oral health.

Legislators waive chance to set up repeal of expanded Medicaid services, and are talking with administration officials about it

University of Kentucky dental Dean Jeffrey Okeson, left, spoke to
a legislative committee in August unsupport of expanded Medicaid
dental services along with Dr. Margaret Hill center, dental dean at
the University of Louisville, and Dr. Pamela Stein, dental dean at
the University of Pikeville. (Kentucky Lantern photo by Deborah Yetter)

By Deborah Yetter

Kentucky Lantern

Around 400 patients every week, most covered by Medicaid, flood the University of Kentucky’s dental clinic seeking care they can’t find elsewhere for advanced tooth decay or other oral disease.

Some are in such critical condition they must be airlifted to UK, Dr. Melvyn Yeoh, the university’s chairman of oral-health science, recently told state legislators. Swelling from dental infection threatens some patients’ airways, leaving them unable to survive an hours-long ambulance ride to Lexington from rural Kentucky.

Others arrive with advanced oral cancers that could have been detected and treated sooner with regular dental care.“Bad teeth cause life-threatening infections,” said Yeoh, who testified Sept. 12 before a legislative committee in support of expanded Medicaid dental benefits.

“With late-stage oral cancer diagnosis, people can die,” Yeoh added, noting that Kentucky has the nation’s second highest rate of oral cancer. It ranks 49th in overall oral health.

Some patients wind up in intensive care for days or weeks, Yeoh said, and such cases run up hundreds of thousands of dollars in medical bills, often paid by Medicaid, in cases that might have been addressed earlier at far less cost in a dentist’s office.

“It’s actually driving up the costs of health care,” he said.

Yeoh was one of the latest health professionals to speak on behalf of expanded Medicaid dental services, as well as broader hearing and vision care, introduced this year by Gov. Andy Beshear.

“I am extremely excited about it,” Yeoh told the committee. “We think it can do a lot for us as providers of dentistry in Kentucky.”

But the Democratic governor's changes have run into a wall of opposition from Republican legislators who control the General Assembly and claim he usurped their authority by expanding care through executive order.

Legislators can’t take any action to override the expanded benefits until they meet in the next legislative session in January, but some continue to blast Beshear, who is seeking a second term in the Nov. 7 election.

‘At home on their couch’

An outspoken critic, Rep. Randy Bridges, R-Paducah, said at the Sept. 12 hearing that Beshear’s effort was “a loophole or political move” to avoid going through proper legislative channels.

Senate Majority Floor Leader Damon Thayer complained that Medicaid — which covers health care for some 1.6 million low-income Kentuckians, about one-third of the state’s population — has grown too large and includes enrollees simply unwilling to work.

“When I continue to see these stories about 18- to 34-year-old white men who’d rather sit at home on their couch with their Netflix remote and their DoorDash, it really aggravates me that they are living on the taxpayers’ money when they are able-bodied and should be out there working,” Thayer said.

Thayer didn’t cite any source for that claim, and Medicaid money goes to providers, not patients. Advocates who spoke that day said his characterization was inaccurate because most Medicaid beneficiaries who are not disabled work at low-wage jobs that don’t include health coverage. 

To get better jobs, they need better health benefits, which may help them get into the labor market, advocates said.

“We’re talking about workforce readiness here,” said Sheila Schuster, executive director of the Kentucky Mental Health Coalition. “If we want people to get back, as Senator Thayer has suggested, into the real workforce, the full-time workforce, we need to make sure they can see and hear and are not suffering from dental pain.”

The expanded benefits include services such as dentures, fillings, root canals, and crowns not previously covered by Medicaid, which for years covered only one annual checkup and tooth extraction for adults.

A shortage of dentists, and Medicaid's low reimbursement rates, causing many dentists to opt out of the federal-state health plan, has created an oral health crisis in Kentucky, they say. Even with the expanded benefits introduced this year, patients can’t find providers who take Medicaid.

“It’s an enormous problem that we have here and it’s not getting any better,” Dr. Jeffrey Okeson, dean of the UK dental school, told lawmakers at a hearing in August before the Administrative Regulation Review Subcommittee.

Okeson was joined by the deans of the University of Louisville dental school, and a new one in development at the University of Pikeville, in urging support for the expansion of Medicaid dental services.

One patient ‘alive today’

Meanwhile, advocates say such services are especially needed for vulnerable adults struggling to escape circumstances including domestic violence and addiction.

Ann Perkins, executive director of Safe Harbor of Northeast Kentucky, one of the state’s 15 regional domestic-violence shelters, said dental as well as vision and hearing services are essential for clients who need them to succeed in school, job training and employment.

“This is how our state can actually do something productive,” Perkins told legislators. “Your money will never be better spent.”

She said some of her clients are in dire situations, including a woman suffering from lung cancer who could not undergo chemotherapy until she got treatment for abscessed, infected gums. The client had called every dentist in the region but none who accepted Medicaid could fit her in, Perkins said.

Perkins used $500 in Safe Harbor funds to pay for the dental treatment, which the woman later repaid, she said. “She’s doing great,” Perkins said. “She’s just one example of how important dental care was for her to be alive today.”

John Bowman, Kentucky coordinator for Dream.org, a national non-profit that works for criminal-justice reform, said such benefits are “huge” for people recovering from addiction, including himself.

“It gives people a sense of self-worth,” he said. “If we want people to be productive members of society, we need to back them with these services.”

‘To us, it was a win’

Legislators took no action on the regulations expanding Medicaid benefits at the Sept. 12 meeting. They could have found them “deficient,” setting them up to be voted down when the legislature next meets. So iIt appears that an effort is uderway to keep the benefits in place.

Rep. Derek Lewis, R-London, co-chair of the committee, said discussions have begun with Beshear administration officials, following complaints by lawmakers they had not been consulted. Lewis said he and co-chair Sen. Stephen WestR-Paris, were contacted recently by Eric Friedlander, secretary of the Cabinet for Health and Family Services, and Medicaid Commissioner Lisa Lee, to discuss the issue.

“I think that goes a long way toward working this out,” Lewis said.

Rather than voting to disapprove the regulations on Sept. 12, the commitete sent them for further review to the joint Health Services Committee, which is unlikely to take them up for several months.

Yeoh, the UK dental official, said he views it as a good sign the committee didn’t reject them outright.

“To us it was a win,” he said. “We’re extremely happy about that.”

Beshear administration issues regulations to restore expansion of Medicaid dental, vision and hearing benefits legislature nixed

Family Health Centers in Louisville serves many
Medicaid patients. (FHC Louisville website photo)

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear has again proposed regulations to expand dental, vision and hearing benefits for  Kentucky adults on Medicaid, after the legislature found similar regulations deficient, thus ending the benefits. 

Each regulation says why it is "substantially different" from the original regulation. Most of the reasons have to do with changes in the services offered under the original and new regulations. This language was necessary because the bill that quashed Beshear's original regulation to expand dental, vision and hearing services for Medicaid adults requires any new regulation to be "substantially different."

The bill had an emergency clause, so it became law as soon as the legislature overrode Beshear's veto. But it also told the Medicaid program to reimburse health-care providers "for services rendered or initiated prior to the effective date of this act," which was March 29.

The proposal is open for public comment through the end of May. 

"The legislature needs to hear from people about whether dental, vision and hearing services do make a difference in their life, if in the past there have been times when they needed additional hearing care or hearing aids or additional dental work," Cara Stewart, policy-advocacy director for Kentucky Voices for Health, which favors expansion of such benefits, told Kentucky Health News.

Anyone interested in participating in a Zoom hearing at 9 a.m. ET May 22 should notify the Cabinet for Health and Family Services in writing by May 15.  Those who have made this request will have a Zoom invitation emailed to them the week before the scheduled hearing. If no requests to attend the public hearing are received by May 15, the hearing may be canceled. 

The cabinet is accepting written comments on the regulations until May 31. Comments should be sent to Krista Quarles, Policy Analyst, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort KY 40621. Her phone number is 502-564-6746; her fax is 502-564-7091; and her email is CHFSregs@ky.gov.

Kentucky Voices for Health will also be collecting comments from anyone who would like to make a public comment on these regulations, as they have done before for other rules.  Stewart said KVH will include these comments in their written public comment submission to the health cabinet. 

Stewart said the purpose of their easy-to-use comment collector is to be able to hear people's "real voices" tell what these policies mean in their "real lives because that's what matters most." 

Each of the new regulations addressing expanded dental, vision and hearing services for adults on Medicaid starts by giving reasons they are needed, including concern that failure to implement these services, which have gained federal approval, could result in the loss of federal funds. 

They say the regulations are needed to be able to pay providers for these services, and as a way to ensure that appropriate services are being offered in appropriate settings, instead of emergency rooms. 

Stewart also noted that it is especially important for people to get dental care from an appropriate provider because dental pain in the emergency room is a gateway "to addiction to pain medication." 

"Offering better and more comprehensive dental services is a way to stop that," Stewart said. "So literally, it's a way to save lives and save suffering." 

The regulations say these services will help more than 900,000 Medicaid recipients in Kentucky who are 21 and older return to the workplace.

The governor's veto of Senate Bill 65 said the dental expansion had served "more than 1,000 Kentuckians in all 120 counties" with "nearly 3,330 dental services, including from a dentist in Clay County, who . . . has provided four sets of dentures for patients and has 44 more sets of dentures in progress." Clay County is the home of Senate President Robert Stivers, R-Manchester.

Beshear added, "Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place."

Stewart said that having access to dentures and hearing aids will make the biggest difference because many of the managed care organizations already offer glasses as an extra benefit, but not the others. As an example, she noted that many domestic-violence survivors and crime victims have lost teeth and need access to dentures.

"And that really affected their recovery and their ability to feel great about themselves," she said. "And also, every time they open their mouths to smile, they have memories of being abused. . . . There are so many populations for where this is a really big deal." 

State Sen. Stephen West, R-Paris, the sponsor of the bill, has not responded to a request for comment. Legislators complained that Beshear, without consulting them, funded the expansion through savings that Medicaid achieved by having only one pharmacy benefit manager, a middleman between drug manufacturers and the managed-care organizations that deal with Medicaid beneficiaries.

UPDATE, April 26: In a statement to Kentucky Health News, the heath cabinet said the bill affected Medicaid members treated by providers that the state reimburses through fees for services. "Managed-care organizations have the flexibility to continue to provide the extra dental, hearing and vision services referenced in Senate Bill 65 as a value-added benefit to plan enrollees," the cabinet said.

Poor oral health in children is not just from too many sugary foods; education, income and environment all play roles

CDC photo

While brushing your teeth is important to maintaining good oral health, dental-health experts say it's not the only thing responsible for poor oral health, especially when it comes to children in Appalachia, where sugar is usually blamed.

"It’s a common misconception that consuming sugary foods and beverages is the only cause of tooth decay. While that is undoubtedly a problem, there’s much more to good oral health," Daniel W. McNeil and Mary L Marazita write for The Conversation, a site for journalistic writing by academics. "It includes consistent brushing and flossing; eating healthy foods, like fresh fruits and vegetables; avoiding tobacco products; and wearing mouth guards while playing certain sports. Regular visits for dental care are also critical, as they provide an opportunity for cleanings and preventive care." 

McNeil and Marazita, who run the University of Pittsburgh's Center for Oral Health Research in Appalachia, say the region's poor oral health stems from a combination of factors beyond tooth brushing and other personal hygiene.

Poor oral health, they write, is more common among "people who have less formal education or lower incomes, marginalized ethnic and racial groups and those living in more rural areas, such as Appalachia," which has one of the highest rates of oral health problems in the nation. And among these groups, oral health issues tend to show up at younger ages. 

Other than education, behavioral and social influences, reasons for poor oral health can include genetic influences that dictate a preference for sweet foods, mouth bacteria that can lead to oral diseases, environmental factors such as air quality, access to healthy foods, the cost of dental care, access to transportation to and from the dentist, access to school-based programs, water quality and whether one lives in a community with fluoridated water, which can keep cavities from forming.

McNeil and Marazita note that cavities are the most common chronic disease in children, despite being preventable and that "more than 40% of children have tooth decay when they start kindergarten. . . . Dental problems in kids can lead to missed school, pain and embarrassment about visible decay, and missing or crooked teeth." 

They write that parental and caregiver role modeling can greatly influence children's oral health habits. Examples include drinking water instead of sugary beverages, eating a healthy diet, practicing good dental hygiene habits and expressing a positive attitude about going to the dentist. 

The article offers several other suggestions to improve oral health, saying one of the best things parents or caregivers can do is to take their child to the dentist.  

"The American Academy of Pediatric Dentistry and other professional health organizations recommend that children see an oral health care provider before age 1 or at the emergence of the first tooth," they write. "Access to dental treatment, especially preventive care, has been shown to improve oral health in families and their communities."

McNeil and Marazita also call for system-level changes that ensure routine dental care is affordable and accessible to everyone. They also call for integrating oral health practices into schools and educational programs, saying this will benefit all children regardless of their family's socioeconomic status.

Traditional orthodontics remain popular, but the sale of invisible braces boomed during pandemic, and a 'high-stakes war' is on

Photo from healthline.com

As invisible braces offered by Invisalign and direct-to-consumer companies like SmileDirectClub become more popular, the firms are in a "high-stakes war" with traditional orthodontists over how best to straighten your teeth, Nathan Bomey reports for Axios.

The new products are taking traditional orthodontists' profits, pitting them "against new upstarts against state dental boards, with millions of dollars in marketing and legal bills piling up along the way," Bomey reports.

Invisalign and consumer-direct companies like SmileDirectClub offer clear-plastic aligners that progressively straighten your teeth. The aligners can also be removed as needed. 

The difference between these two companies is that Invisalign involves in-person oversight from a dentist or orthodontist while consumer-direct companies allow users to obtain their teeth aligners through an online process that largely does not require office visits. Bomey reports, "Invisalign costs about $5,000 to $6,000 per case," while "SmileDirectClub typically costs a few thousand less." 

The American Association of Orthodontists has discouraged the use of direct-to-consumer orthodontics and has issued a consumer alert on its website that cautions: "Orthodontic treatment involves the movement of biological material, which could lead to potentially irreversible and expensive damage such as tooth and gum loss, changed bites and other issues if not done correctly." 

Bomey reports that while sales boomed during the pandemic for Invisalign and SmiledirectClub, they have since "trailed off over the past year, bruising manufacturers' stock prices."  

And after years of legal battles and aggressive marketing, SmileDirectClub is in "particularly rough financial shape,"  Bomey reports. And in an effort to increase opportunities for grown, SmileDirectClub has attacked state dental boards, which it views as protecting the orthodontics industry, he wriets. 

All that said, Jefferies analyst Brandon Couillard, who tracks the teeth alignment industry, told Axios that traditional braces are still used in about eight in 10 cases, including in most children -- leaving lots of room for the aligner industry to grow. 

University of Pikeville names Dr. Pamela Sparks-Stein as the first dean of its dental school, the third in Kentucky

Pamela Sparks-Stein

The University of Pikeville has named Pamela Sparks-Stein as the first dean of its College of Dental Health, Kentucky's new dental school.

"Among several strong candidates, Dr. Sparks-Stein stood out for her incredible alignment to the mission of the University of Pikeville,”  UPike President Burton Webb said in a news release. “Her compassion and empathy will help her create the kind of dental school where care for the underserved is central to our identity, where the health of the public is paramount, and where quality care is an absolute necessity.”

Sparks-Stein comes to UPike from the University of Kentucky College of Dentistry, where she serves as division chief of dental public health. Prior to her roles in education, she was in private practice in Kentucky for 13 years. 

“I am a public-health dentist and my heart has a passion for helping vulnerable and underserved populations,” Sparks-Stein said in the release. “My years of working with grants and projects in Eastern Kentucky have shown me there are so many wonderful partners who are willing to help, making it a great place to forge partnerships that will allow us to make a true impact in central Appalachia.”

Sparks-Stein received her dental degree and and master’s of public health degree from UK.

The UPike College of Dental Health is the third dental school in Kentucky and was made possible from a $25 million gift from an anonymous donor's family foundation. The other two dental colleges are at UK and the University of Louisville. 

Free dental, health and vision clinic comes to Hazard June 11-12

Free dental, vision and medical care will be provided in Hazard on a first-come, first-served basis on the second weekend in June.

The clinic will open at 6 a.m. Saturday, June 11 and Sunday, June 12 at East Perry Elementary School at 301 Perry Circle Rd. in Hazard. The clinic's closing time may vary, based on the service area’s daily capacity.

All of the services are free and no identification is required, but patients will be required to wear a face covering and must undergo a Covid-19 screening before entering the clinic. Patients are also asked to bring a list of their medications, or pictures of the bottles with the label visible, and to take their medications on the morning of the clinic as directed. 

The patient parking lot will open no later than midnight on Friday night, June 10, and remain open for the duration of the clinic. Once in the parking lot, additional information will be provided regarding next steps.

Photo provided

RAM encourages everyone who would like services, especially dental services, to arrive as early as possible. 

Due to time constraints, patients should be prepared to choose between dental or vision services. Medical services will be offered free to every patient attending the clinic. 

"Services include dental cleanings, dental fillings, dental extractions, dental x-rays, eye exams, glaucoma testing, eyeglass prescriptions, eyeglasses made on-site, women's health exams, general medical exams and mental health services. Free take-home colon cancer screening test kits will also be available," says the news release. 

The clinic is sponsored by Remote Area Medical Volunteer Corps, a nonprofit provider of free pop-up health clinics, and the Hazard-based University of Kentucky Center for Excellence in Rural Health. 

For more information or to donate or to volunteer, please visit www.ramusa.org or call 865-579-1530. Click here for RAM's webpage of frequently asked questions. 

University of Pikeville says it will build Kentucky's third dental school with a $25 million gift from an anonymous donor

University of Pikeville website logo

The University of Pikeville plans to create Kentucky's third dental school with a $25 million gift from an anonymous donor's family foundation, the largest in the school's 133-year history.

UPike President Burton Webb announced the gift last Saturday during the private university's health-professions commencement.

“The foresight of a generous family giving to a university to establish a dental school is special,” Webb said. “This is another example of challenges being met and solved right here by those who call this area home. It’s also incredible that the university, this family and now a dental school will each have their roots right here in these mountains. It’s a great day to be a Bear!” The university's mascot is a bear.

Webb told the Appalachian News-Express of Pikeville that the proposed school would go through an accreditation process, similar to that for its Kentucky College of Osteopathic Medicine and Kentucky College of Optometry, which will determine the project's timeline and size.

“Sometime before we started the optometry college, the university had done a feasibility study on the need for more dentists in Appalachia,” Webb told the newspaper. “At the behest of the family foundation we refreshed that study and it showed continued need. The gift is generous and we are deeply grateful.”

Kentucky's dental colleges are at the University of Kentucky and the University of Louisville. Pikeville is the seat of Pike County, Kentucky's easternmost, and is nearer to Charleston, W.Va. That state has one dental school, at West Virginia University in Morgantown, and Virginia has one, at Virginia Commonwealth University in Richmond. Lincoln Memorial University in Harrogate, Tenn., just south of Cumberland Gap and Kentucky's southeast corner, is scheduled to open a dental school this fall.

Terry Dotson, chair of UPike's Board of Trustees, said in a news release, “The founding of a dental program in these mountains will lead to better healthcare outcomes for a historically medically underserved population. This institution, its students, faculty and staff are a driving force for health education in the commonwealth. The dental school will complete the circle of medical services for the region and the immediate area. The economic impact with the addition of more professional students will grow businesses throughout the entire community and the region. This will be a project that will take the time and talents of many partners locally and statewide.”

Vice President for Advancement and Alumni Relations David Hutchens said the anonymous donor “has a deep love for Appalachia and a passion for improving healthcare in our region. Their generosity will reverberate for generations, impacting not only the graduates of the program but also profoundly benefitting the lives of the countless patients they will serve for generations to come. This is a transformative gift, an act of deep love and devotion for this region. We are humbled by this generosity, thrilled to have this opportunity and ecstatic about this vision.”

'Back to normal' should include 'Back to the dentist," and remind us of oral health's importance to overall health, providers say

iStock photo via Getty Images

By Stephanie and Linda Poynter

Like many Kentuckians, we are eager for a summer of “back-to-normal” activities — backyard barbecues with neighbors, family trips to our favorite state parks, and evenings at the county fair.

One big “back-to-normal” activity for families across the commonwealth this summer is reviewing that ever-growing back-to-school checklist. As a dentist and dental hygienist and committed members of the Kentucky Oral Health Coalition, we are encouraging you to make sure scheduling a dental check-up for you and your family is at the top of that list!

With Covid-19 guidelines shifting, many dental practices are back up and safely running as usual, though some are currently serving a lower patient volume than prior to the pandemic. Whether you are looking for a new dental provider or returning to your community dentist, now is the time to schedule a check-up. Not only will the provider examine your teeth, gums, and mouth for any concerns, they will advise on preventive practices, screen for oral cancer, and recommend treatment for any dental problems.

Caring for your teeth and having routine dental check-ups are critical for optimal oral health and overall health — for those little ones celebrating their first tooth to those older adults mitigating tooth loss. In fact, oral health is often described as the gateway to overall health as gum disease is linked with other health problems, such as cardiovascular disease and diabetes, for example. And for children, a healthy, pain-free mouth makes it easier to focus and listen, play and learn, and grow and thrive.

You and your family can practice preventive dental care at home between check-ups by:

• Brushing your teeth for two minutes, twice a day.
• Flossing your teeth once a day.
• Limiting sugary drinks and choosing fluoridated tap water.
• Replacing your toothbrush every three or four months and after an illness.

While this checklist may seem simple, a reality remains in which disparities persist throughout the oral health system. Factors like cost barriers to accessing care, utilization of dental care, and the racial makeup of the dental workforce impact the oral health outcomes – and daily lives – of many Kentuckians, especially for our communities of color. The American Dental Association findings show that 15 percent of those in need of dental care did not obtain it citing financial and insurance coverage reasons as the top barriers.

To support student oral health, many school districts in Kentucky partner with their local health departments to provide school-based oral health education and preventive dental services right in the schools. These services are normally provided at no cost to the families who qualify, and the programs work directly with the schools and local dental providers to ensure that needed dental treatment is done and your child’s good oral health restored.

Ensuring equitable access to dental care, health coverage, safe drinking water, and nutritious food are at the bedrock of improving the oral health of every Kentuckian. We are reassured in these efforts as we’ve seen new investments being made both federally and at the state level to expand access to safe drinking water and nutritious food across the commonwealth through the American Rescue Plan Act dollars allocated to Kentucky.

We must continue to strengthen investments and programming that support optimal oral health, including oral health education campaigns, regular collection of state and county-level oral health data, and adequately funding Medicaid to ensure all Kentuckians can access the oral health and preventive healthcare they need.

Back-to-normal should include back-to-the-dentist. It should also include a refreshed look at the vital importance oral health is to the overall health and well-being of our children, communities, and ourselves.

Dr. Stephanie Poynter is the dental director at Family Health Centers in Louisville and chair of the Kentucky Oral Health Coalition. Linda Poynter is a public-health dental hygienist and oral health manager at the Northern Kentucky Health Department.

It's National Children's Dental Health Month, time to think about improving the poor oral health of Kentucky's children

By Stephanie Poynter
Chair, Kentucky Oral Health Coalition

It is no secret that Kentucky has historically had a poor reputation when it comes to our dental health. In a recent study ranking states with the best and worst dental health, the state ranked 41st in the nation in indicators of dental wellness. We have among the lowest dentists per capita, highest sugar-sweetened beverages consumption, and highest percentage of adult smokers – all contributing factors to poor oral health outcomes.

This is a reality that dental providers and advocates have grappled with for decades. And this is the reality that motivates the Kentucky Oral Health Coalition and its diverse membership in its collaborative oral health campaign designed to educate parents, activate policymakers, and inspire health professionals, as well as engage the public to create optimal oral health for all.

February is National Children’s Dental Health Month – a time when dental health providers and advocates promote the importance of establishing good oral hygiene habits early in life, needs around access to dental care and coverage, and ways to improve health outcomes across the lifespan.

Dr. Stephanie Poynter

Now, many of us have likely experienced some sort of tooth pain in our life – think back to how distracting or limiting that pain was for your daily life.

For children, when experiencing prolonged and persistent dental pain, it is difficult for them to develop the skills they need to learn. Once in school, students with poor dental health are three times more likely to be absent than other students. Additionally, children with poor oral health care experience higher rates of emergency room visits and have less promising job prospects as adults compared to children who receive appropriate oral health care.

The bottom line: when teeth are healthy and pain-free, it is easier for children to focus and listen, play and learn, and grow and thrive.

A recent survey of Kentucky parents and oral health, primary care, and school professionals conducted by KOHC indicated that the Commonwealth needs increased education around dental care early in a child’s life from pediatricians, school professionals, and parents as well as improved access to affordable dental care across the state for there to be real progress in health outcomes. Here are a few urgent recommendations for action in the statehouse to the schoolhouse to your house:

• Promoting oral health literacy campaigns to teach the basics of oral health.

• Integrating oral health services into doctor’s visits to prevent cavities in children, pregnancy complications in women, and oral health infection in adults.

• Ensuring all children entering Kindergarten have a dental screening/exam.

• Establishing school-based health programs and utilizing the Expanded Care Services policy in schools to increase access to care for children right where they are learning.

• Increasing access to care in rural and urban communities by leveraging tele-dentistry to detect oral health concerns – a practice that has increased in use during the Covid-19 pandemic.

• Sustaining state funding for Medicaid and Kentucky Children’s Health Insurance Program (KCHIP), and prioritizing investments focused on closing the remaining gap in child health coverage.

Oral health is much more than a bright, beautiful smile.

It takes establishing good brushing and flossing routines early in life and maintaining regular dental check-ups across the lifespan. It takes more equitable access to dental care right in our communities. It takes a commitment from state leaders to allocate funds for Medicaid and KCHIP programs and to address persistent racial disparities in coverage and access so that every child and their family can access the health care they need. It requires healthy foods and safe drinking water in every neighborhood and county.

It takes all of us to recognize that oral health IS health and that it must be prioritized in our homes, in our communities, and in our state budget. Only then will we see progress in that poor oral health ranking that has burdened Kentucky for far too long.

Dr. Stephanie Poynter is dental director at Louisville-based Family Health Centers Inc.

With first vaccinations expected Monday, but only the beginning of long rollout that will run well into summer, Beshear urges caution

A container with insulated boxes of vaccine is rolled into the UPS
Worldport in Louisville. (Photo provided by governor's office)

By Al Cross
Kentucky Health News

As the first shipments of coronavirus vaccine arrived in Kentucky, and the pandemic's advance remained steady, Gov. Andy Beshear again asked Kentuckians to "remain vigilant," said a press release from his office.

The state reported 2,454 new cases of the virus, more than 100 fewer than last Sunday, and its seven-day rolling average of new cases dropped to 3,228. During that time, the state saw 1,235 fewer cases than the previous week, and the share of Kentuckians testing positive continued to fall.

The current seven-day positivity rate is 8.52%, 1.23 percentage points below where it was last Sunday, 9.75%. That's a decrease of 12.6%. The rate, which Health Commissioner Steven Stack has called a "leading indicator" suggestive of future trends in cases, has declined for 10 consecutive days.

“We are seeing good trends and getting great news in our battle against Covid-19,” Beshear said in the release. “Now we are less than 24 hours from the true beginning of the end of this virus,” with the arrival of vaccine.

The first plane from the Pfizer Inc. plant in Michigan arrived at the United Parcel Service hub in Louisville at 12:06 p.m., reports Lucas Aulbach of the Courier Journal. The shipments are being sorted "and shipped out the same day to destinations across the eastern U.S.," he writes.

Beshear said in another news release that he expects the first Kentucky vaccinations Monday -- at 11 strategically selected hospitals that can maintain ultra-cold storage of the vaccine -- and nursing homes, where pharmacy chains CVS and Walgreens have federal contracts to vaccinate residents and staff.

One of the first boxes that arrived at the UPS Worldport was headed to a nearby hospital and another was going to an undisclosed Kentucky site, NBC reported.

Health Commissioner Steven Stack said in the release, “Early doses will be limited in supply and immunization will begin with nursing-home residents and frontline health-care workers. From there, as vaccine shipments continue, Kentucky will immunize all health-care (including oral-health) workers and first responders, followed by the K-12 education community, to get our children and educators safely back to school.”

Beshear said, “Our community doctors and nurses, as well as long-term care residents and staff, are preparing to do their part first. We will all get a turn. When it is your turn, I strongly encourage you to get vaccinated so you can do your part to protect yourself, your family and our entire state.”

Stack said the state is awaiting more guidance from federal officials on who will come next. He added, “Having vaccines this quickly is a modern medical miracle. Having patience in the months ahead is essential, though, as vaccine supplies increase and hopefully all interested persons have access to vaccination by the end of summer 2021.”

The 11 hospitals expected to get 12,675 doses of the vaccine are in Louisville, Paducah, Bowling Green, Madisonville, Pikeville, Corbin, Lexington and Edgewood. Another 25,350 are going to CVS and Walgreens for nursing homes.

The vaccine developed by Moderna, which does not require ultra-cold storage, is expected to get federal approval next week. Between the two, Kentucky could get 150,000 doses this month, Beshear said. Both require second doses, which will come in later shipments. 

"The immediate goal is reducing Covid-19 deaths," the release said. "With 66% of the deaths coming from long-term care facilities, vaccines could help significantly decrease Kentucky’s Covid-19 death toll beginning in January. Also, because long-term care residents tend to require the most care, vaccinations in these facilities will help reduce Covid-19’s burden on Kentucky’s health-care system."

Sunday's 15 Covid-19 fatalities, which raised the state's toll to 2,207, were a 75-year-old Bell County woman; two women, 65 and 58, from Boone County; an Caldwell County man, 85; two Daviess County women, 65 and 74; a woman, 82, and a man, 79, from Hopkins County; a Jefferson County man, 83; a Kenton County man, 85; a Lawrence County woman, 58; an Oldham County man, 56; two Pulaski County women, 89 and 50; and a Taylor County man, 76. 

In other coronavirus news Sunday:

• Counties with 10 or more new cases were: Jefferson, 446; Fayette, 165; Boone, 115; Pulaski, 111; Kenton, 106; Mercer, 79; Hardin, 75; McCracken, 61; Harlan, 52; Campbell, 48; Boyle, 44; Bullitt, 39; Warren, 39; Russell, 36; Carter, 34; Laurel, 33; Daviess, 32; Taylor, 30; Whitley, 30; Boyd, 29; Scott, 29; Jessamine,  27; McCreary, 26; Franklin, 24; Madison, 23; Letcher, 22; Bell, 21; Christian, Greenup, Lincoln and Wayne, 19; Grant and Perry, 18; Adair, Henderson, Nelson and Oldham, 17; Breckinridge and Pike, 16; Calloway, Floyd, Shelby and Spencer, 15; Meade and Trimble, 14; Casey, Graves and Harrison, 13; Bracken, Grayson and Green, 11; and Allen, Estill, Logan and Monroe, 10.
• Hospitalizations for Covid-19 remained steady, at 1,712, with 434 of them in intensive care and 224 of those on ventilators. The share of intensive-care patients on ventilators is 52%, which is the average for the past month. 
• The Centers for Disease Control and Prevention approved the Pfizer vaccine for use in 16- and 17-year-olds. The Food and Drug Administration approval Friday was for adults.
• Extension volunteers in northeastern Kentucky made 250 surgical gowns for employees at Primary Plus, which has 10 clinics in the region and was having difficulty getting protective gear to do coronavirus testing, Katie Pratt reports for the University of Kentucky.
• "A bipartisan group of senators is expected to introduce a $908 billion coronavirus relief bill as soon as Monday, with a twist: The deal is expected to be split into two pieces," Politico reports, citing "two people familiar with the negotiations. One would be a $748 billion piece of coronavirus relief with less controversial items like schools and health care; the other would marry $160 billion in money for local governments with a temporary liability shield. Those two components have been the toughest part of the negotiation so far, and Senate Majority Leader Mitch McConnell has suggested dropping them and concentrating on the less divisive areas. McConnell had long called a liability shield from coronavirus legislation his 'red line,' while congressional Democrats say the money for states and cities is their top priority. Some Republicans from states with hard-hit budgets like Sen. Bill Cassidy (R-La.) also are pushing for local aid, but many conservatives don’t want to send money to states. Splitting the bill could make it more likely that a relief package can be finalized before Congress leaves for the holidays — something deemed essential with 12 million Americans set to lose unemployment benefits in the coming weeks."

Lawmakers pass one-year budget, including pension reprieve for health departments; funding remains similar to last year's budget

By Melissa Patrick
Kentucky Health News

Amid an expected revenue shortfall from the coronavirus pandemic, Kentucky lawmakers passed a conservative one-year budget, instead of the usual two-year one, that offers another reprieve for health departments in a year that they were looking to enact big reforms.

The budget will freeze pension contribution rates for health departments, regional universities and quasi-governmental agencies at 49.47 percent of payroll, allowing them to dodge for another year the looming 93% rate that was set to kick in on July 1.

Many health departments have said that rate would force them to close. The legislature was planning to revamp the contribution system, but the uncertainty about state revenues killed that idea, at least for now.

"While this budget doesn’t provide the language or funds to support our public health transformation and ensure the number of foundational employees to meet our statutory obligations, we understand as well as anyone the uncertainty of our times and recognize the legislatures need to try and maintain current operations for all government another year," Randy Gooch, executive director of the Jessamine County Health Department, said in an e-mail. "However, I have great confidence the legislature will now have more clarity than ever of the need to fund public health at a an appropriate level and will take that action when considering changes to the budget in the future."

The budget provides $23 million for regional mental health boards' pension payments and $25.4 million for health departments' pension payments. The overall budget for public health remains about the same as the previous budget, around $370 million.

Health departments, state health officials and legislators worked for months to help the departments afford their pension obligations, and were nearing success when the coronavirus hit, making likely a huge drop in state revenues. Costs are expected to rise, too, and exactly how much financial help the state will get from federal government remains an unknown.

"We have no way to know how far this recession is going to go, how deep it will truly be and what it will mean to the coffers here in Frankfort," House budget chair Steven Rudy, R-Paducah, said on the House floor while offering the House-Senate compromise budget bill April 1.

All of this has resulted in a one-year budget for the fiscal year that begins July 1 that largely keeps spending at current levels, with plans to pass a budget next year for the 2021-22 fiscal year.

Here are some of the health-related provisions in the budget:

From the Tobacco Settlement Fund:

• $500,000 for a rural mental-health and suicide-prevention pilot program 
• $1.4 million for substance-abuse prevention and treatment for pregnant women with a history of substance abuse 
• $7 million for the Health Access Nurturing Development Services Program (HANDS)
• $942,000 for Healthy Start initiatives
• $942,000 for early childhood mental health 
• $989,100 for early childhood oral health
• $2 million for smoking cessation, much less than advocates want  

From the General Fund:

• $93,700 each for grants to the Brain Injury Alliance of Kentucky and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma
• $7.4 million for more school-based mental health services
• $300,000 in the current fiscal year and $1.9 million in the next one for the Kentucky Poison Control Center, which operates the recently created covid-19 hotline
• $500,000 for the Kentucky Colon Cancer Screening Program 
• $2.5 million to the Kentucky Pediatric Cancer Research Trust Fund
• $500,000 for ovarian cancer screening

The budget does not provide any money for additional social workers, or raises for social workers, as had been included in all previous versions of the budget. It also lacks any new waivers for community-based care for individuals with disabilities, as all previous versions had provided.

The General Assembly will reconvene April 13 to reconsider bills Beshear vetoes. House Speaker David Osborne said that more bills are also likely to get passed, including one to help rural hospitals.

Dentist gives warning signs of oral cancer, 'not always definitive'

By Dr. Shelley Shearer

There are nearly 50,000 new cases of oral cancer in the United States each year, accounting for 3 percent of all cancer diagnoses. Most are discovered in a dental office.

Oral cancer is caused by the uncontrolled growth and reproduction of cells in some regions of the mouth. It can occur inside the cheeks, under the middle and front of the tongue, or on the tissue lining of the mouth or gum. That’s why it is worthwhile to ensure that people know the symptoms, causes and risk factors.

Shelley Shearer

Early detection and treatment of oral cancer can help prevent the cancer from developing further or spreading to other areas. Be sure to tell your dentist is you have experienced any of the following for more than two weeks:
• difficulty chewing or swallowing
• a lump or sore area in the mouth, throat or on the lips
• a white or red patch in the mouth
• difficulty moving the tongue or jaw
• unexpected weight loss
• a sore or ulcer that does not heal or bleeds
• tenderness, pain, or lumps anywhere in the mouth or on the lips.

These are not always definitive signs of oral cancer and may be caused by other conditions, such as an allergy or an infection. But it’s better to check out these occurrences before it’s too late.

Patients often ask what causes oral cancer so they can try to avoid it. Here are some of the main causes and risk factors:
• Tobacco and alcohol use: Any form of tobacco use involves carcinogenic substances entering the mouth, which significantly increases the risk for oral cancer. Excessive alcohol use can also increase the risk.
• Age: The risk of oral cancer increases with age, with the average age of diagnosis at 62 years old.
• Human papillomavirus (HPV): This is a sexually transmitted infection that has strong associations with several forms of oral cancer.
• Sun exposure: The sun emits rays that can burn the lips and trigger the development of oral cancer.
• Gender: Males are more than twice as likely to develop oral cancer than women. Researchers have yet to discover a reason why.

As with most other cancers, it is not always possible to prevent oral cancer. Some risk factors for oral cancer, such as being male or aging, are not preventable. However, consider some lifestyle factors that can reduce the risk of oral cancer such as:
• avoiding tobacco
• consuming alcohol in moderation
• maintaining a healthy diet
• using screen around the mouth and a balm on the lips when exposed to sun
• exercising regularly
• maintaining good oral hygiene by brushing and flossing twice a day
• regularly visiting a dentist for check-ups.

Conduct Your Own Self-Check: Just as women take time for a monthly breast self-exam, those with oral cancer risk factors should conduct their own self-check.

First, look at and feel your head and neck in a mirror. Do the left and right sides of the face have the same shape? Are there any lumps, bumps, or swellings that are only on one side of your face? Also view the skin on your face for changes in color or size, sores, moles or growths. To check the neck, press along the sides and front of the neck for tenderness or lumps.

Lips and cheeks can reveal much as well. Pull your lower lip down and check for sores or color changes. Then use your thumb and forefinger to feel the lip for lumps, bumps, or changes in texture. Repeat this on your upper lip. Examine your inner cheek for red, white, or dark patches. Put your index finger on the inside of your cheek and your thumb on the outside. Gently squeeze and roll your both sides of your cheeks between your fingers to check for any lumps or areas of tenderness.

Often the roof of the mouth is an indicator that something is off. Tilt your head back and open your mouth wide to look for any lumps and see if the color is different than usual. Touch the roof of your mouth to feel for lumps. Extend your tongue and look at the top surface, sides and underneath for lumps, swelling or changes in color and texture.

Tell your dentist if you suspect anything unusual in your mouth. Catching oral cancer early can save time, money and most importantly, your life.

Shelley Shearer is founder of Shearer Family and Cosmetic Dentistry in Florence, and wrote this for the Northern Kentucky Tribune and KyForward.

Six Kentucky health centers awarded more than $1.7 million in first-of-their-kind grants to be used for oral health infrastructure

Six health centers in Kentucky have received more than $1.7 million in competitive federal grants to be used toward improving oral health.

The Health Resources and Services Administration awarded over $85 million to 298 health centers as part of its Oral Health Infrastructure program.

The six in Kentucky and their headquarters towns are: Cumberland Family Medical Center in Burkesville, Big Sandy Health Care in Prestonsburg, Healthfirst Bluegrass in Lexington, Healthpoint Family Care in Covington, Shawnee Christian Healthcare Center in Louisville and Pennyroyal Healthcare Service in Princeton. All got $300,000 except Pennyroyal, which got $226,345.

A news release from Department of Health and Human Services the says the money can be used for things like "minor alteration and renovation to modernize existing facilities, purchase and installation of dental and radiology equipment, training and consultation to increase oral health integration, and purchase of mobile dental units to increase access to oral health care."

"These are the first awards HRSA has ever made solely for health centers’ oral health-care infrastructure, and they will support better access to oral health services in communities across the country, including under-served urban and rural areas," HHS Secretary Alex Azar said in the release.

Cumberland Family Medical Center plans to use its grant money to purchase portable equipment for its school-based health centers, which provide preventive oral health care to its students, according to a separate news release from Senate Majority Leader Mitch McConnell. The release notes that McConnell contacted HRSA on behalf of the center, which has more than 25 locations.

"We applaud Senator McConnell's efforts to ensure that we and other community health centers can continue to provide high quality care to patients who need it the most," Tracey Roy Antle, the center's chief operating officer, said in the release.

UK professor who won whistleblower settlement for loss of post-retirement job returns to run an oral health program for 18 months

Raynor Mullins

When he retired from the University of Kentucky dental school several years ago, Raynor Mullins, now 74, continued working for UK on efforts to improve oral health in the state, especially in rural areas.

When he lost that job, he alleged in a lawsuit that it was retribution for his criticism of Gov. Matt Bevin's removal of dental care as a basic benefit for the working poor in Medicaid. Last month, as the case was about to go to trial, the university agreed to pay him $620,000 and rehire him.

His new job will be director of a new Oral Health Innovation Initiative in the College of Public Health, with the first big goal developing a strategic plan for the initiative. It will receive $100,000 in start-up funding and "Mullins will be paid $52,800 for working 40 percent of a full-time job" for 18 months, and hold the rank of professor, Linda Blackford reports for the Lexington Herald-Leader.

His attorney, Joe Childers, told Blackford, “Dr. Mullins is excited to lead this new Oral Health Innovation Initiative, and believes it will lead to long-term gains for the health of Kentuckians. It is truly a win-win for both Dr. Mullins and the University of Kentucky.”

In settling the lawsuit, "UK did not admit that College of Dentistry Dean Stephanos Kyrkanides had pushed Mullins out for his comments, despite numerous depositions from witnesses who heard Kyrkanides say that Mullins had to go," Blackford notes. "In agreeing to allow the lawsuit to go to trial, U.S. District Judge Robert Weir called the case 'the epic story of academic intrigue and the place of free speech.'" Mullins' post-retirement job did not have traditional tenure protection.

In his lawsuit, Mullins said Kyrkanides had told him that he needed to stay "off radio" on the matter, and "communicated that this direction came from 'up top'." The first named defendant in the suit was Mark Birdwhistell, the UK HealthCare vice president and former state Medicaid director who helped Bevin's staff draft the proposed changes. Mullins claimed Kyrkanides was acting at the direction of Birdwhistell, who was acting at the behest of Bevin or his agents. The other defendant was "John Doe," identified only as a member of the governor's administration. They were dismissed from the case several months ago, after Mullins amended his complaint to exclude them. Bevin's office denied any interference, and Birdwhistell testified in a deposition that he had no discussions with anyone in Frankfort about Mullins' comments and never discussed Mullins with Kyrkanides (who testified likewise).

UK to pay dental professor $620,000 to settle lawsuit alleging he was terminated because he criticized governor's Medicaid plan

The University of Kentucky has agreed to rehire a former dental professor and pay him $620,000 to settle a lawsuit alleging he was taken off the payroll because he criticized Gov. Matt Bevin's plan to remove dental and vision care as a basic service of the state's Medicaid program.

Raynor Mullins

Dr. Raynor Mullins, a statewide oral-health leader who had remained on the College of Dentistry payroll after retirement from normal duties, lost his job as an emeritus faculty member, a position that did not have traditional tenure protection.

After depositions had been taken in the case, U.S. District Judge Robert E. Weir ruled in October that it should be decided by a jury trial, calling it “the epic story of academic intrigue and the place of free speech.”

The suit charged that a few days after Bevin made the proposal in June 2016, new dentistry Dean Stephanos Kyrkanides told Mullins that he needed to stay "off radio" on the matter, and "communicated that this direction came from 'up top'." It says that Mullins presumed that to mean no radio or television interviews, and that he told Kyrkanides, “I have not received any requests from the media, but I do have serious concerns,” and said he would submit formal comments about it.

The next month, Mullins was among five Kentucky oral-health leaders who filed comments saying that the cost explanation for reducing dental and vision benefits was "fuzzy," and based on "flawed cost assumptions." They argued that removing the benefits would cost the state more than it would save, because poor oral health increases "major cost drivers such as diabetes and cardiovascular disease," as well as obesity, and would increase wasteful use of emergency rooms.

"According to legal documents, someone from Bevin’s administration called UK officials, who then expressed the administration’s displeasure to Kyrkanides," Linda Blackford reports for the Lexington Herald-Leader. "The person who allegedly called UK has never been identified. When the lawsuit was filed in August, 2017, a Bevin spokeswoman denied the claims that anyone from Bevin’s office had pressured UK."

The suit claimed that Kyrkanides asked other dental-school leaders and faculty how to terminate Mullins' appointment and told his colleagues "that they could no longer work with Dr. Mullins on new grant-funded projects, in retaliation against Dr. Mullins," and told them to stop speaking to him "in an effort to ostracize and retaliate against Dr. Mullins for exercise of his First Amendment rights."

The first named defendant in the suit was Mark Birdwhistell, the UK HealthCare vice president and former state Medicaid director who helped Bevin's staff draft the proposed changes. It claimed Kyrkanides was acting at the direction of Birdwhistell, who was acting at the behest of Bevin or his agents. The other defendant was "John Doe," identified only as a member of Bevin's administration. Birdwhistell was dismissed from the case several months ago.

"Mullins’ colleagues testified that Kyrkanides’ attitude toward Mullins changed," Blackford reports. "Kyrkanides took Mullins off projects and caused dissension between Mullins and his colleagues. In January 2017, Mullins was informed that his post-retirement appointment was finished because he had not secured more grant funding to support it. UK spokesman Jay Blanton said Mullins will return to the university although the details are not yet final."

In a joint statement, UK and Mullins said, “Both parties have reached a settlement and desire to resolve their disputes in a positive manner. Just as important the resolution only serves to strengthen our shared commitment to the University of Kentucky’s mission and goals to improve health in the commonwealth. Oral health and its relationships with overall health and well-bring are critically important issues that need and deserve our full commitment. We will have no further comment on this matter as we are united now in our intent to focus squarely on these shared goals moving forward.”