Teaching the Teachers

I interviewed a friend, Stacey H., who attended a training session facilitated by the Boone County Hospital one month ago. The subject of the session was regarding proper oral care for children. This session was for pre-school teachers and helpers working in a licensed daycare across Columbia, Missouri.

Boone County Hospital and with the aide of a dental hygienist, helped the teachers make lesson plans for their students. They started off the lesson with “Mr. Happy Mouth” and “Mr. Sad Mouth”. “Mr. Happy Mouth” was an over-sized mouth that had healthy teeth and gums. “Mr. Sad Mouth” on the other hand, had unhealthy teeth and was not taking proper care of his mouth. A stuffed animal bear, who was supposed to be teaching the students through this activity, had a grocery bag full of plastic fruits. The children would see the food the bear pulled out and answer whether the food should be eaten “all the time, sometimes, or never” according to each mouth that was eating it. This gives the children a way to interact during the lesson and allow their minds to think about the foods. For example: an apple is pulled out of the bag and “Mr. Happy Mouth” would eat this apple “all of the time”. “Mr. Sad Mouth” on the other hand, would “never” eat this apple, due to his poor teeth. If a piece of candy were pulled from the grocery bag, the response, as many of you could guess, would be “never or sometimes” for “Mr. Happy Mouth” and “all the time” for “Mr. Sad Mouth”. The lesson would continue by using various fruits, vegetables, breads, etc to make a useful demonstration.

Stacey recited a song that was taught to them to help make brushing fun for the children.

“I brush my teeth to keep them clean, up and down and in between. Up like a rocket, down like a plane, back and fourth like a train!”

This song can be very beneficial to the children as they can use their imagination with the different modes of transportation. Chances are, they have seen some video or toy that is a rocket, plane, or train, and can relate the motions to how they can effectively brush their teeth. This makes brushing that much more appealing to the kids.

The dental hygienist gave a presentation to the teachers to explain the more technical parts of brushing and what is destructive to the children’s teeth and why. She explained to the teachers how soda can be destructive to the children’s teeth, from the sugars that are in every soda. This should also be taken into account when the children drink a lot of juices, as they too are also high in sugars. To be on the safe side, water should be provided a majority of the time.

The point of drinking water tied in with giving children bottles when being put down for a nap or for bed. If the teacher or parent gives a child a bottle when sleeping, they are helping the formation of baby bottle caries, as I have previously discussed. The hygienist advised to those who give their kids bottles to fill them only with water when being put to sleep. This is to help reduce the formation of the caries caused by the milk when they are sleeping. This to me is such an important point to make and follow. Why would a parent want to facilitate cavities being formed in their child’s mouth, especially when the child is barely old enough to tell you what they even want?

Lastly, the hygienist showed the teachers how plaque tablets work. They are a chewable tablet that the older children can chew to see where things are forming on their teeth. This gives the older students, who better understand that something is going on in their mouths, an incentive to brush. When the color has been removed from their teeth by brushing, the students can know that the plaque and other destructive debris have also been removed. The hygienist suggested for the independent students wishing to brush their own teeth to allow them to brush your teeth. This way the parent or supervisor can make sure the child’s teeth are being properly cleaned instead of letting them do it and not reach all of the places need. (Of course, the parent should still brush their teeth after the child has, to do a proper job.)

After interviewing Stacey and gathering all the information she learned from the continuing education session, I realized how important it is to train the teachers too. Not only do you need to teach the students, but the teachers as well. If teachers are not relaying the proper information that a student can use, what is the point? The Boone County Hospital appears to have done a sufficient job planning the session and bringing in a dental hygienist to describe the more technical parts of the session. Giving teachers a new approach to brushing and different interactive learning strategies is vital to continue the education in our schools and students.

Lessons on Plaque and Fluoride

I will be discussing two different lesson plans provided by Oral B. The first will be similar to the decay lesson I previously shared. This deals with the effect of fluoride. The second will be an experiment to show students the negative effects of plaque.

To teach students about the importance of fluoride, the lesson has the teacher take eggshells, put them into a container and cover the shells with a fluoride solution. After allowing the eggshells to sit in the fluoride solution for about five minutes, remove the shells. Pour vinegar into two separate containers. In one container put the fluoride-treated eggshells and in the other put in the untreated eggshells. The results of this experiment are similar to those seen with the decay: bubbling will occur in the container of vinegar and untreated eggshells. This is due to the chemical reaction taking place between the acid in the vinegar and the calcium in the eggshells. These eggshells begin to dissolve and if left along long enough to react, will completely dissolve. The other container with the treated eggshells does not produce a chemical reaction. Any guesses why? It is because the fluoride treatment provided a protective coat to the eggshells, keeping them from being dissolved. It is important to remember that the acids from the vinegar represent the acids that people ingest on a daily basis, and can hardly be avoided. Some of these acids can be produced by the body so no matter how careful you are in choosing the food you eat, acids cannot be completely removed from a diet. Taking this into consideration, one therefore cannot avoid acids and should be aware of the damage the acid can cause to the teeth.

After doing this experiment, it would be a great time to talk about the negative and positive effects of fluoride. (Many of my previous posts explain the details of fluoride and fluoridation.) The teacher should remind the students that fluoride is only good in limited amounts. They should not directly ingest fluoride, but rather brush with fluoride toothpaste twice a day to sufficiently protect their teeth.

The second lesson plan a teacher can do for their class demonstrates the negative effects of plaque. Again, Oral B outlines the easy steps to follow. An apple is used to represent the teeth. A quarter-sized diameter, one inch deep hole is cut in the apple and placed into a brown paper bag. It is left for a few days and then brought back out for reexamination. At this time, the teacher cuts the apple in half and the class views the changes. The apple has turned rotten in just a few days.

The results should be explained to the class that they are observing the effects of too much plaque. When the student overlooks brushing, the plaque is able to accumulate on their teeth and start a destructive process. This is one of the ways cavities are formed, and what child wishes for cavities?

By showing the students these various experiments they are able to better understand the importance of brushing. Seeing results always seems to be more effective than simply lecturing on a topic. The students do not only learn the importance of good oral hygiene but also how to keep a science notebook, make hypothesis, take observations, and see chemical reactions at work. This ought to be very interesting to the class because many science experiments are not seen until middle school, so witnessing an experiment should be stimulating and new to their minds.

Teaching about Decay

As I previously mentioned, the adolescent years are vital in teaching students how to properly care for their teeth. This is the time their body changes, and so do the needs for keeping their mouth healthy. Many schools lack the continued education for their students. I have found some lesson plans that teachers can use to show their students how important good oral care is. The lessons are geared for younger students, in elementary school, but it is important to realize that the sooner the students understand the benefits of good health, the sooner they will start to take the initiative to clean their teeth.

The lesson plan describing the importance of proper brushing and flossing deals with the idea of decay. Oral-B suggests doing an experiment with egg shells, water, and white vinegar to show the students the destructive nature of decay to our teeth. The teacher should have the students make observations in their science notebook of what they hypothesis to occur, what they see happening during the experiment, and after the experiment. The students should then compare their initial thoughts and the actual results to gain the science part of the curriculum.

The experiment is simple: put egg shells into two different jars and cover the shells in one jar with water and the other with vinegar. The vinegar and egg shells react to produce bubbles, and after a few days of letting the jars sit, the egg shells are completely dissolved by the vinegar while the ones in the water are unphased.

The theory behind the experiment is quite simple as well. The egg shells are made of calcium, similar to our teeth and therefore represent the enamel of our teeth. The vinegar is an acid, which is similar to the acids in our mouth that can be destructive if not properly cared for. The production of bubbles demonstrates the acids that eat away at the tooth enamel, weakening it which increases the change for tooth decay (cavities). After allowing the experiment to sit and react for a few days, the egg shells are completely dissolved in the vinegar. This emphasizes the importance of properly cleaning the teeth because the acids could remove the entire protective enamel layer.

By doing an experiment with the class, the students are more prone to remember the startling outcome. The active learning is more beneficial for the students because they are able to see a simulated version of what is going on in their mouths. If I were to see this experiment as a child, I have a feeling I would never complain about brushing my teeth again! It is probably confusing for the students to know the difference between the actual teeth and the enamel layer, so it may appear that the teeth themselves could be dissolved. While the acids contribute a destructive nature to the teeth, the teacher should thoroughly explain the difference of the tooth and enamel, to make sure the students are not confused or scared of dissolving their own teeth.

This simple experiment can be very effective if properly explained. A great follow up lesson would be to then teach the class how to properly clean their teeth to remove all of the acids.

Time to Teach

During a telephone interview with Dr. Thomas Kiefer who practices in Omaha, Nebraska, the subject of education arose. He mentioned that the education children receive on dental care is limited. In the Omaha public schools, around the third grade students are educated on the importance of proper dental care. Either the teacher, school nurse, or a local dentist comes into the classroom and gives a brief presentation. There is not much education or training after that. As students change schools and get older, they are required to take a few different health education classes. These are normally in the 6th grade and then again in high school. The health classes teach the changes that come with puberty and the harmful effects of drugs and alcohol. Nowhere in the classes do they touch on dental health. Dr. Kiefer said that puberty is a vital time in a child’s life. As their body changes, so does the care needed for their teeth. This would be an ideal time to re-teach students the importance of proper dental care and how to effectively get results. So many students are beginning to make their own decisions of what food to eat for lunch or snacks at these transition times. By providing more incentives to choosing healthy food, students may see why healthy decisions are important for more than just weight control.

The teachers do not have to be the ones to provide the information. The teachers or school nurses may not know enough themselves to properly teach the class. Even if the school provides adequate information, it may not be taken seriously by the students. It would be most beneficial from my standpoint, to bring someone in from outside the school. There are unlimited dentists who would be willing to come teach young adults the importance of dentistry. Another option would be to seek a dental school. There are students training to not only become dentists or specialists, but hygienists and assistants. Any of these people would be great resources to provide ample information for adolescents. The middle school or high school students would probably receive the information with more respect and take it to heart more than if it came from their teacher who taught them a wide range of subjects. By bringing in an expert, the students are more prone to listen and take their advice, or at least to think about what they are saying. By planting a thought in the students mind, the goal would be achieved.

Because teaching students is such an important part of continuing their education and making their oral health better, I will be discussing different approaches for teachers who can’t bring someone in from the outside to achieve this goal with the next few posts.

Michigan Town Returns to Flouridation

The town of Mt. Pleasant, Michigan voted to remove fluoridation in 2004 with a small margin of 52 percent to 48 percent. Mt. Pleasant had their water fluoridated since 1957 and changed after a "clean water" initiative passed. This past year, in November of 2005, they voted on the topic of fluoridation again. This time around the community voted to fluoridate their water by a much larger margin of 63 percent to 37 percent. The reason for the turn-around in the public's vote was due to the hard work of local dentists. The dentists took extra steps to educate their patients on why fluoridation is important for their health and the community. Some of the ways the dentists approached the situation was by mailing out postcards, talking with the media and putting up road signs. The dentist in charge of the movement said he wanted to better educate the public on the confusing terminology and wording that the ballot used in the previous vote. The article describes in greater detail about the different measures the dentists took to educate their patients to make the best decision for themselves.

I find this case of Mt. Pleasant interesting not because a town had fluoridated water for several years and then decided to change it, but more that the town voted to return to fluoridated water, only a year later. It is apparent that the information that the dentists provided had an overwhelming effect on the town. I think that the people of Mt. Pleasant would not be easily influenced since only a year earlier they heard information that was dramatic enough to vote fluoridation to be removed. I hope that the community would remember the arguments of those opposing fluoridation when voting on the topic again in 2005, and compare it to what they heard the previous year. I wish the writer of the article would have included the main points of the arguments so others could evaluate the situation on their own. Unfortunately it only discusses the steps the dentists took to educate and not the information itself. It is amazing how fluoridation, like many other controversial topics, can take on many different arguments. Some positions are stronger than others, but the fact that dentists were providing the information it seemed to be much more credible. I hope that the dentists did not abuse the trust that patients have for them, but provided solid evidence that was the best for the whole town. It does not seem to give the dentists a lot more business if the water is fluoridated or not, so hopefully the dentists could give advise based on how they truly felt, leaving the business side behind. As a public health provider, I think providing the public with sufficient information to make their own decision is part of their job. The town of Mt. Pleasant, Michigan gives hope to those who are trying to implement or continue the use of fluoridated water in their community.

Don’t Be Fooled: Use Your Brain

As I have mentioned time and time again, the process of adding fluoride to a community’s drinking water is very controversial. Not surprisingly, there has been research done to help sway the public and committees one way or the other. It is important to question the authors when reading through the studies, articles and other gathered other information. Many of the documents will be written by a person working for, or donating to, one specific side of the debate. The articles and studies are meant to be persuasive, so they will be presented with this in mind. Studies can be conducted from an uneven population distribution which can alter the results, or information that is not positive for their debate can easily go unmentioned. Keep these things in mind and don’t suppress your speculations. Research both sides of the debate to make the most educated decision for both you and your community.

An article was published just a few weeks ago detailing why Martin County delayed their decision to add fluorine to their water systems. The county had all the details on how to execute the implementation of fluoridization. By January or February of next year, fluorine would be added to the community water supply, as soon as the plant, Tropical Farms, was complete. The state has already issued a grant for $127,500 to implement the process. When the commissioners met a few weeks back, they came to the conclusion that the information they were provided with to make a decision was inadequate. They voted to postpone their decision until further research was gathered to analyze. The commissioners want to gather more information on the benefits or risks of the artificial fluoridization process. They were provided with a study done by the National Research Council that concluded high doses of fluorine, 4 milligrams per liter or higher, proved to have health risks in consumer’s bones. The commissioners noted that the amount of fluorine that would be added to the community’s water would be much lower than what was used in their study, and they would be staying within the regulations of 0.7 to 1.2 milligrams per liter. The research conclusions were insignificant to the case at hand because they were reviewing totally different standards. Like it is often concluded, too much of a good thing isn’t always the best. It is not surprising that the research team found the results that they did, because many other research projects with the same conditions had similar results.

It seems that the commissioners of Martin County made the best decision that they could: to wait. More information was needed for them to make a decision that affects the entire community. Had they rushed into the situation and voted without adequate information from unbiased sources, the results could have been detrimental to the community and they would have been partly to blame. I applaud the commissioners for their courtesy to the public, and for using their intuition. They realized that the facts they were presented with were not applicable to the situation they were going in to. The beginning of the article stated that the research conducted by the Congressional Research Service is a part of the US Congress research team that provides unbiased research. This team of researchers would be credible, while the one stated in the article, National Research Council, was presented without any details of their stance on the debate, or who was paying for the research they conducted. In all, I urge you to be aware of what you read, and continually question the credibility of the source, as that could change all of the results.

Response to Over-Fluoridation

The New York State Coalition Opposed to Fluoridation (NYSCOF) commented on my last post. They included an article talking about medical cases when people received too much fluoride in their diet and how their bodies reacted. They hit on some of the same points I already have, including skeletal fluorosis where a patient looses bone strength and mobility throughout their entire body. In the first case, a man acquired arthritic-like pain and it lead to limited neck mobility. When the scientists studied his habits, they noted that he was not getting any fluoride from outside sources such as fluoridated water, tea, or wine. He was ingesting fluoride when he brushed his teeth with fluoride toothpaste. He brushed before and after every meal, amounting to at least six times a day. After stopping his use of fluoride toothpaste and continuing to stay away from other foods and drinks that had fluoride in them, his symptoms of skeletal fluorosis decreased. The article states it took the man eight months going fluoride-free to get a significant reduction in his symptoms. After two years the man had finally regained all of his neck mobility. The article briefly mentioned other cases of skeletal fluorosis and how those people were affected.

I found this article to be quite interesting. It gave a few examples of what people have experienced from receiving too much fluoride. It was interesting to see what the people were eating or doing to receive so much fluoride. From the main case in the article, it baffled me to learn that someone brushed their teeth SIX times a day! This seemed a little outrageous to me, especially since many people do not brush their teeth twice a day. I didn’t understand his reasoning of brushing his teeth before he ate, since he was going to eat and then brush again. Besides the shock of his routine, I was surprised to find out that the man was only getting fluoride from his toothpaste. Right away I assumed he was brushing with fluoride toothpaste and mouth wash, as well as drinking fluoridated water. I was started to find that his condition was from the toothpaste alone, because I had never heard of a case like this before. It seems understandable to me now, because fluoride toothpastes are advertised and sold for the fluoride. The man subjected his body to six doses of fluoride and had troubling side effects. This case shows the toothpastes must have a large amount of fluoride in them, much more than fluoridated water systems have since a person probably drinks water from the faucet more frequently than they brush their teeth with fluoride. It appears that a solution for this man could have been to alternate the toothpaste he used throughout the day if he felt like toothpaste was necessary. (If you recall, in an earlier post I found several sources stating that brushing twice a day with fluoride toothpaste and the other times throughout the day only with water would be significant.) If the man had followed these suggestions he could have reduced the amount of fluoride he was taking in and thus, may have been able to prevent his skeletal fluorosis. The cases the NYSCOF documented were eye-openers, showing that over-fluoridation can be a serious matter. It troubles me however, that a dental professional was unable to catch the symptoms before they got so extreme. I feel this article proves that people need to be better educated about the effects of fluoride to their body and how they may control their fluoride intake. If people are better informed, there may be fewer people suffering from skeletal fluorosis and more people actually helping their teeth, not hurting their bodies.