Harvard Medical School studied longevity and found one of the most important contributing factors was daily flossing

2003

December 2003

Oral health problems associated with anxiety disorders include canker sores, dry mouth, Lichen Planus (lacy white lines, red areas or mouth ulcers, burning mouth syndrome, and temporomandibular joint disorders,.

People with anxiety disorders may disregard their oral health altogether and are at an increased risk for dental caries, periodontal disease, and bruxism (grinding). Anxiety could be caused by being anxious of a needle and complicate procedures.

Tell your dentist about your anxiety disorder and what medications you are on.

Some medications decrease the mouth's ability to produce saliva, which can increase the risk of developing tooth decay and periodontal disease. Other medication side effects include dry mouth, vomiting (which could cause tooth decay and erosion), anemia and bleeding

Academy of General Dentistry, Impact 12/03

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Chew Your Way to Relief

This is the season for large meals and even larger digestive discomfort, however researchers recently found that chewing sugarless gum for 30 minutes can be an effective remedy for those times when mild heartburn strikes.

Anger may be a risk factor of gum disease!

Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance and potentially increased risk of periodontitis. Methods. The authors examined the association between social support, anger expression and periodontitis in 42,523 male.   Subjects who reported having at least one close friend had a 30 percent lower risk of developing periodontitis. Men who participated in religious meetings or services had a 27 percent lower risk of developing periodontitis. Men who reported being angry on a daily basis had a 43 percent higher risk of developing periodontitis compared with men who reported being angry seldom. 
Prospective Study of Social Support, Anger Expression and Risk of Periodontitis in Men Merchant A.T. et al., December 2003 JADA 

Tooth loss and diet change

A recent study was published in the Journal of the American Dental Association.  Harvard University researchers assessed the relationship between tooth loss and changes in diet over an 8-year period among over 30,000 male health professionals.  The results of the study confirm if you can’t chew well, you tend not to eat certain foods.  These dietary changes make it more difficult for you to keep your body’s health in balance.

There was a different experience for men who lost five or more teeth.  They were also more likely to stop eating hard-to-chew foods such as apples, pears, and raw carrots, while maintaining or increasing their consumption of softer, less nutrient-rich foods.

 Mayo Clinic commented on this very subject....their medical opinion that keeping a full mouth of healthy teeth adds 10 years to your life, compared with losing all your teeth.  “Dentures are not a substitute for teeth.  They are a substitute for no teeth.” Good dentistry should enhance your health as well as your comfort and appearance.

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Premature Births: Know the Facts and Stats

 Recent studies have shown that women with periodontal disease are at three to five times greater risk of preterm birth than those who are periodontally healthy.

ADHA 12/03

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Caries in Primary Teeth Predict Future Decay

 Children with tooth decay in their primary dentition are nearly three times more likely to have decay in their permanent teeth, according to an eight-year study conducted in China. In 362 Chinese children age 3 to 5 years at the time of the 1992 baseline study, 85 percent who had had caries in their primary molars showed at least one decayed permanent tooth in a follow-up examination in 2000. In contrast, 83 percent of the children who exhibited no caries in their primary teeth remained decay-free until at least age 12. The authors of the study suggest that children with caries in their primary dentition should be considered high-risk cases for decay in permanent teeth, increasing the importance of dental sealants and fluoride treatments for decay prevention. The recommendation is consistent with a recent recommendation from the Centers for Disease Control and  The results of the Chinese study were published in the August 2002 issue of the Journal of Dental Research.

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November 2003

Increased preventive practices lead to greater tooth retention  

 In the US, the ADA and the Surgeon General have recommended that individuals brush twice and floss once daily, and have regular prophylaxis visits. The desired outcome is to maximize tooth retention, but there is little research on whether this is achieved. This study considered data from 736 dentate men (mean age 48 yrs, range 28-80) examined 3-yearly from 1969. The first 4 cycles (13 yrs) were examined as predictors of the clinical data over 26 yrs. Initially, participants had a mean of 24 teeth, 72% had education beyond high school, 20% smoked, 55% brushed once and 43% twice daily, 38% flossed, 85% had regular prophylaxis treatment, and 8% had a denture. Consistently good oral health behavior over the 13 yrs was related to less tooth loss. Of a mean 24 teeth per subject, 13% were lost over the study period. A significantly increased relative risk for tooth loss occurred with smoking (1.92 for a pack per day), and reduced risk with brushing (0.51), brushing & flossing (0.44), and brushing, flossing & prophylaxis (0.33).British Dental Journal (2003); 195, 327. Preventive dentistry- Increased preventive practices lead to greater tooth retention Kressin NR, Boehmer U et al. J Dent Res 2003; 82: 223-227 

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Relationship between dental health and 10-year mortality in a elderly. The aim of the study was to assess the possible role of dental health as a predictor of mortality. The results showed that the more teeth or filled teeth a subject had, the smaller was their risk for death. The effect of missing teeth was significant after adjusting for the general health variables. Results support the hypothesis that poor dental health is linked to increased mortality among elderly people.
European Journal Of Oral Sciences Volume 111 Issue 4 Page 291 - August 2003

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Signs of early oral cancer

While those at greatest risk for oral cancer are typically over 40 with a history of smoking and/or alcohol use, we are seeing reports of an increase in populations traditionally considered at lower risk.   Data show that oral cancer incidence among women has increased from 15% of all patients with oral cancer to a full third of oral cancer cases over the last 45 years. The changing ratio is likely the result of the increase in smoking among women in the past three decades. Cancer also is an age-related disease, and in the United States, there are 50% more women over 64 years of age than men over 64. It also appears that tongue cancer in males under 40 years of age may be increasing.  Approximately 28,000 new diagnoses of oral cancer occur each year in the United States. According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims almost as many lives as melanoma cancer. Although tobacco users and those who consume alcohol are at higher risk for developing oral cancer, more than 25 percent of oral cancer patients do not fall into these risk categories. The stage of an oral cancer diagnosis is critical. When detected at its earliest stage, oral cancer is more easily treated and cured. When detected late, its five-year survival rate is about 50 percent. Testing is painless and there is no question that early detection saves lives." ADA News Nov 03

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October 2003

Weight and Teeth

Being overweight may also contribute to bacterial infection of the gums that can lead to tooth loss.  In a study at Case Western Reserve University , obese adults between he ages of 18-34 were 76% more likely to have periodontal disease than similar aged people at a healthy weight.  And adults under 35 with large waistlines, at least 34 inches for women and 40 inches from men, were about twice as likely to have gum disease as their slimmer counterparts.  While the study does not prove that obesity causes gum disease, it points out that excess fat secretes substances called cytokines that can damage tissues around the teeth.  Also heavy consumption of sugary foods may allow bacteria to thrive in the mouth, while fiber rich fruits and vegetable may inhibit plaque.

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Diet Changes Because of Tooth Loss Could Lead to Heart Risk 

Changes in diet because of tooth loss could increase the risk of developing chronic ailments, including cardiovascular disease, according to a study in this month's Journal of the American Dental Association (JADA). In the study, researchers assessed the relationship between tooth loss and changes in diet over an eight-year period among 31,813 male health professionals. They focused on consumption of specific foods and nutrients associated with cardiovascular and other systemic diseases.  The results of this study support the detrimental impact of tooth loss on dietary intake. Results suggest that changes in diet owing to tooth loss could contribute to an increased risk of chronic disease that has been associated with poor dentition.  According to the study, the dietary change of men who lost five or more teeth was unhealthier than that of men who lost no teeth.  www.rdh.net 10/03

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Gingko biloba has anti-platelet properties that may reduce blood clotting. Aspirin is an anticoagulant, or blood thinner, that also may increase the time it takes for blood to clot. Thus, combining gingko use with daily or frequent aspirin use could increase the risk of bleeding complications. Ask your doctor before taking both regularly.

RealAge Cost: Taking unnecessary vitamins and supplements can make your RealAge as much as 1.7 years older.

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Acne Treatment May Cause Appearance of Discolored Gums

The use of minocycline, an antibiotic prescribed in the treatment of acne and rheumatoid arthritis can cause the teeth and bone to discolor and may make gum tissue appear blackish-blue in color.  Permanent teeth could become permanently discolored with continued use of this medication. Journal of Periodontology.  Dentistry Today pg 36 September 03

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Osteoporosis, a bone disorder affecting 28 million Americans, also increases those patients risk factors for tooth loss, bone loss and periodontal disease according to AGD.  

Early warning signs of osteoporosis may include:

Dentist also may be able to help detect the first stages of osteoporosis through dental x-rays, which have the ability to show the amount of jawbone loss from year to year, signifying advancing stages of the disease. Dentistry Today 9/03

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Bacterial Infections Can Halt Oral Surgery
Posted on: 09/23/2003.... "Extreme Makeover," helps people enhance their features from head-to-toe through plastic surgery. However, if a patient already has a bacterial infection in the body or mouth, the surgical procedure may have to be postponed.

On one episode, the patient was unable to proceed with breast augmentation because of a bacterial infection in her mouth known as periodontal disease. The periodontist and plastic surgeon were concerned that the bacteria in the patient's mouth may affect the outcome of her plastic surgery.

Periodontitis is a bacterial infection of the gums, bone and periodontal ligament. The bacteria from periodontitis can enter the blood stream and cause systemic complications,  The bacteria in the bloodstream can compromise recovery from any surgery, but is particularly problematic for patients receiving implants, transplants or replacements of body parts since it may cause these procedures to fail. Before undergoing surgery, patients should have a periodontal examination to ensure that they don't have bacteria in their mouth that may affect their recovery."

Source: American Academy of Periodontology

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September 2003

A Pain in the Brain 

Of the 46 percent of women and 38 percent of men who regularly suffer from tension headaches, many may not realize the source of head pain may be directly linked to the mouth. Rather than reaching for a bottle of painkillers, people who suffer from tension headaches should consider reaching for their phone and calling their dentist. Tension headache sufferers often blame headaches on a stressful day or a bad night's sleep but when the headaches consistently keep coming back, dentists can help investigate the real source of the pain to determine a diagnosis. A dentist can look in a patient's mouth and tell by how the jaw is positioned or by how the teeth are aligned whether or not the mouth may be the source of the pain. Nearly two-thirds of tension headache sufferers clench or grind their teeth, which is known to trigger a headache. The size, position and movement of the jaw muscles also is a factor, which is why 70 percent of Temporomandibular Disorder (TMD) patients complain of this problem. Although the medical community has a role in helping patients identify and cure headache pain, the dentist's office should be their first stop on the way to becoming headache-free.  09/03

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Various herbal supplements have been reported or are suspected to interact with certain oral health drugs, the most important ones being 1) bromelain, cayenne, chamomile, feverfew, dong quai, eleuthro/Seberian ginseng, garlic, ginkgo, ginger, ginseng and licorice interacting with aspirin; 2) aloe latex, ephedra, ginseng, rhubarb, cascara sagrada, licorice, and senna interacting with corticosteriods; 3) kava, St. John's wort, chamomile, and valerian interacting with central nervous system (CNS) depressant drugs; and 4) herbs acting on the gastrointestinal system, altering the absorption of several orally administered drugs. Further, the use of some herbal supplements has been reported to be associated with oral manifestations, including aphthous ulcers, lip and tongue irritation, and swelling with feverfew; gingival bleeding with feverfew and ginkgo; tongue numbness with echinacea; xerostomia with St. John's wort; oral and lingual dyskinesia with kava; and salivation with yohimbe. These potential effects of herbal supplements in conjunction with factors related to regulation restrictions suggest that the use of these products may be associated with various adverse reactions that can affect oral health and treatment.  [JADHA www.adha.org Winter 2003]

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The Effect of Different Types of Smoking Habits on Periodontal Attachment - Journal of the International Academy of Periodontology April 2003, Ashri NY, Al-Sulamani A

The result showed that there is increased loss of attachment in smokers than non-smokers. However, when comparing Shesha smokers to cigarette smokers it was found that Shesha smokers had a greater attachment loss, recession  and deeper pocket depth than cigarette and Argela smokers. These findings suggest that all types of tobacco consumption increase periodontal disease severity and Shesha smoking had a greater effect than cigarette and Argela smoking on disease severity. This study confirms that tobacco is an important risk factor for periodontal disease. 

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A dentist may be the first one to suspect health problems, including heart disease. A sore or painful jaw is one indicator of heart disease. There's also a connection between gum disease and heart problems. By eliminating a local infection involving a tooth or the gums, patients have been able to decrease blood pressure medications and improve overall health. New research is suggesting that people with gum disease are at higher risk for heart attacks. If bacteria in the infected gums dislodge, they can enter the bloodstream, attach to blood vessels and increase clot formation. That in turn decreases the blood flow to the heart, increasing chances of a heart attack and aggravating high blood pressure.

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Plaque Can Cause Aspiration Pneumonia 

In research on a group of 95 elderly persons from nursing homes who were hospitalised for severe aspiration pneumonia, investigators concluded that the bacteriology associated with their disease could have sprung from micro-organisms that had been colonized in either their dental plaque or oropharyngeal cavity at the time of aspiration.  Many older institutionalized patients have deterioration in their activities of daily living, It is quite plausible that poor oral health, because of the difficulty of accessing professional dental care and insufficient or poor oral hygiene, leads to an environment that promotes colonization of dental plaques by anaerobic and Gram-negative organisms.
June 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine, Ali El-Solh, M.D., M.P.H., of the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Buffalo School of Medicine, Buffalo, New York

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Quality of life = health, wealth…and teeth! 

 While having life's cake and being able to eat it comfortably is a goal we all share, how much does losing teeth change the quality of life? Can we manage with fewer teeth? Unstable prostheses? Loose dentures? For that matter, how do dentures impact on lives? The hypothesis that adults with teeth had a better oral health-related quality of life than did adults without teeth.   All denture wearers expressed similar dissatisfaction with their dentures when they first sought treatment. Their complaints included looseness, pain beneath the dentures, and difficulty eating with unstable dentures. Most complained about mandibular dentures but not about their maxillary dentures. While complaints by denture wearers may be similar relative to their dental problems, their psychological makeup and needs are quite different.  Regardless of treatment, patients with their own teeth reported the best quality of life-outcomes. Patients who choose to replace dentures with implants have a poor oral health-related quality of life and that some of these issues remain post-treatment. These issues may continue post-treatment, but to a lesser extent.  *Allen PF and McMillan AS: A longitudinal study of the quality of life outcomes in older adults requesting implant prostheses and complete removable dentures. Clin Oral Impl Res 14:173-179, 2003.

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Oral Health Mirrors Overall Health

       Poor oral health and untreated oral diseases can have a significant impact on quality of life.  Oral health can mirror condition of the body.  More than 90% of all systemic disease have oral manifestations, meaning your dentist may be the first health care provider to diagnose a health problem.

     75% of the American population is affected by some type of gum disease or gingivitis.  Recent studies show that infections in the mouth may affect major organs.  One condition is bacterial endocarditis, a condition in which the lining of the heart and hear valves become inflamed.  Poor mouth care contributes to oral cancer, which now takes more lives annually than cervical or skin cancer.  Poor oral health affects the digestive process, which begins with physical and chemical activities in the mouth.  Problems here can lead to intestinal failure, Irritable Bowel Syndrome and other problems.

     Mouth tissues reflect symptoms of other problems.  Many diseases can be diagnosed in their early stages through oral examination.  These disease may be characterized by swollen gums, mouth ulcers, dry mouth and/or excessive gum problems.  Some of these diseases include diabetes, leukemia, cancer, heart disease and kidney disease.

     Seeing a dentist every six months can help identify disease in their earliest stages.  A regular exam allows your dentist to be an active partner in helping you to maintain and keep good health  Theses exams pick up on poor nutrition and hygiene, growth and development problems and improper jaw alignment, and home care for special oral health care needs.

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Toothprints Adult version

"...Another even uglier war is affecting our country; missing and abducted children.  In addition to these tragedies, lives are lost unexpectedly in disasters like fires and plane crashes. Unfortunately, this is reality.

 For years, forensic investigations have relied on dental radiographs and records to aid in identification and recovery efforts. Now that so many children and young adults are caries-free, our traditional information is no longer as valuable. Also, many investigations have been hampered when records have been difficult to obtain. Finally, we have a way to help our law enforcement and governmental agencies more than ever before. 

Science tells us that we each have a unique bite and that our saliva contains precious genetic information, as well as our own unique scent. We now have the ability to record our patient's bite quickly, accurately and inexpensively with a new product called Toothprints. It should be stored at room temperature in a marked zip-lock bag, preferably in a safe place at  home. It is advisable to put a current picture with the Toothprints record.  Valuable genetic information can also be stored on a cotton swab that has been rubbed on the buccal mucosa. The swab should be placed in a marked zip-lock bag and stored in the freezer. Finally, even though Toothprints was designed for identification of children, this same technology can be used to record adult dentition. If the impression material is too small for an adult, once it is flexible it can be stretched to fit a larger dentition and still capture all of the necessary information. Some people are concerned about having fingerprints, personal records and genetic information stored in gigantic databases. Toothprints eliminates these issues. Family members can store this information at home or in a safety deposit box. 

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May 2003

Get Healthy Teeth.....Got 2 Minutes?

Crash test dummy to build a better mouthguard 

Two summers ago, a 10-year-old boy playing Little League baseball found himself sprinting for home plate. When he glanced up to check the throw from second, the ball smacked him square in the mouth. In an instant, the boy lost three upper incisors. The ball luxated the fourth, fractured his alveolar bone and drove four lower incisors back into his head. The boy wasn't wearing a mouthguard. But Dr. David Kenny, who fitted the boy for a partial denture, says he's treated so many smashed-in kids' faces in his 20 years of pediatric dentistry at the Hospital for Sick Children. "Kids' bones and teeth aren't done growing yet. "So when there's facial trauma, all you can really do is fit them with a partial denture, then remake and adjust it as they grow. That's thousands of dollars in dental expenses, with little or no insurance coverage."  Dr. Kenny believes a mouthguard should protect much better than so- called boil and bite mouthguards currently on the market—semi- circular pieces of rubber users heat in boiling water, then bite down to create an impression around the teeth.  Mouthguards are like bumpers on a car, the bumper takes the hit, but the car's frame—or in a person's case, bone—absorbs the real force of impact. Dr. Kenny agrees that custom-made mouthguards shaped by a dentist will fit better. Each cadaver will be fitted with all kinds of data input devices, including five strain gauges: one in the palette, two in the canine fossa and two in the bilateral zygoma. A baseball pitching machine will launch a baseball at 50 mph at the cadaver's four upper front teeth, which Dr. Kenny says suffer most from sports-related injuries.  Dr. Kenny and his colleagues will start building a working prototype of the new mouthguard. 

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Study finds some women lose sensitivity to sweet tastes after menopause.

After menopause, some women may increase their use of sweeteners due to a decreased sensitivity to sweet tastes, with potentially serious complications for obesity and diabetes. Researchers found that the hormonal changes women experience during menopause seem to reduce the ability to taste sucrose for some. Comparing 20 postmenopausal women with 20 men of similar age, noted a significantly lower sensitivity to sucrose on the palates of the women. However, sensitivity to salt, sourness and bitterness was virtually the same for both groups and there were no changes in taste sensations on the tongue. The researchers said this decline in sensitivity to sweetness was often accompanied by dietary choices skewed toward sweeter foods reported by the women subjects. While only 35 percent of the women said they had noticed a change in taste perception, 45 percent reported an increased preference for sweeter fare. The researchers noted that a preference for sweeter foods could have potentially serious consequences for diseases such as obesity, heart disease and diabetes.
British Dental Journal

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Oral contraceptive may increase pain after wisdom tooth extraction 

That tests on 267 women showed that those on the birth control pill were more susceptible than non-users to both postoperative pain and a condition known as 'dry socket.' In this condition, normal healing of the vacant tooth socket is delayed by the failure of a blood clot to form. Infection instead causes the socket to remain empty. In the study, pain on the day after the operation was experienced by 30 percent of pill takers compared to just 11 percent of non-users. Five days after the operation the difference was 14 percent compared to 5 percent. The researchers said these results suggest that the pill may reduce the pain threshold. The differential was similar when the development of dry socket was compared. Here, 11 percent of pill users were affected compared to 4 percent of non-pill users. 
SOURCE: British Dental Journal 2003;194:453-455.

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April 2003

Sweets For Stronger Teeth? 

Scientists as the Paffenbarger Research Center in the USA are working to develop gum and sweets that will aid in the remineralization of teeth, reports the American Dental Association. Calcium phosphate-based technologies have been shown to eliminate the ability of sucrose challenged plaque to demineralize tooth enamel and, therefore, prevent caries. Other studies have shown that separate calcium and phosphate compounds can even produce a more positive affect by remineralizing enamel.

Kids and Mouth Breathing

     Mouth breathing is an upper airway obstruction which causes the inability to breath through the nose and is a major cause of lots of medical problems.    These children need orthodontic evaluation at age five instead of 7 to avert future medical problems and correct existing problems.

Preventing Stain 

Over-the-counter tooth-whitening gents may be able to prevent staining according to researchers at the University of Brighton. In the study, the tooth model was pretreated with the whitening agent, and then a standardized tea stain solution was added. Minimal stain adhered to the hydroxyapatite surface, thus demonstrating an inhibitory action. British study suggests tooth whiteners may also prevent staining 
Dentistry Today 2002; 21(12);25-26]

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	Food and Drug Administration, October 1997: “[Our] analysis did not support claims that individuals with dental amalgam restorations will experience adverse health effects, including neurologic, renal or developmental effects.”
	U.S. Public Health Service, September 1995: “There is no sound evidence of any harm for millions of Americans who have dental amalgam fillings and no persuasive reason to believe that avoiding amalgams or having existing amalgams replaced will have a beneficial effect on health ... the removal process itself may expose the patient to additional mercury.”
	WHO/FDI consensus statement, September 1997: “No controlled studies have been published demonstrating systemic adverse effects from amalgam restorations. Amalgam restorations are durable and cost-effective... ”
	National Institute of Dental and Craniofacial Research, August 1991: “There is no scientific evidence that currently used restorative materials cause significant side effects. Available data do not justify discontinuing the use of any currently available dental restorative material or recommending their replacement.”
	Consumer Reports, May 1991: “Removing amalgam in favor of an alternative material can be a risk in itself. With large fillings, the process can damage tooth structure and may injure the nerve, requiring a root-canal procedure.” The magazine later noted: “Given their solid track record and a risk that’s still conjecture, amalgam fillings are still your best bet.”
	ADA Council on Scientific Affairs, April 1998: “Given the available scientific information and considering the demonstrated benefits of dental amalgams, unless new scientific research dictates otherwise, there currently appears to be no justification for discontinuing the use of dental amalgam.”

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February 2003

Modern Lifestyle Damaging Teeth 

      Today's fast-paced lifestyle is damaging oral and overall health, according to a new study in the latest issue of General Dentistry. Quick meals made up of nutrition bars and carbonated beverages may help to keep teens alert during the day, but they're contributing to permanent health damage. '

     Premature loss of tooth enamel and weakening of overall tooth structure are two devastating oral affects of teens' poor diet that can not be reversed later in life. Dr Soxman's research shows that drinking carbonated beverages seems to be one of the most significant causes of increased cavities and obesity for today's teens. Fifteen percent of American adolescents aged six to 19 are overweight. This number is expected to increase as 10 per cent of children aged between two and five are overweight, and today's pre-school children are already becoming addicted to caffeine and sugar. 

     . (cited smile-on.com)

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Toothbrush Trounces Car as Top Invention

Lowly toothbrush is the king of inventions.

So say the findings of a new survey released Wednesday by the Lemelson-MIT Invention Index at the Massachusetts Institute of Technology, which asked which of five inventions Americans could not live without. The toothbrush emerged the undisputed champ, beating out the car, the personal computer, the cell phone and the microwave -- in that order -- as the most prized innovation.

But the toothbrush finding has received the most attention, researchers said, because it shows that the public recognizes that great inventions don't have to be complicated.

It's been a long road to the top for the toothbrush. The first was built in 1498 by a Chinese emperor who had hog bristles embedded in a bone handle, than the hog bristle toothbrush became popular in Europe, but because it cost so much, poor families would often share the same brush. It wasn't until 1938,  that DuPont introduced nylon bristles as a replacement for pig hair. 
By Jeordan Legon CNN

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January 2003

Power toothbrushes
-Reuters Health

Based on data from 29 clinical studies, dental researchers found that only one type of power toothbrush—the rotational oscillation toothbrush—did a better job of cleaning teeth than a manual brush.

Rotational oscillation toothbrushes removed up to 11 percent more plaque and reduced gingival bleeding by up to 17 percent more than did manual or other power toothbrushes, according to research results from the Cochrane Oral Health Group.

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Oral Health Status of Rural Adults in the U.S.