HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Extract Full Text (PDF) Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Formicola, A. J. Search for Related Content PubMed Articles by Formicola, A. J.

Allan J. Formicola, DDS

Correspondence: Requests for reprints should be sent to Allan J. Formicola, DDS, Center for Community Health Partnerships, Columbia University Medical Center, 630 W 168th St, Box 100, New York, NY 10032 (e-mail: ajf3{at}columbia.edu).

In her letter regarding our article on strengthening the oral health safety net, Widome proposes the widespread use of xylitol gum as an effective measure to prevent dental caries in children. Our purpose was not to specify individual or communitywide preventive strategies. We described 3 operational programs to improve access to oral health care for children and adults. Improving access for the millions of Americans who are uninsured or underserved is a great challenge. In describing successful models to open access to care, our hope was that others might employ similar programs and strategies for low-income populations.

Experience has taught us that preventive programs should not operate in isolation but should coexist with treatment systems for existing disease. In northern Manhattan, the Columbia Community DentCare program in the public schools uses proven preventive interventions such as screening the children, providing oral hygiene education, providing cleanings, and applying dental sealants. However, the existing disease burden in children is high in northern Manhattan and in many communities where access to care is limited. In the northern Manhattan example, the prevalence of untreated dental caries in the school children was 36%, with 13% of children having at least one severely carious tooth requiring endodontic therapy or extraction.¹ Thus, improving access to treatment was as important as implementing preventive measures. The 3 programs we described—the northern Manhattan Columbia Community DentCare program, the New Mexico Health Commons Model, and the FirstHealth Model in North Carolina—all provide both treatment and preventive services.

Water fluoridation, oral hygiene measures, and dental sealants are widely accepted cornerstones of preventive programs in the United States. Xylitol chewing gum, as pointed out by Widome, appears to be a promising caries prevention method.² In the United States, large-scale studies may be necessary before the general use of xylitol is recommended.³

References

1. Mitchell DA, Ahluwalia KP, Albert DA, et al. Dental caries experience in northern Manhattan adolescents. J Public Health Dent. 2003;63:189–194.[Medline]

2. Hayes C. The effect of non-cariogenic sweeteners on the prevention of dental caries: a review of the evidence. J Dent Edu. 2001;65:1106–1109.[Abstract]

3. Scheie A, Fejerskov O. Xylitol in caries prevention: what is the evidence for clinical efficacy? Oral Dis. 1998;4:268–278.[Medline]

This Article Extract Full Text (PDF) Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Formicola, A. J. Search for Related Content PubMed Articles by Formicola, A. J.