Something to Chew On: Keeping Those Pearlies Healthy

From the WebMD Archives

March 26, 2001 (Bethesda, Md.) -- Dental care has come a long way from the days of George Washington, when our first president struggled with custom-rigged ivory dentures after losing his teeth to disease.

A surgeon general's report last year noted that our nation's oral health is its best ever. Tooth disease, called dental caries by dentists and other experts, has declined significantly in terms of both numbers and severity.

"We feel that people should be able to retain their teeth for their lifetime," Dushanka Kleinman, DDS, deputy director of the National Institutes of Health's (NIH's) National Institute of Dental and Craniofacial Research, tells WebMD. "There is no reason to lose a tooth due to dental caries."

But in too many cases, bacteria are still often able to work their way underneath dental enamel and rot teeth away. Many poor and minority groups still suffer untreated tooth disease, and effective prevention and treatment actions don't get fully used.

"We know how to prevent this disease," Alice Horowitz, PhD, senior scientist at the dental institute, tells WebMD. "Children born now needn't have this, even though they do."

Tooth decay is five times as common as asthma and seven times as common as hay fever in 5- to 17-year-olds, and 78% of 17-year-olds have experienced tooth decay.

This week, dental experts are meeting at the NIH to discuss the latest research and offer recommendations. On Wednesday, an independent panel will close the conference by releasing a statement that outlines the best ways to prevent and treat dental caries.

According to the researchers, prevention is most easily achieved through exposure to fluoride.

"Fluoride exposure through water supplies or supplemental tablets should be recommended for all children as a primary preventive measure," says Norman Tinanoff, DDS, at the University of Maryland Dental School in Baltimore. "Perhaps the next best method is daily use of a fluoridated toothpaste."

About 100 million Americans don't have community water fluoridation, although 144 million (62% of the population) do receive this public health benefit. Federal officials hope to increase this proportion to 75% by 2010.

Another key prevention move is having your dentist apply dental "sealant," a plastic film that coats the chewing surfaces of teeth. The sealant prevents decay from sprouting in the nooks and crannies of teeth, where fluoride is less effective on food debris and bacteria.

Sugar was a primo dental health villain back when fluoridation wasn't as widespread. But sugar consumption in this country has been on the rise even as dental caries has declined, notes Brian Burt, PhD, of the University of Michigan School of Public Health in Ann Arbor.

That doesn't mean reach for the sweets, but Burt said that if an individual has strong exposure to fluoride, sugar is a "moderate-to-mild" risk factor, "not the most crucial aspect" of prevention.

Tinanoff also notes that there is "good evidence" that chewing gum with xylitol (a type of sugar) actually reduces caries in children's teeth.

And there are other, more fanciful ideas in the hopper.

Peter Milgrom, DDS, of the University of Washington, referred to new electric toothbrushes and toothpaste tubes that come with timers and beep if not opened every day. And there's also the thought of making toothpaste tubes that send email to your dentist if it is not opened often enough.

Back to Earth -- How about treating those cavities?

It's still primarily "drill and fill," a basic treatment model that hasn't changed in 100 years, says Amid Ismail, BDS, of the University of Michigan School of Dentistry. Science may bring further advances, however.

"Some of our more basic research is looking at how we could even take extensively diseased teeth and apply biomimetic materials -- materials that mimic biology -- and be able to regenerate tooth structure," Kleinman says.

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