Although many of you have heard some of this before, I wanted to be as explicit as possible so you can perhaps tweak your own knowledge, but more importantly share this with people in your life. One of the great tragedies in our society is that we do not share things that we have learned with each other so we are constantly reinventing the wheel. Along those lines, there are two things that I think are important to discuss. 

As you well know, there has been the politicalization of science. One Pandora’s box that’s been open relates to the benefits of fluoride in the water supply. 

First, a little history. Fluoride was discovered during World War II as a benefit when soldiers who were being examined in their basic training who were from certain parts of America were free of decay and in addition had some slight whitening or mottling of their teeth. The absence of decay triggered an interest by dentists at these various bases in the United States, resulting in an examination of the water supply where these decay-free young men had come from. Scientists discovered in those areas the water had a high level of fluoride which would explain the absence of decay, as well as some of the mottling or whitening of the teeth. This led to the decision to provide fluoride in many of American reservoirs, but in much lower concentrations than those found naturally occurring. 

Henceforth, there was a substantial decrease in decay in children and young adults.

In countries that had eliminated fluoride, fifteen years ago they discovered a rapid increase in decay in the youths of their countries. These countries have now reinstated fluoridated water. 

Unfortunately I was not one of those who experienced fluoride in my water. The result was my life as a dental patient as a young boy and right into my teen years. The one advantage was that it piqued my interest in dentistry and thus I am able to share this with you. 

There is no question, scientifically, that fluoride in the concentration that is currently used in our water supplies is safe. But as you are well aware, all science is under some form of political attack. The good news is that, unlike politics, science can be affirmed in laboratories and studies around the world.

Thanks to the proliferation of social media, cable news and alternative facts all aspects of our society are being questioned and to some degree are under attack. 

On other issue which just came to my attention. A recent study looking at people with Alzheimer’s found that a statistical increase in the incidence of this scourge was found in individuals who had evidence of periodontal disease. In addition, in the brains of patients who had Alzheimer’s that underwent autopsies, the presence of a particular bacteria called P.gingivalis was found. This same bacterium is found in the pockets of people with periodontal disease. 

When you brush your teeth, if you have periodontal issues, those bacteria do enter your bloodstream and are almost always eliminated by our own immune systems. However, the fact that they accumulated in the brains of these individuals is of note and should be further studied.

NOW TO DENTISTRY 3.0 

Modern medicine and dentistry are educationally, clinically and financially driven by the concept of providing sick care to patients while dentistry is focused on repairing and replacing teeth. 

The economics of these approaches is unsustainable. Science has provided us with more effective treatments for acute and chronic diseases and dental technology has provided the dental profession with more efficient ways to replace teeth. 

Preventing disease in both professions has become an orphan in a world of sick care options. 

Current media advertisements fill the airways, promoting the concept of replacing all one’s teeth in a day with titanium roots and manmade crowns and unfortunately, influencing the viewpoints and treatment provided by dentists. 

As medicine should focus on providing patients with a long health span, Dentistry 3.0 should be committed to preserving the natural teeth for a lifetime. The Mayo Clinic has observed that patients presenting with a healthy, intact natural dentition live on average 10 years longer. 

Let’s first discuss the issues that lead to dental disease and ultimately tooth loss. There are ten horsemen of the dental apocalypse. 

1) YOUR GENETIC VULNERABILITY TO DENTAL DECAY AND PERIODONTAL DISEASE 

If your parents or siblings suffer from dental issues, you are more vulnerable. Knowing this should guide your dentist, as well as yourself, in seeking preventive dental procedures as early as possible and as frequently as necessary. Just as knowing that your family has a history of breast cancer and the Bracha gene can prevent death from ovarian cancer, knowing the risk of dental disease can make an enormous difference in the care you seek and receive. 

2) UNDERSTANDING THE CAUSE OF DENTAL DISEASE 

The oral cavity is populated by hundreds of different bacterial species. A dozen or so survive by growing on your teeth, between your teeth and below the gum line. Within 12 hours of your teeth being thoroughly cleaned, these bacteria begin to re-form. The outcome of your future dental issues will depend upon your genetics, your general health and most importantly, how effective you are at disrupting the bacteria before they’re capable of causing damage to the teeth or the bone around the teeth. The accumulation of bacteria does not depend upon what you eat. However, sugar rich foods can increase your rate of decay if there are bacteria present at the time of ingestion.

3) EFFECTIVE ORAL HYGIENE IS NOT INTUITIVE 

All of you reading this brush your teeth, as do all the patients who’ve come to me for dental treatment. It is not the toothbrush or the other devices you are using. Ultimately it is how effective and completely you remove the bacteria between your teeth and at the gum line every 12 hours. 

Having utilized and observed all types of toothbrushes, both electric and manual, the key is keeping the toothbrush at the gum line where the bacteria begin to form and using, in my experience, a water irrigator between your teeth which has been found to be the most effective way to remove the bacteria in the difficult areas where most periodontal 

disease begins. That is between your teeth. However, this requires instruction, motivation and, as I said, it is not intuitive. It is also time dependent. You need approximately 5 minutes in the morning and 5 minutes in the evening to completely remove the bacteria at the gum line and between your teeth. 

4) BRUXISM OR CLENCHING OFTEN BEGINS IN CHILDHOOD 

The forces generated while you sleep are more than 10 times the forces generated during eating. These forces can cause severe wear, fracture of natural teeth or even fracture of crowns. You and your dentist should be aware of this problem which is easy to recognize by just examining the teeth for wear, or shiny areas. The investment in a night guard or a mouth guard can be one of the most significant ones you will make, saving you physical, emotional and economic stress.

5) SMOKING AND VAPING 

The use of tobacco products, whether they be smoked or vaped, increases the rate of periodontal disease significantly. Needless to say, it also results in the deaths of hundreds of thousands of people a year. I have lost the greatest number of my patients to tobacco.

6) MEDICATIONS TAKEN FOR CHRONIC DISEASES 

Many medications taken for various illnesses can aggravate dental issues. Dry mouth is a common side effect of many drugs. The dryness allows bacteria to adhere to the teeth more readily and can increase, markedly, dental decay. Medications, especially those taken for high blood pressure, can cause an overgrowth of the gum tissue, making it difficult for the patient and the dentist to adequately clean your teeth, and predisposes you to periodontal issues.

7) DIET 

Foods rich in carbohydrates are directly linked to dental decay. Again, if bacteria are present when you eat. Particularly dangerous are sucking candies for they constantly bathe the teeth in sugar. They can melt away teeth in a year, something I’ve observed in many patients. They can cause rampant decay.

8) FLUORIDE 

One benefit of fluoridation has been that when individuals have less decay as children and young adults. As a result they often will not require crowns and root canals on teeth that have already been restored in their youth. These restorations require the removal of much of the tooth structure. This can lead to problems such as tooth fracture or infection. Thus preventing decay for children and young adults have benefits throughout their lives. 

Fluoride has been under attack for political reasons. However, it is one of the most effective means of reducing decay in children and ultimately eliminating the need for large restorations and crowns as we get older. Multiple countries and cities that have removed the fluoride from the water supply have discovered a rapid increase in decay among the children. Unquestionably, the level of fluoride used in the water supply is absolutely free of any harmful effects, despite what you might read on more contentious sites. 

9) DENTAL IMPLANTS 

Dental implants were introduced in the 1980’s following a long-term Swedish study which demonstrated their predictability. They’ve enabled people with no teeth to be able to chew, smile and speak normally, a great improvement over dentures. They’ve also allowed us to replace individual teeth without involving the adjacent healthy teeth. However, the downside has been that they’ve become a first choice go-to for dentistry when the teeth that they are being used to replace do not have to be removed. Prior to implants, many teeth that are today extracted, were preserved for a long period of time with a combination of periodontal and restorative care. 

There are many patients in my practice who, if appeared decades ago, would have had all of their natural teeth removed. Thanks to periodontal care and patient education, they still have their natural dentition. 

In addition, implants are not bulletproof. They require the same maintenance as natural teeth. They can develop periodontal disease called peri-implantitis which is much more difficult to treat than teeth with periodontal disease. 

My message is, before your dentist suggests you remove a tooth or teeth to replace with implants, carefully discuss your options. 

10) THE CORPORATIZATION OF DENTISTRY 

There has been a huge increase of corporations or hedge funds buying dental practices and monetizing them. Young dentists, as I’ve mentioned before, are working in these practices. Many of these young people have a great deal of debt and cannot afford to purchase a practice or even start a practice of their own. Unfortunately, when there is a corporate owner of the practice and not the name of the doctor on the door, the incentives to provide dental care at a high level can be distorted. The individual that owns the practice, in this case the corporation, has only one interest and that is the monetization of their original investment when they bought the practice. Sadly this often leads to unnecessary or less than ideal dental care. For much of my career this was an unknown entity. Dentists developed a reputation based upon the manner in which they treated their patients as well as the quality of the care they provided. Corporate entities are not motivated in the same fashion. 

Finally in closing, the most important thing you will learn from a dental practice, from a dental hygienist is how to effectively remove bacteria on a daily basis from the gumline and between your teeth. The ten minutes you will spend, if it is effective, will have the greatest effect on the

maintenance of your dental health and the preservation of your natural teeth. In addition, it will hopefully minimize the emotional, physical and financial toll that invasive dentistry often elicits. Just remember that when you pick up your water irrigator.

By Westchester Center for Periodontal & Implant Excellence

December 31, 2023