Brighter smiles

Despite the sugar surge, dental health has never been better -- except in poor people


Baby boomers who grew up dreading their next dental appointment are observing a phenomenon that once seemed inconceivable: children without cavities.

A recent report by the U.S. Centers for Disease Control and Prevention revealed that almost 60 percent of youngsters from 6 to 19 years of age have never had a cavity in their permanent teeth, up from 51 percent in 1988-1994. Just over a third could make that claim in 1980.

Dentists whose careers have spanned two generations say the gap between today's children and those of the 1960s is astonishing. They credit dental sealants, fluoridated water and toothpaste, dental insurance and an increasingly health-conscious public.

"Usually, we felt that there would be a cavity for each year of life," said Dr. Allan M. Dworkin, a Cross Keys pediatric dentist, recalling the patients he saw when he began practicing in 1969. Now, he says, the majority of children coming for checkups have experienced no decay since their last visit.

Mysteriously, dental health seems to be improving despite sugar-rich diets that have helped promote an epidemic of obesity.

One exception to the good news involves the nation's poor children, who have considerably more decay than children of wealthier families. But the condition of children's teeth across income levels has improved significantly over income levels has improved significantly over the decades.

Dr. Robert Jones, a Chestertown dentist, has seen the transformation within his own family. "I have a mouth full of fillings and root canals," said Jones, 58, who grew up drinking unfluoridated well water. "My son, Mike, he's never had a cavity."

The improvements in the nation's oral health were reported last month in the CDC's Morbidity and Mortality Weekly Report, a statistical journal that tracks public health problems ranging from AIDS to dog-bite fatalities.

Six years ago, the journal listed fluoridation as one of the 10 great public health achievements of the 20th century.

Though there were gains among low-income families, 20 percent of children from households below the federal poverty level -- about $19,000 for a family of four -- had untreated cavities in their permanent teeth. This compared with just 8 percent of youngsters from families whose income is at least twice the poverty level.

"We see horrible oral health," said Jones, who spent his career treating low-income children on the Eastern Shore. He said he frequently saw children with baby teeth rotted down to stumps and extensive decay that set them up for lifelong dental woes.

"That child becomes a teenager and an adult with a whole slew of problems," he said, including gum disease and the eventual loss of permanent teeth.

The CDC report also showed that decades-long improvements among the nation's youngest children have leveled off. In one instance, the trend had reversed: 20 percent of children 2 to 5 years old had untreated cavities in their baby teeth, more than in the earlier period.

Despite this, the CDC found improvements in most indicators of dental health: l Eight out of 100 people age 60 and older were missing all their teeth in 1999-2002, when the latest survey was done. That's a drop of about 30 percent from 1988-1994. l One in seven children from ages 6 to 19 had untreated decay in their permanent teeth - a 10 percent decline. l One in five of children ages 6 to 11 had filled or unfilled cavities in their permanent teeth -- a 20 percent reduction. l One in four adults (20 and older) had untreated tooth decay -- an 18 percent reduction. l A third of children ages 6 to 19 had been treated with dental sealants -- a 64 percent increase. "The good news is that things are getting better," said Dr. Bruce Pihlstrom, acting director of clinical research at the National Institute of Dental and Craniofacial Research. But he added, "Clearly we need to do more to improve the oral health of poorer Americans."

Since the 1940s, the nation has seen a sea change in the condition of its teeth -- and it had a long way to go. During World War II, 9 percent of would-be military inductees were declared medically ineligible because they had too many missing teeth, Pihlstrom said.

That prompted legislation, which President Harry S. Truman signed in 1948, adding a dental institute to the growing National Institutes of Health in Bethesda.

Communities also began to fortify their water supplies with fluoride, a chemical that strengthens tooth enamel and helps developing teeth to form shallower grooves. It also reduces acids from decay-producing bacteria.

The movement began in earnest 60 years ago, when studies in Michigan, New York, Illinois and Ontario showed that youngsters' cavities fell by 50 percent to 75 percent after fluoride was added to drinking water.

In 1952, Baltimore became the largest city to fluoridate its water when Mayor Thomas J. D'Alesandro Jr. pushed a button activating a typewriter-sized pump at the Montebello filtration plant.

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