ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, February 27, 1996 TAG: 9602270068
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Many adults in the United States are justifiably envious of young people who grew up drinking fluoridated water, using fluoride toothpastes and rinses and having sealants applied to protect the chewing surfaces of their teeth.
Children and young adults today have far fewer cavities than members of the prefluoride generations, many of whom spent a significant part of childhood in dentists' offices and now spend a significant part of their incomes trying to hang on to teeth that have rotted to the roots.
Indeed, no less a source than the National Institute of Dental Research has repeatedly rejoiced in the findings of a 1986-87 survey of oral health among schoolchildren. Half of the schoolchildren in the United States have never had a cavity, the federal agency concluded.
But is this really true?
Two professionals at the Harvard School of Dental Medicine, Dr. Burton Edelstein and Dr. Chester Douglass, maintain that the 50 percent cavity-free claim is a myth derived by ignoring decay in baby, or primary, teeth and by averaging the decay in permanent teeth among children from 5 to 17 years old.
If decay in primary teeth is included, these experts report, 42 percent of kindergartners have been affected by tooth decay, half of 7-year-olds have had at least one decayed tooth and children younger than 9 have an average of nearly four decayed or filled tooth surfaces.
And if progress of decay is tracked through the childhood years, the Harvard experts say, 84.4 percent, rather than 50 percent, of the nation's 17-year-olds have had decay in one or more permanent teeth.
With each passing year of age, ``250,000 additional children are afflicted with tooth decay,'' Edelstein and Douglass wrote in Public Health Reports.
The 50 percent figure may be breeding complacency about the extent of dental disease in children, which is still major, the Harvard researchers say. They, among many other experts, point out that the problem of tooth decay is almost entirely preventable.
As Dr. Michael Till, a pediatric dentist at the University of Minnesota, put it: ``Dental decay is an elective disease. You can choose to have it or not.''
Baby teeth that are going to fall out in a few years may seem unimportant. But a decayed baby tooth can spread infection into the permanent tooth that will take its place.
Primary teeth help to properly align the emerging permanent teeth; a decayed tooth can change the spacing of teeth and may be lost prematurely. This, in turn, can interfere with speech and cause permanent teeth to come in crooked.
A major cause of decay in primary teeth is nursing-bottle syndrome: rampant decay on the tongue side of the front teeth, caused by the pooling of milk or juice in the mouths of infants and toddlers who fall asleep with a bottle.
Till cautions that bottles of milk or juice should not be used as pacifiers and that babies and toddlers should not be given a bottle at bedtime or naptime unless the bottle is filled with plain water.
Parents who think that their children's teeth are safe because the youngsters only rarely eat sweets are sadly mistaken.
While sugars of all kinds, including honey and the ``natural'' sugars in dried fruits, are the favored foods of decay-causing bacteria, sugar-coated and unsweetened carbohydrates, especially those that stick to tooth surfaces, are also a problem. Children who snack between meals on dry cereals, pretzels, crackers or bagels are also providing fodder for decay-causing bacteria.
Children need not be denied sweets, but these are best given as dessert with meals, after which the teeth should be brushed. Preferable snacks include fresh fruits and vegetables, dairy products, popcorn, nuts, unsweetened peanut butter, and potato and other vegetable chips.
To maximize resistance to decay, every child needs dietary fluorides. Only about half the population has a fluoridated water supply.
If the household water does not have adequate amounts of fluoride, babies should be given supplements of the mineral starting at birth, with the amount tailored to the level of natural fluoride in the water, Till said.
Together, fluorides and sealants have the potential to eliminate dental caries as a public health problem, these experts say. Yet sealants, which should be applied as soon as the permanent teeth start coming in, are still underused.
Even the most diligent parents are often neglectful about cleaning a baby's mouth, which collects decay-promoting plaque just as the mouths of adults do. Start by wiping an infant's gums and first teeth regularly with a gauze pad. As soon as the baby has several teeth, start brushing them daily with a soft brush.
Once a child has two teeth that make contact, they should be flossed daily as well. Because young children lack the needed dexterity, parents should be the primary cleaners of children's teeth until the age of 7, 8 or 9. After that, parents should supervise the child's own efforts.
Finally, children should start seeing the dentist regularly at no later than the age of 2, with visits every six months.
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