Save Your Smile

Dentures don't have to be your destiny. These tooth tips will help you keep your pearly whites.

Not too long ago, people believed losing their teeth was like getting wrinkles--an unavoidable part of aging.

"My mother and father believed that when you got to be 45 or 50, you lost your teeth," says Harold Slavkin, .S., director of the National Institute of Dental Research in Bethesda, Maryland.

Not anymore. More than half of dental patients over 65 still have more than 20 of their own teeth. And toothlessness among that age group has declined 40 percent in the last five years.

Improvements in managing gum disease, dental implants, and cosmetic procedures are making it easier than ever to care for your teeth. Here's how to maintain a healthy smile.

Avoid gum disease. The best way to keep teeth for a lifetime is to maintain healthy gums. Yet more than three in four Americans over age 35 have some form of gum disease. A 1997 Centers for Disease Control survey was even more bleak: It showed more than nine in 10 people over age 13 having some evidence of the disease.

Gum disease starts with dental plaque--the sticky film of bacteria--that builds up on teeth, especially when they're not brushed or flossed well. Plaque irritates gums, causes infection, and destroys the supporting tissues around the teeth. The most common signs are swollen and tender gums, gums that bleed during brushing, and persistent bad breath.

Did you know you can "catch" gum disease? Researchers have discovered that the disease can be transmitted through saliva--from a parent to a child sharing a toothbrush, for example, or a couple kissing.

The good news is that people with gingivitis, the earliest form of the disease, can reduce further damage by daily brushing and flossing, and getting regular cleanings. Those with more advanced cases may have to undergo scaling and planing, procedures in which a dentist or dental hygienist cleans below the gum line. These patients also may be candidates for Periostat, a prescription pill approved last October by the Food and Drug Administration (FDA) to fight gum disease. When gums are inflamed, Periostat suppresses an enzyme that can potentially destroy the bones that hold teeth.

Implants. For those who have already lost teeth, tooth implants are becoming an increasingly popular alternative to bridges or dentures.

Carl E. Misch, .S., an implant pioneer on the faculties of the University of Pittsburgh and the University of Michigan dental schools, estimates that 650,000 implants were placed in patients in the United States last year.

In the most common implant procedure, a small titanium anchor is surgically implanted under the gum line into the patient's jaw. After the bone has been allowed to grow around the anchor--usually three to six months--another surgery is required to uncover the implant anchor beneath the gum, and attach a small post to it. The replacement tooth, which is made of porcelain, metal, and polymer resin (the same types of materials used for dentures), is then attached to the post.

Implants are more comfortable and feel more secure than removable dentures. Most natural teeth can withstand biting pressure of up to 540 pounds per square inch, but many dentures support only 50 pounds per square inch. Implants, on the other hand, can withstand as much as 450 pounds per square inch. Implants also look more natural and can actually help prevent gum recession and damage to jawbones that come with missing teeth--something a plate of dentures does nothing to prevent.

Implants aren't without potential problems, however. In some instances, the bone may not satisfactorily bond around the implant, causing the false tooth to loosen. Implants have a current survival rate of 70 to 95 percent after 10 years, according to the Academy of General Dentistry (AGD).

Also, the dental work needed is neither simple nor inexpensive. Most implants are done in two stages, which can mean several hours in the dentist's chair over as many as nine months. Surgery to replace one or only a few teeth can cost as little as $1,000, but more complicated surgery, such as a bone graft to help rebuild the jaw, can cost approximately $40,000, particularly if the surgery has to be done at a hospital.

Most dental plans pay for a portion of the artificial teeth, however, patients quickly reach the maximum amount that most dental insurance will pay for a year, usually around $1,000.

In considering implants, it's crucial to find a dentist with extensive implant experience. Implant dentistry is not yet a specialty. Oral surgeons, periodontists, and general dentists can install implants.

Sealants. If the most obvious route to saving your smile is prevention, then the least known method is sealants.

A dental sealant is a thin plastic film painted on the chewing surfaces of molars and premolars, the teeth in front of molars. A dentist applies an etching solution or gel to the tooth's enamel, then brushes on the sealant material and allows it to harden--either by itself or with a special light. A dentist can place a sealant on a tooth in about five minutes.

Sealants can help prevent cavities in anyone's teeth, but they can be especially beneficial in children because of the protection they offer and potential cost savings in cavities. When properly applied and maintained, sealants are 100 percent effective in protecting a tooth surface from decay. They last from five to 10 years. An American Academy of Pediatric Dentistry survey found that children who had just a single application of sealants on their back teeth had 50 percent less tooth decay and tooth restoration after 15 years than children without sealants.

On average, a sealant for a single tooth costs about $50, which is roughly the cost to fill a cavity, but many insurance plans don't cover sealants.

Dentists disagree on sealant's effectiveness. Some dentists say that fluoridated water and better dentistry have lowered the number of cavities an average child gets, so putting sealants on teeth that will probably be cavity-free anyway is a waste of money. But other dentists believe that putting sealants on molars--the teeth most susceptible to cavities--saves money in the long run.

Denise LeBloch, vice president and chief of staff for Oral Health America, a nonprofit group dedicated to improving the public's oral health, says sealants may save a tooth from a lifetime of repeated repairs that, over time, wear it down.

"I believe having the sealants can make the difference between having your teeth for the rest of your life, or not," LeBloch says.

Bleaching/bonding. People who work at keeping their teeth want them to look good. Today, bleaching accounts for more than half of all cosmetic dental procedures performed in the United States.

You can have your teeth bleached in one of three ways, or by using a couple of the options in combination.

Most dentists offer "power-bleaching," in which 35 percent hydrogen peroxide is put on gauze and placed on the tooth. The whitening is then activated by heat or light, often by a laser. Treatments take about 35 minutes, and four to six visits are usually needed.

But the procedure can be expensive and time-consuming. Many dentists believe a less expensive treatment--in which patients wear custom-fitted mouth-guard trays containing a whitening agent--works just as well.

In this procedure, an impression of your mouth is made in a plastic mouth guard. A tasteless liquid whitening agent is poured into the mouth guard and worn either a few hours a day for several weeks or while you sleep for 10 to 14 days. Many dentists believe the results can be as good as with in-office bleaching.

There are many over-the-counter bleaching products, but dentists generally don't recommend them. The one-size-fits-all mouth-guard tray won't fit your mouth as well, and your dentist won't be able to supervise the treatment and possible side effects.

The AGD says dentist-supervised bleaching is successful in at least 90 percent of patients--although teeth with grayish stains caused by smoking won't show as much improvement as teeth stained from coffee or tea. While results will vary, most patients who undergo bleaching can typically see a two-shade improvement in the whiteness of their teeth, the AGD says.

The lightness should last from one to five years, depending on your personal habits, such as smoking or drinking coffee.

Bonding is another technique also gaining in popularity. Bonding is the term dentists use to describe several procedures in which they cover discolored teeth, repair chips or cracks, and fill in gaps with special plastics or a porcelainlike material. The material is attached to the tooth surface and then exposed to special light, which hardens the material in seconds. Once it's hard, the tooth is shaped and polished for a natural look and feel.

There's one final point dental experts make: All the knowledge and new technology will mean little if people don't take care of their teeth between visits to the dentist's office. That means brushing every day--for at least three minutes--and flossing daily.

"You see your dentist once every six months--that's fine," says Dr. David Whiston, .S., president of the American Dental Association. "But then tomorrow, it's back in your court."

RELATED ARTICLE: THE DENTIST'S OFFICE OF THE FUTURE

Dentists are starting to offer patients an escape without the patient ever having to leave the chair.

Some patients now don virtual reality glasses and earphones that engulf them in sights and sounds that seem a million miles from the dentist's whirring drill. At Dr. Richard Hansen's dental office in Fullerton, California, patients can wear virtual reality glasses and watch a movie or a kaleidoscopelike display of colors with accompanying music. "Patients who have used the glasses said they can't believe they were having dental work done," he says.

Other new technologies coming soon to a dental office near you include:

* Intra-oral cameras. A pencil-sized wand outfitted with a tiny camera allows a dentist to take freeze-frame pictures anywhere inside a patient's mouth. The image then appears on a computer monitor, so the patient can see what the dentist is diagnosing.

* Digital radiography. Using a conventional X-ray camera, a dentist projects a beam onto an electronic receptor placed in the patient's mouth. The system allows dentists to see a digitized computer image of a patient's teeth--making it easier to transfer the image to other dentists or to insurance companies. It also saves office expenses by eliminating X-ray film and developing costs. The biggest bonus: Patients are exposed to 50 to 90 percent less radiation than with conventional dental X rays.

* Lasers. Some dentists already use lasers to shape gums and bleach teeth. A new laser system can remove decay and prepare a tooth for filling.