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Fluoride for all the family.

We are the "older adults," the prefluoride generation. Our parents may have no teeth at all; they often wear dentures and are, in the jargon of the dental profession, "edentulous." Our children, born in the 1940s and 1950s, have suffered dramatically less tooth decay than we have. Our grandchildren may never know the agony of toothaches, abscesses, or root canal treatment. But what about our generation? Did water fluoridation and fluoride treatment come too late to help keep our older teeth intact?

No, the experts say. The good news is that you can benefit from fluoride no matter how old you are. In fact, you can benefit, said National Institute of Dental Research (NIDR) health educator Alice Horowitz, "for as long as you have any of your natural teeth in our mouth."

The bad news is that not many people seem to know this, and few take advantage of it. "My soapbox speech," said Linda Niessen, the director of geriatric dental programs at the Veterans Administration Medical Center in Perry Point, Maryland, "is look, older people have teeth too!"

Niessen is tired of seeing TV ads that feature older people selling denture adhesives, and toothpaste ads designed exclusively for children. What Niessen wants to tell the advertising world about older people is "Don't sell them denture creams; that's not what they need anymore. Start selling them fluoridated toothpaste."

This is an important message to get across to the public, experts say, because fluoride makes teeth less susceptible to decay, not only during the developing years, when it is incorporated into tooth enamel, but later on, when it continues to promote the repair of tooth enamel in a process called remineralization.

Most people think teeth are static, said Philip Fox, the dentist-investigator who heads the National Institute of Dental Research Clinical Studies Unit in Bethesda, Maryland. "Actually, teeth are very dynamic. There's a turnover of minerals in the mouth that takes place on a daily basis-Aemineralization, remineralization."

There's a sign tacked on Fox's laboratory wall: "Saliva Is Your Friend." This is so, he explains, because saliva, a solution supersaturated with calcium and phosphate, bathes the teeth, providing them with the minerals they need to stay strong. Fluoride can enhance the power of these minerals in the saliva, and it can help repair enamel previously damaged by bacterial acids, restoring considerable hardness at an early stage of decay, before open cavities develop in teeth.

There is also evidence that fluoride in the saliva helps control the bacterial population in the mouth, those bugs that use the sweets that people eat to produce enamel-destroying acids in dental plaque. And the further past age 35 an adult is, the more important is fluoride's ability to protect the roots of the teeth, as well as the crowns.

Of course, fluoride cannot work for your teeth unless it comes into contact with them. This can be accomplished by the use of fluoride-containing toothpastes, fluoride mouth rinses, and fluoride gels, or by having highly concentrated solutions of fluoride applied by a health professional, usually every six months. Niessen has put her 62-year-old mother on a regimen she and other experts feel that all older adults should follow to help keep their teeth intact:

Live in a community where the water supply is fluoridated.

Brush your teeth with fluoridated toothpaste (most commercially available toothpastes are now fluoridated).

Use a one-minute fluoride rinse daily (several should be available at drugstores or supermarkets), or ask your dentist about a topical fluoride gel if you have had any tooth decay in the past five years or if your gums are beginning to recede, exposing new root surfaces susceptible to decay.

Niessen prescribes fluoride gel, which she suggests her mother brush on her teeth before she goes to bed. Other dentists custom-make gel trays to fit over the upper and lower jaws, or provide stock mouthpieces that conform to the shape of the jaws. At home, the fluoride gel is placed in the trays and kept in place over the teeth for as long as the dentist directs.

For some, such topical treatment is mandatory, according to William Wright, a former staff periodontist and now a consultant to the National Institute of Dental Research. These include people who suffer any sort of dysfunction of the salivary gland, whether it be the result of injury, radiation, or chemotherapy, or an uncommon disease called Sjogren's syndrome.

Growing older in itself does not cause salivary glands to stop producing the saliva that prevents tooth decay and promotes remineralization, Wright said. But older adults are prone to "dry mouth." They take more medications, such as antihistamines and drugs for nervous disorders; they sometimes eat a less well-balanced diet, including highly refined sweets, which the mouth converts to enamel destroying acids; and they fall ill and are treated for chronic disease more frequently. Whatever the cause, a feeling of dryness in the mouth should be checked to see if special fluoride treatment is needed.

Today's young health professionals may have reason not to be concerned with dental health for older adults. "I lecture in a number of dental schools all over the country," Horowitz said, "and the students in most classes have gorgeous mouths. If they've lived in states where they have had access to fluoridated water all their lives, they have to be taught to be sensitive to the problems of the prefluoride generation."

For most dental students, Horowitz said, the concept of prevention is not as exciting as the concept of treatment and rehabilitation. Still, she said, "We haven't done enough. Most people don't even know if their water is fluoridated or not. We have data showing that, generally, adults don't know that the primary way to prevent tooth decay is through the use of fluorides, in teeth without fillings, or, as is often the case, in teeth that have been restored."

An NIDR dental epidemiologist, Philip Swango, agrees. A national survey by the institute in 1985 and 1986 showed tooth-decay rates beginning to shoot up around the age of 55, and investigators have begun to demonstrate that topical fluoride helps older people as well as children. But Swango said more research is needed on the effects of the toothpastes, rinses, and gels. Some of this research is under way. In any case, the American Dental Association's Council on Dental Research, Dental Therapeutics and Dental Health and Health Planning has recommended the use of topical applications of fluorides in adults in certain instances, such as radiation treatment for oral cancer or a high incidence of dental decay. Whether professional topical application is indicated, the council said in 1984, should be decided by the attending dentist, on the basis of individual needs.

Four years later, a Surgeon General's Workshop on Health Promotion and Aging recommended that older adults and their caregivers be educated about "the value of primary preventive methods to maintain oral health, including community water fluoridation and other fluoride uses."

Before long, awareness of the benefits of topical fluorides for adults may be greater than what Swango calls the present "creeping consciousness." Indeed, perhaps this awareness will be part of the general consciousness.*
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Author:Spingarn, Natalie Davis
Publication:Saturday Evening Post
Date:Jan 1, 1990
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