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Super solutions for tooth decay; dental scientists are closing in on cavities with new mouth rinses that prevent decay by remineralizing teeth.


Look out, Mr. Tooth Decay!Until recently, brushing with fluoride toothpaste and flossing daily has been the best way to keep cavities away, but dental scientists are now well on their way to a more effective solution. Super salivas--mouth rinses containing calcium, fluoride, phosphate, and other chemicals --will prevent and repair microscopic lesions before they turn into cavities. Using such rinses, dentists will be able to help you treat cavities long before they grow large enough to be detected by X-ray.

The problem with teeth is thatthey are not as hard and slick as they appear, but porous, like a hard sponge. Plaque-forming bacteria --which thrive on the fermentable carbohydrates in foods --form weak acids that corrode the enamel and leach out the minerals forming the outer surface.

This incessant demineralization(which fluctuates with the amount of fermentable carbohydrate residue in the mouth) would soon rob us of our teeth without saliva to counteract it. The minerals in natural saliva (in particular, calcium and phosphate) held to remineralize tooth surfaces and enable us to withstand the continual acid attack.

Dental caries (cavities) form whendemineralization outpaces remineralization. One cause is a diet high in sugar, which produces excess acid in the mouth. Another is xerostomia, or "dry mouth,' a condition stemming from various diseases, drug interactions, chemotherapy, or radiation therapy to the head and neck. Some people simply produce abnormally low levels of saliva, or their saliva may not remineralize well.

The new super-saliva rinses supplementnatural saliva and help the body to fight decay in a natural, more effective way by speeding up the remineralization of the teeth. Dr. Athena Papas, a clinical scientist at the Tufts University School of Dentistry, is enthusiastic about super saliva's role in preventing and repairing dental decay. She and Tufts' dean, Dr. Erling Johansen, a pioneer in the development of super saliva, have treated approximately 1,500 patients with solutions; they have nearly 500 under active treatment.

Many Tufts patients are especiallyprone to caries for various reasons. Dr. Papas reports great success with the solutions. "Using the rinses for two minutes at a time, twice a day, many patients have been able to greatly reduce the rate of caries formation,' she says.

Dr. Papas has been particularlysuccessful with bulimics, whose frequent vomiting exposes their teeth to high concentrations of stomach acids. These especially corrosive acids vastly increase vulnerability to caries.

Patients undergoing radiationtherapy in the head or the neck also benefit from the super salivas. Radiation therapy often compromises the blood supply to the jaw. The salivary secretions of such patients are often affected. And with less blood in the lower jaw, infections take much longer to heal. Patients also often suffer from osteoradionecrosis, or loss of bone. Thanks to the super salivas, however, tooth decay and bone loss are both reduced. Dr. Papas also notes, "An unexpected benefit is that the super salivas also seem to speed the healing of soft-tissue lesions.'

Dr. Leon Silverstone, at theUniversity of Colorado, and Dr. Mark Jensen, of the University of Iowa, among others, are formulating the most effective super-saliva solutions. Researchers are "really dealing with five main components: calcium, phosphates, fluoride, strontium, and magnesium,' Dr. Jensen explains. "Our biggest challenge right now is to find the optimal combination of these ingredients. It would appear that the roots of the tooth may respond to a different solution than the crown or upper portion of the tooth.'

Aging and periodontal diseaseoften leave portions of tooth roots exposed to decay. Although dentists can treat and fill cavities on the roots, such areas are usually difficult to reach. On top of Dr. Papas' remarkable success in treating root caries with her solutions, Dr. Jensen's root-targeting formula could make super saliva a significant treatment for root caries, a disease that affects many elderly Americans.

"A particular advantage of therinses is that they can be administered by a dental hygienist or by patients themselves,' Dr. Papas notes. "Nursing homes and extended-care facilities are often underserved by dentists. I can foresee a day when dental hygienists will be allowed to do screenings and preventive work in nursing homes; they'll be able to teach elderly people how to do the rinses.'

What role will the rinses play indental health? Dr. Papas sees their immediate use for patients prone to cavities and for people with low saliva levels. "These individuals are highly motivated,' she says. "Without the super saliva, they face chronic decay problems.' Their alternative is a lifetime of recurring dental problems and bills for dentures or expensive restoration work.

As for the population at large, Dr.Papas thinks people will be slower to adopt the super-saliva rinses. "It's hard for most of us to rinse twice a day for two minutes,' she says. Nevertheless, it now appears certain that super saliva, in combination with fluoridated water, offers our best hope yet for ensuring strong, healthy teeth.

Photo: A laboratory-created cavity (top), worn in a patient'smouth for two weeks at the "caries-prone' interproximal site, was remineralized by twice-daily rinses of "super saliva' (bottom).
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Author:Born, David O.
Publication:Saturday Evening Post
Date:Jan 1, 1987
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