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Prevention of Decay

Of course, much of the pain and expense of treating cavities can be eliminated through preventive measures.

Many of these measures, says Dennis Mangan, Ph.D., chief of the Infectious Diseases Branch of the extramural division of the National Institute on Dental and Craniofacial Research, are aimed at interrupting the decay process -- for example, eliminating the sugars that serve as a source of food for bacteria in the mouth, eliminating the bacteria that feed on the sugars, strengthening the tooth's enamel to make it harder for acids to attack. Or, Mangan says, "It can be some combination of all of them."

Some of the most successful preventive measures involve fluoride, a mineral that occurs naturally in many foods and water. Fluoride helps prevent decay by making the tooth more resistant to acid attacks. It also has been found to reverse early decay where acid has broken through the enamel by re mineralizing the affected area.

To function effectively as an anti-decay substance, fluoride should not only be applied to the teeth but ingested, as well. The most important way in which fluoride is ingested is through fluoridated public drinking water. Dental experts cite water fluoridation, which began 50 years ago, as the main reason for the decline in cavities in children since World War II.

In areas with inadequate or no water fluoridation, children between 6 months and 16 years may need fluoride supplements. A dentist can prescribe the correct dose.

Fluoride can be applied directly to teeth with the use of fluoridated toothpastes and mouth rinses. Less-concentrated rinses are available over-the-counter, while stronger concentrations require a dentist's prescription.

Consumers need to be sure that children don't use fluoride products without supervision because excess ingestion of fluoride can cause defects in the tooth's enamel that range from barely noticeable white specks or streaks to cosmetically objectionable brown discoloration. The defects, known as fluorosis, occur while the teeth are forming, usually in children under 6 years. Although tooth staining from fluorosis cannot be removed with normal hygiene, a dentist may be able to lighten or remove these stains with professional-strength abrasives or bleaches.

Although excess fluoride intake can be toxic, most reported adverse reactions involve vomiting, diarrhea and eye irritation. Because fluoride is a drug, FDA requires toothpaste manufacturers to include on the labels of fluoride toothpastes a warning that the products should be kept out of the reach of children under 6. In addition, because FDA requires all over-the-counter oral drugs to bear an accidental-ingestion warning, toothpaste labels also must carry a warning that instructs consumers to contact a professional or a Poison Control Center if more than the normal amount used for brushing is swallowed. This labeling requirement took effect April 1997.

Another highly effective way to prevent cavities is sealants. Plastic material that is usually applied to the chewing surfaces of the permanent back teeth, sealants bond into the depressions and grooves of the chewing surfaces, acting as a barrier to plaque and acid.

According to the American Dental Association (ADA), sealants are "virtually 100-percent effective at preventing tooth decay." They can be used on the permanent teeth of both children and adults.

Though sealants are considered to be most beneficial to children, a 1996 study published in ADA's journal found that only 20 percent of school-aged children have dental sealants on their permanent molars. Cost-wise, sealants average about half the cost of a filling, according to the American Academy of Pediatric Dentistry.

Another reason for the decline in dental caries can be attributed to public education aimed at encouraging consumers to follow good oral health practices at home and see a dentist regularly, beginning as early as age 1.

"Most patients now know [they should] see a dentist regularly," says Cleveland dentist Matthew Mecini, D.D.S., citing statistics that show that 50 to 55 percent of adults actually follow that advice. "We [the dental community] are doing a better job of educating the public on the need for regular dental care."

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