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In the September 2006 issue of the AARP Bulletin, Carole Fleck describes the problems many older persons experience in finding affordable dental care. She attributes their dental health problems either to lack of insurance or the inability to pay for services. She does not mention that dental health depends almost entirely on the self-care one uses to control oral infections, not on the fillings, crowns, bridges, root canals, etc. that are used to treat diseased teeth.

The “50+ Americans” who go to a dentist or hygienist on a regular basis should be receiving hands-on oral hygiene instructions that will prevent and arrest tooth-destructive diseases. Unfortunately, this does not happen in most dental practices. Thus, a great need exists for the costly reparative services Ms. Fleck writes about.

Comprehensive dental care should put infection control first and appropriate restorative services after that. Providing large sums money for “fixing” teeth will not lead to better dental health unless a change occurs in the orientation of most dentists in practice today. They should be teaching prevention by educating patients on how to take control of their own oral health. My letter to the editor of the AARP Bulletin follows.

Dr. Keyes Letter

September 19, 2006

Mr. James S Toedtman, Editor
AARP Bulletin
601 E St. NW
Washington, DC 20049

Dear Mr. Toedtman,

I am Dr. Paul H. Keyes, a dentist who served in the U.S. Public Health Service from 1955 to 1981. I was stationed in the National Institute for Dental Research where I spent 20 years in the laboratory working with colleagues on bacterial cofactors associated with dental caries and periodontal diseases. From 1975 to 1981, I worked in the dental clinic in the NIH Clinical Center. While there, I spent most of my time using conservative non-surgical anti-infective measures in the treatment of patients with advanced periodontal infections. Some of these patients had been previously treated once or twice with surgery. I am the clinician who has advocated the combination of baking soda and hydrogen peroxide as a bactericidal dentifrice. Many baking soda dentifrices on the market today are there because of my recommendations. My work received considerable attention 20 years ago and was written up in “Modern Maturity,” “Reader’s Digest,” “People”, “Saturday Evening Post”, etc. You can find my website at drpaulhkeyes.com. Throughout my professional career, I have been especially interested in prevention.

As you know, on the front page of the latest issue if the AARP Bulletin there is a picture of a man with his hands covering his mouth and the question, “Why Isn’t This Man Smiling.” Apparently he isn’t smiling because his teeth have been severely damaged by tooth decay and/or periodontal (gum) disease. Unfortunately, this has occurred because his dental self-care has not prevented and intercepted the tooth-destructive bacterial infections that have damaged his teeth. It has not occurred because he has not received adequate restorative dentistry. The same can be said for the mother of three who, mentioned by the author of this article, Carole Fleck, needs restorative services that would cost thousands of dollars. Fixing dentitions damaged by tooth-destructive infections without first arresting them would be like repairing a house damaged by termites without first eradicating the termites.

Tooth decay and periodontal diseases are caused by contagious infections induced by microorganisms transmitted from mouth to mouth largely by saliva while kissing. What happens to these microorganisms depends on the conditions in one’s mouth after they are acquired. Persons, who consume products that leave sugar-residues around their teeth, put themselves at risk of cavities caused by Streptococcus mutans. Acid produced by this bacterium, as it metabolizes sugar, is the primary cause of tooth decay. Research in Sweden has shown that this bacterium can be passed from the mouths of mothers to the mouths of their children. One can prevent tooth decay by not consuming, or removing soon after ingesting them, substances that contain sugar. Fluoride in drinking water and dentifrices helps to make the teeth more resistant to decay-producing acids.

Destructive periodontal infections are caused by pathogenic germ-life, now called bacterial biofilms, that grows on the necks and roots of one’s teeth. These are complex microbial infections. Several different types of bacteria contribute to the inflammation that destroys the tissues and bone that attach the teeth to one’s jaws. Clinical observations and anecdotal data reveal that these infections can be largely prevented by measures as simple as careful tooth-brushing with salt and/or soda.

So, why is there a “50+ America’s growing dental epidemic”? It exists because persons have not taken proper care of themselves, not because they have not had adequate restorative dentistry. There are two possible reasons for this very unfortunate situation: carelessness or ignorance - and by that I mean lack of know-how. All too many persons have not received the information and guidance they need to prevent “dentopathic” infections. Excellent dental health can be attained with two relatively simple measures: keeping sugar residues in one’s mouth at very low levels and by carefully brushing one’s teeth for few minutes a day with an antibacterial solution or dentifrice. Salt and/or soda have an excellent antibacterial potential after they go into solution in one’s mouth.

Unfortunately the dental profession at large has not done a very good job in promoting dental health. The teaching of preventive dentistry has been sadly lacking in dental education. Far too much emphasis has been on cosmetic and restorative services, but that is where the money is. Dental hygienists have been far more interested in preserving dental health than most dentists. Perhaps in the future they will be able to provide their services without so many of the restrictions they now experience in many dental offices.

“America’s growing dental epidemic” is not unlike the AIDS epidemic. It is caused by contagious infections. Effective control can only be attained by the use of effective preventive measures. Comprehensive care is needed for all infected persons. For dental patients, resources are badly needed for providing anti-infective treatment and appropriate restorative measures for persons willing and able to use self-care that will help to control existing and future infections.

Americans who have computers can find valuable information on prevention by searching for dental health on the Internet.


Dr. Paul H. Keyes


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