Seattle Cosmetic Dentist Article
CUTTING DOWN ON CAVITIES
THE WONDERS OF MODERN TECHNIQUES ARE TAKING A BITE OUT OF TOOTH DECAY
BY SCOTT MAIER P-I Reporter
Tuesday, June 3, 1997
Section: News, Page: A1
Look, ma, no cavities!
The advertising refrain of the 1960s has become reality for the majority of kids today.
You might have thought getting cavities was a fact of life, but thanks to fluoride, sealants and better dental habits, 55 percent of school-age children now have no cavities.
This advance in the health of our teeth is as much marketing as medicine. We can credit successful communication campaigns and sound public policy - along with science - for the quantum improvement in our public health.
As far as teeth go, dentists predict that baby boomers - those born before 1965 - will be the last generation to have a mouthful of fillings.
Our children, the children of the boomers, they don't have fillings. They're not going to need crowns. They're not going to need bridges,
said Dr. Jeffrey Parrish, an Issaquah dentist and officer of the Washington State Dental Association.
Does this mean dentists will have to retire their drills and picks?
No way. They're busier than ever replacing the boomers' aging fillings and digging out root canals at a record pace.
The dramatic drop in cavities among those with regular dental care also highlights dentistry's limited reach: Millions of children still go without basic treatment that likely would save their teeth. Studies show that up to 80 percent of low-income kids have untreated tooth decay.
Nonetheless, preventive dentistry remains a remarkable success story in public health. In less than two decades, the percentage of school-aged children without cavities in their permanent teeth has doubled, according to findings by the National Institute of Dental Research.
And those with tooth decay have fewer cavities. In the early 1970s, schoolchildren had, on average, seven cavities. Twenty years later, the average had fallen to 2.5, researchers reported.
In the same period, the use of sealants doubled, fluoridated water became more widespread and people visited dentists more often.
Prevention has worked. People got the message,
Parrish said.
To understand the breadth of the achievement, consider the shining teeth worked on by Bellevue Cosmetic Dentists Drs. Patricia Pauley and Cynthia Pauley-Topham, a mother-daughter dental team in Bellevue. After graduating from dental school 20 years ago, Bellevue Cosmetic Dentist Pauley put into practice a new dental technique of applying a plastic sealant to the chewing surfaces of the back teeth.
The plastic resin bonds into depressions and grooves, providing a barrier that seals out plaque and food where toothbrush bristles often can't reach. Applying the sealant to young children's teeth before they have cavities virtually prevents decay in those teeth.
Bellevue Cosmetic Dentist Pauley had several other factors going for her patients' dental health.
One is fluoride. Just about everyone in her practice benefited from fluoride in the public water supply in Bellevue and the Eastside. Study after study demonstrates fluoride is effective in reducing dental decay.
Pauley's young patients also tended to come from affluent, well-educated families that could afford regular checkups and were receptive to instruction on flossing teeth, good nutrition and other preventive measures.
Seattle Cosmetic Dentist Pauley-Topham, who joined the practice five years ago, often checks on the teeth of young adults her mother began treating two decades ago. Rarely is a cavity found.
I would say 99 percent of her (then) child patients are cavity-free,
Seattle Cosmetic Dentist Pauley-Topham said.
Dentistry is also making big strides helping adults keep their teeth.
U.S. dental patients now have their teeth extracted at a rate at least 44 percent lower than in the late 1950s, according to the American Dental Association.
So why aren't dentists working themselves out of a job?
Well, all those children whose teeth were sheathed with silver and gold in the 1950s and 1960s now have adult teeth with fillings cracking and falling out. And many of their parents have reached the age when their fillings need to be replaced again.
Dentists are changing the way they do business.
Instead of spending time filling children's teeth, they hire dental assistants to apply sealants and fluoride.
Treatment today is also more comprehensive. An exam now may include a blood-pressure check and lessons on diet, flossing and other aspects of dental education.
We're treating them as a person, not just a set of teeth,
said Dr. Victor Barry, a 20-year Bellevue dentist.
They've also made the visit to the dentist as pleasant as possible.
Dental offices now tend to use softer lighting and more colorful decor. Some dentists have turned to aroma therapy to give their office a soothing fragrance. A few offer lattes in the waiting room.
In some offices, patients can select rock 'n' roll on a headset or even tune into a video using virtual-reality glasses. Consequently, people have their teeth examined more than twice as often as two decades ago.
Dentists offer root canals as an alternative to tooth extraction, tooth implants and dentures. As a result, the number of root canals has more than doubled since 1979, researchers estimate. Some dentists also place new emphasis on cosmetic repair, bleaching or applying porcelain veneers to whiten teeth.
All that requires more staff members, more overhead and more patients to cover the costs, dentists say. For example, Barry estimates he has to bring in $50,000 to $60,000 a month in business just to meet overhead expenses.
None of that has deterred would-be dentists. Washington state now has 7,185 licensed dentists - 2,316 more dentists than in 1980, a growth rate twice that of the state's population.
Improved tooth care is not universal. Even though sealants are considered virtually decay-proof, only one in five school-aged children have sealants on any of their permanent teeth, according to the National Institute of Dental Research.
Racial minorities are even less likely to have sealants, underscoring the lack of dental care for those who can't afford it. Seeking to bridge the gap, a team of public-health workers - a dentist and three or four dental technicians - set up a mobile dental lab twice a week in Seattle-area schools whose students are predominantly from low-income families.
I treat the real problems in dentistry - and that's access,
said John Caron, chief of dental services for the Seattle-King County Health Department. At a recent visit to Highland Park Elementary, 84 second-graders lined up at the school library for a dental exam. Some of the children were nervous. Many had never seen a dentist.
Open real wide,
Caron begged.
Admiring the youngster's shiny teeth, he asked, Did you buy them at the store?
No reply.
Seal all four,
Caron told an assistant.
One by one, children were led to a portable dentist chair, where each was reassured that no shots were involved. Their reward for having their teeth painted: a toothbrush and a sticker that says
I've been sealed.
Tiffany Trainer, age 8, was not impressed. How does it feel?
Yucky.
Asked why she was given the treatment, Tiffany shrugged her shoulders and dashed back to her classroom. Her sealed teeth should permanently resist cavities.
By the end of the morning, Caron found that 60 percent of the children had cavities. Those who needed dental work were referred to health centers that provide low-cost treatment.
More than 3,000 children are served a year by the program. The service is provided free of charge. The cost to taxpayers is $30 a child, less than half what a dentist customarily charges, Caron said. Yet he knows that he reaches only a small portion of the children who need dental care.
It's been 52 years since Grand Rapids, Mich., became the first American city to put fluoride in its water supply. Researchers confirmed that tooth decay declined in Grand Rapids, a finding replicated in many studies elsewhere.
Nevertheless, resistance to fluoridation persists. In fact, fluoridation remains the exception, not the rule, in Washington state. Resistance remains strong in some quarters because of cost and concerns about adding another chemical to the water supply.
Only 43 percent of the state's population has fluoridated water, according to the Washington State Dental Association. Places without fluoride include Spokane, Yakima, Olympia, Snoqualmie and North Bend, said Rick Larsen, a lobbyist for the dental association. Bremerton approved the use of fluoride in April.
Year after year, the dental association has asked the Legislature to require water districts to put fluoridation up to a local vote. The effort has foundered so many times that the group has given up for now.
It's the most cost-effective public-health initiative you could have,
Barry said.
Dr Patricia Pauley DDS, Dr Cynthia Pauley DDS and Dr Carrie Magnuson DDS: Family Dentistry - Providing services in children's cosmetic dentistry to the areas of Bellevue and Seattle, Washington.
Bellevue Cosmetic Dentist
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