Where the Ouch Went

U.S. military dentists who examined World War II inductees were shocked by the extent of tooth decay and tooth loss that they found. From the evidence it appeared that what is now regarded as routine oral hygiene was then largely unknown to a good part of the American population. Now, almost 50 years later, dental experts are reporting another remarkable finding--this one much more pleasant. Tooth decay in the young is dropping sharply, with nearly half of all children up to the age of 17 free from any decay in their permanent teeth. In the early 1970s only 28% of the children examined were found to be entirely free of cavities.

This latest survey by the National Institute of Dental Research shows continuing improvement since the beginning of this decade. In 1980 children on average had nearly five instances of filled, decayed or missing teeth. By 1987 that average had fallen to a little over three--a decline of 36%. Most notable was the drop in interproximal caries, the decay that occurs between the teeth that is particularly difficult to treat. Here the decline measured 54%.

Freedom from tooth problems is not uniform among the young. As children get older their susceptibility to cavities increases. But even older children are getting fewer cavities than before, and many of them are reaching adulthood without the need ever to experience the dentist’s needle or drill.

Streptococcus mutans , the bacterium that is believed to be the principal cause of tooth decay, is probably as prevalent in the American mouth as it ever was, but among the young at least it seems clearly to be doing less damage. Credit the great strides made in preventive dental care over the last 30 years or so. More people are being trained at an earlier age to brush and floss regularly. Almost certainly the major reason, though, is the increased use of fluoride--in water supplies, toothpastes, rinses and the like--which does much to protect teeth against decay-producing acids.

About 60% of Americans live in areas where the water supply contains optimum levels of fluoride, either naturally occurring or deliberately added. But that still leaves a very large 40% of the people whose public water supply is not fluoridated. Los Angeles residents are among them, thanks to the past refusal of the City Council to approve fluoridation.

Dr. James P. Carlos, chief of the dental institute’s epidemiology branch, believes that “we are at a point were we can say that (tooth decay) is no longer a major public health problem, and that is remarkable.” The time indeed may be coming when the use of fluorides and dentist-applied adhesive sealants could virtually eliminate the nearly 70% of cavities occurring on the teeth’s chewing surfaces. That time could be brought much closer if fluoridated water were the norm in all parts of the country. It is absurd, given the record, that so many people, children and adults alike, must still be condemned to suffer tooth decay and avoidable pain because local officials refuse to add minute amounts of fluoride to the public water supplies.