Fluorides for Adults

DENTISTRY Fluorides for Adults

Virtually all U.S. dentists now agree that the best way to prevent tooth decay is to fluoridate water supplies so that children get the benefits from the time their tooth buds begin to form--only a few weeks after conception. Failing that, many dentists paint stronger fluoride solutions on children's teeth once or twice a year. Adults, with their fully developed teeth, have seemed beyond fluorides' help--destined to suffer the traditional "find the cavity, then drill and fill."

Now, that adult tradition may be on the way out, largely because the U.S. Navy found itself swamped with dental patients. Each year Navy dentists become responsible for the dental health of 120,000 new "boots" and Marine Corps recruits suffering from an average of seven cavities apiece. In addition, Navy dentists are responsible for 850,000 in-service or dependent personnel who had been getting decay holes at the rate of two a year, making a total of 2,500,000 cavities.

Dent in the Backlog. Putting fluorides to work on a test basis, the Navy has adopted a three-stage treatment. First, each patient is given a basin, a toothbrush, a small cup of pumice paste containing stannous fluoride, and a five-minute lecture on how to proceed. He brushes his teeth for ten minutes. Next, he is plopped into the dentist's chair. A technician spends three to five minutes air-drying his teeth and applying a 10% stannous fluoride solution. Third, the patient gets up to 15 minutes of instruction in how to make daily use of the stannous fluoride toothpaste, which the Navy recommends.

After its dentists satisfied themselves that the fluoridated toothpastes help to keep adequate amounts of fluoride in the teeth after painting, the Navy settled on painting every year. The first treatment costs only 25-c- a man for materials; dental technicians are treating three or four times as many patients as before, and the Navy expects soon to make a big dent in its huge backlog of cavities, treating 1,000,000 patients a year at 48 preventive-dentistry centers. Says Rear Admiral Frank M. Kyes, chief of the Navy's dental services: "It now takes us less time to prevent cavities than to fill them."

Mouthful of Chemicals. Some civil ian dentists think that the Navy's claim of preventing two-thirds of new cavities is overoptimistic, and they emphasize that a program like the Navy's, which the Army and Air Force are now adopting, is no substitute for general fluoridation. The Navy never said it was. But after the massive consensus reached years ago on the value of fluorides for children, there is growing agreement that fluorides in the water, plus periodic paintings and regular use of fluoridated toothpastes, give some degree of protection against cavities at all ages.

With the Navy work to encourage them, more and more civilian dentists seem likely to give their patients a mouthful of one chemical or another as an alternative to the dreaded drill. Dr. Finn Brudevold of Harvard's famed Forsyth Dental Center is concerned that the tin in the stannous fluoride solution commonly used for painting may interfere with the absorption of fluorine, and he is casting around for a better compound. Meanwhile, he says, it helps to cover the teeth, right after painting, with a protective coat of silicone grease. A colleague, Dr. Basil Richardson, believes that the best coating is polyoxyethylene soya amine--a sort of reverse detergent to keep the saliva from washing the fluoride away.

Other chemicals are also gaining status as decay preventives. Zirconium salts have been suggested by some researchers, but they appear to be too poisonous for general use. Phosphates are safer and more promising, and several communities are trying the addition of dicalcium phosphate to cereals and bread. Even the most skeptical investigators at the National Institute of Dental Research now believe that decay may be arrested in its earliest stages by painting the teeth with a solution containing tricalcium phosphate and potassium fluoride.

There is no lack of work for all such chemicals, The National Institute's former director, Dr. Francis A. Arnold Jr., estimates in round, "open wide" numbers that there are 1,000,000,000 unfilled cavities in the U.S.

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