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Three Dental Challenges

Recently, I spent a week with a well-known dental lecturer. Several times during the week, he talked about the "big three" in dentistry--three main problems the profession has been trying to conquer since many years back. The big three are: Caries (cavities), periodontal disease (diseases of gums and bone), and occlusion (bite problems).

These are the main three areas of endeavour in the field of dentistry. Are these three areas treated effectively in our field?  Well, yes and no. Usually, we spend most of our time and effort treating caries (cavities).  We know how to prevent tooth decay. We can fix decayed teeth most of the time even if the decay is quite deep. This area of dentistry is covered pretty well. The methods of prevention (toothbrush, floss, professional cleaning, and fluoride) work, but are too tedious, or time consuming, or expensive for quite a few people. So the research continues to treat decay better and prevent it more effectively.

The next area is periodontal disease (problems with the bone and gums that support the teeth). How is the profession doing in this area?  Not that great, really. Experts say fully one third of the population has periodontal disease. Many who are affected don't even know it. Of those who do know they are afflicted with periodontal disease, a large number do not think it is important enough to do anything about it. Much of this apathy is certainly because until about half of the bone supporting a tooth is gone, periodontal disease is painless. Its progression is slow. Once it is advanced, with current technology it is not usually possible to add bone back to the areas where it has been lost. Early detection and treatment is at present the only truly reliable way to arrest the progress of this malady. A high degree of ongoing patient cooperation is essential to arrest this disease process. This disease needs much simpler methods of treatment to conquer it.  Research continues in this area around the world.

Then there is occlusion. This is the nearly forgotten nephew in dentistry. One third of the population bruxes (grinds) or clenches. A small fraction of that third of the population is being treated or will even accept treatment. But literally millions of people spend large portions of their lives enduring preventable headaches or are destroying their teeth because of untreated bruxism (grinding) or clenching. I graduated from dental school in 1992. Since that time, there has been tremendous progress in this field. A large part of that progress has occurred because of the efforts of physiotherapists. Surgery to treat these problems is extremely rare these days and many treatment modalities are available--even in a town as small as ours.  Continued progress is certainly possible, but is often impeded by narrow minded thinking in this field.  It is a complicated part of dentistry where many patients benefit from even small advances, and until more is understood about it, an open minded approach has to be permitted.

So you can see that there is much progress that has been made in these "big three" areas of dentistry, especially in treating tooth decay. And there is a lot of space for more progress to be made. The dentistry of tomorrow will be different than it is today, but at least in the foreseeable future it will remain the "big three" that we will continue to treat. Ask your dentist if you have questions about your case.

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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