Recent health reform reports like item 86 from “A Healthier Future For All Australians” all recommend that additional funding be made available for improved oral health promotion, with interventions to be decided based upon relative cost-effectiveness assessment.
Why is it that even with fluoridation, tooth decay is still our most common disease affecting over 11 million Australians each year?
Over 80% of cavities occur inside pits and fissures on chewing surfaces of back teeth where food is trapped under chewing pressure and any carbohydrate like sugar is changed to acid demineralisation by resident plaque bacteria where brushing cannot reach and saliva has poor access between teeth and no access inside pits and fissures to remineralise tooth like on other easy to reach surfaces where few cavities occur except when continual acid forming food and drink excludes saliva and demineralisation exceeds remineralisation.
Fissure sealants placed over chewing surfaces, like fillings but with no drilling, block food being trapped inside pits and fissures and halts tooth decay there.
Trials on extracted teeth show that sealants are forced deeper inside pits and fissures of all back teeth at once under chewing pressure provided by placing an elastomer strip between extracted teeth in a model and applying the equivalent of chewing pressure.
The photo of minute canals inside pits and fissures that were filled with sealant under chewing pressure, after the teeth were dissolved in acid not only shows that it easy to simplify and reduce chair time and cost of sealant treatment, but indicates where food is forced under chewing pressure or where saliva or fluoride toothpaste can be forced under chewing pressure to give the same protection as more accessible surfaces where brushing has easy access.
Translated into simple improvements of personal tooth care, chewing fresh, fibre vegetables like celery after eating, forces saliva inside trapped food to dilute any carbohydrate like sugar, neutralise any acid and greatly reduce deminearisation and increase remineralisation on a scale that can greatly reduce cavities. Chewing sugarless gum after eating has a similar effect but is not as effective because it cannot absorb and expel saliva.
This also indicates that toothbrushes or a separate elastomer strip can be made to chew toothpaste before brushing to improve access of fluoride toothpaste for better remineralisation like on more accessible surfaces where brushing has easy access.
Flossing or cleaning between teeth before brushing improves fluoride toothpaste access for better remineralisation when brushing.
Health ministers should initiate a review of oral Health Promotion to improve evidence based tooth care skills that prevent tooth decay and highlight the value of personal health care to prevent other chronic food related diseases like diabetes, obesity and heart disease as well as diseases due to smoking.