FUTURE OFDENTISTRYDental caries is the single most common chronic
childhood disease––five times more common than
asthma and seven times more common than
hayfever (USDHHS, 2000b). Caries, periodontal
diseases, and the management of other conditions,
such as wear of hard tissue, oral infections, oral can-
cer, developmental disorders, intentional and unin-
tentional injuries, chronic and disabling conditions
such as temporomandibular disorders, craniofacial
pain, SjØgren's syndrome, and systemic diseases,
present difficult treatment and prevention issues (USD-
HHS, 2000b). The treatment of older people is par-
ticularly complex. Dental therapies are frequently
intricate, and the elderly also have chronic medical
conditions, which complicate patient management.
The prevalence of root caries, strongly age-
dependent, is increasing. Among adults 60-64 years
old, 54% had at least one decayed or filled root sur-
face; among adults 18-19 years old 7% had at least
one decayed or filled root surface.
According to the Third National Health and
Nutrition Examination Survey (NHANES III), 23%
of dentate adults 30-90 years old had significant
gingival recession, 35% had periodontitis, and 50%
had sulcular bleeding upon probing (Miller et al,
1987; Albander et al, 1999; Albander and Kingman,
1999; and Kingman et al, 1988). Ninety-two per-
cent of all persons, regardless of age, had calculus.
Signs of gingivitis and periodontitis were more
prevalent in males than females, and more prevalent
in certain racial and ethnic groups.
As the United States population ages and a larg-
er percentage of older Americans retain some or all
of their teeth, the need for preventive, restorative,
arrestive, prosthodontic services, and regenerative
periodontal services will continue to increase. Thus,
the clinical practice of dentistry faces challenges
from many directions. It must address the needs of
those whose care has lagged behind that of the gen-eral population. At the same
time, it must address the increas-
ingly complex demands of its
more fortunate patients and its
aging patients.
In addition, new research sug-
gests the possibility of linkages
between oral diseases and systemic
disease. This and other research
findings could lead to an increased
relationship between oral health
and overall health. For some
patients, a shift is occurring from need-based den-
tistry––that is, care directed at alleviation of pain,
caries control, management of periodontitis, and
replacement of teeth––to desire-based dentistry. The
latter is characterized by services which may be
viewed as elective and addresses improvements in self-
esteem and quality of life. Dentistry must effectively
integrate the new technologies and clinical advances
into dental practice for all people.
Reports on changes in the use of selected dental
services reflect an increase in the frequency of diag-
nostic and preventive services, with a concomitant
decrease in frequency of restorative and other inva-
sive procedures. For example, from 1980 to 1995
the percent change in use of various procedures
were (Eklund et al, 1997; and Eklund, 1999):u Prophylaxes increased by 20% in newborn to
five-year-olds and 30% in people aged 65 and older.u Oral exams increased by 29% in newborn to
five-year-olds and 75% in people aged 65 and older.u Periodontal services increased by 89% in 25-
to 34-year-olds and 586% in people aged 65 and
older.u Amalgam and resin restorations decreased by
45% in newborn to five-year-olds, and 21% in
people aged 65 and older.u Simple extractions decreased by 40% in new-
born to five-year-olds, and 43% in people aged
65 and older.u Use of complete dentures decreased by 75% in
35- to 44-year-olds and 50% in people over 65
years of age. No data are available on complete
dentures supported by implants.Clinical Dental Practice and ManagementPercentage of People who are Edentulous, by Age GroupSource: USDHHS, 2000 a.
Age Group
35-4445-5455-64
65-749%1633
463 %920
291971 - 1974 1988 - 1994T A BLE 3. 1