By Dr. Henry Wong Meng Yeong | Tuesday, November 26, 2013 at 08:00AM

Failing implant. Photograph courtesy of a colleague

My previous editorial addressed the issue of information asymmetry and discussed how the gap can be closed if patients take an interest and ownership of their own health. Before one can make sound decisions, one has to have facts and information. The current misinformation is that implants are available to replace teeth. They are not. Implants are but an option for replacing MISSING teeth and are not a replacement for teeth. There are even some who are misled to think that implants are better than teeth and are do not fail. They do fail and when they do, they are harder to manage than when teeth fail.

The DMFT Index is an epidemiological indicator of the dental health of communities and countries. It measures the number of Decayed, Missing and Filled teeth at the age of 12, when all of one’s teeth are present in the mouth. It does not take into account unerupted or congenitally missing teeth. Since records began, Singapore’s DMFT index of 12 year olds has declined from 2.98 in 1970 to 0.70 in 2009, surpassing the 3.0target set by the World Health Organization. The inference is that Singaporeans entering adulthood should have their almost all of their healthy natural teeth to last them a lifetime.

Ironically, Singaporeans are still losing their natural teeth as evidenced by the increase in the number of implants placed. Implant sales have been reported to have risen by 15%pa. If the number of decayed missing and filled teeth are on the decline, how does one account for the exponential increase in number of implants placed as evidenced by the rise in implant sales? Could there be a sudden increase in traumatic loss of teeth as in war? Or a rise in the number of teeth lost as a result of periodontal disease? Or are teeth which can be saved with periodontal therapy extracted, only to be replaced by implants?

Implants are meant to replace missing teeth and not to replace teeth. Periodontal disease, the principle cause of tooth loss is preventable if detected and treated early. The objective should be for one to retain one’s teeth for life.

The life span of Singaporeans has increased in the last five decades. In 1960, a Singaporean could have expected to live to about 63.7 years. The mean life expectancy at birth has increased steadily to 82.3years in 2011 repudiating the old Chinese adage 人生七十古来稀 which translated means that since time immemorial, it is rare for one to live beyond three score and ten years. Singaporeans today can therefore expect to live 30% longer lives compared with those in 1960, well beyond 70 years of age.What then are the implications of this extended lease of life?

With the extension of one’s life, amplification of health problems such as dementia, Alzheimers, effects of hypertension and tooth loss from periodontal disease have become more apparent. This increase in the length of one’s life implies that one will have to keep periodontal disease in check if one is to keep one’s teeth for life, especially if one is young. In Singapore, rigorous education on the deleterious effects of refined sugars, tooth loss owing to decay has been kept at bay especially with fluoridation. Periodontal disease is therefore become the principle cause of tooth loss and patients should seek help early in order to keep their natural dentition. The urgency is naturally dependent on the patient’s age. The earlier the onset of periodontal disease,the greater the chance of premature tooth loss if left untreated. In other words, a patient in his/her 80s with periodontal disease has a better chance to keep his/her teeth for the remainder of his/her life compared to someone in the 30s or 40s.

A paper by the American Academy of Periodontology reported peri-implant mucositis was present in 48% of implants. Without intervention, this progresses to peri-implantitis or loss of bony support to the implants. Research concerning peri-implantitis reported distinct differences in the incidence and prevalence from numerous authors with studies ranging from 6.61 percent disease prevalence over a 9-14 year period2 to 36.6 percent with a mean of 8.4 years after loading.

One’s priority should always be to save one’s natural teeth. Oral hygiene is therefore paramount as the bacterial flora in the mouth which causes periodontitis resulting in tooth loss can also cause the loss of implants, termed peri-implantitis. Early intervention is the key to saving teeth and implants.