Ninety Years Old — and Almost All Their Teeth

What a marvel.

I thank them.

Year after year they have put up with me. Always reminding them how much hygiene matters, and how much the recall visits matter. Always repeating that bacteria stay in wait — even when the mouth “feels fine,” even when months have passed without pain, even when the patient arrives already tired of hearing it.

I keep saying it. They keep coming back.

The disappointment I know well

Then that moment arrives. I read it in their eyes before they say a word. They did everything they could: toothbrush, floss, interdental brushes, punctual appointments. They spent time, money, and attention. And despite that, a problem develops that needs further, additional care — a cavity under an old filling, a gum pocket that reactivates, a molar that fractures. Or an implant that, after years of honest service, develops peri-implant disease: pockets, recessions, abscesses.

The disappointment is genuine. And it weighs on me too.

In that moment it is hard to explain that the success of maintenance is statistics. That the problems are certainly fewer than they would have been without periodic professional hygiene. Far fewer. That without those recalls, without that professional hygiene repeated over time, the same mouth would have lost more, and earlier. The patient weighs the effort against today’s episode. I weigh today’s episode against the downward trajectory I know when maintenance is missing.

The perspectives are, necessarily, different.

Thirty years of numbers

The data say it — not only chairside experience. Axelsson, Nyström and Lindhe followed adults in a plaque-control program for thirty years: instruction, self-assessment, professional hygiene at intervals calibrated to need.¹

Teeth lost? Very few — between 0.4 and 1.8 depending on the age cohort. The main cause of those losses was not runaway caries or periodontitis escaping control: it was root fracture. Only 21 teeth, across the whole long-followed sample, were lost to progressive periodontitis or caries. Mean new carious lesions stayed low; most sites showed no attachment loss, and on some surfaces there was even gain.

Frequency. Consistency. A recall interval that is not the same for everyone.

In the first two years of that program the recalls were close together; then, for decades, they moved between three and twelve months depending on the person. Exactly the principle we use today when we calculate risk: bleeding, residual pockets, teeth already lost, smoking, systemic health. A low-risk profile can stretch further. A high-risk profile comes back sooner — and is right to come back.

What I see in the chair after years

But all of it is repaid.

Seeing so many much older adults with almost all their teeth still in place, after years of maintenance, is an immense satisfaction. Maybe they have an implant or two. Maybe a ceramic crown. Maybe a root-canal-treated tooth that held for twenty years thanks to a check that caught the lesion while it was still small. Fundamentally, they have many of their own teeth.

They chew food they like. They speak without hiding the smile. They reach eighty — and ninety — without a full denture as the assumed destiny.

That image is enough for me, and it gratifies me.

The trajectory changes when prevention becomes habit and the recall becomes an appointment, not an emergency.

And it changes even more when trust grows, and patients understand that if we find an occasional cavity, a gum pocket, or a granuloma and insist on treating it, we do it to keep them in a state of health — not to grow the bill.

What prevention actually does

Prevention “prevents” almost everything. Some problems remain: biology does not sign hundred-percent guarantees. Those that remain, though, are mostly small, readable, and easily manageable — a filling instead of a crown, a root planing instead of a complex procedure, a tooth kept instead of an extraction.

In the end, even with an added cost up front, all of this translates into economic savings. And it is also savings of healthy tissue. Savings of time. And, above all, savings of that feeling of always chasing the damage. Because the damage is stopped earlier.

When periodontitis has already been treated, the recall is the second half of care. The first stops the inflammation; the second decides whether that result holds. Bacteria always repopulate. Biofilm reorganizes. Even the best patient in the world at home maintenance still leaves unclean corners. That is why I keep saying it, and why they — year after year — put up with me.

What a marvel.

References

1. Axelsson P, Nyström B, Lindhe J. The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol 2004;31(9):749-57. doi:10.1111/j.1600-051X.2004.00563.x. PubMed