Dentistry has traditionally focused on children, because children have had the majority of dental decay. But with the advent of water fluoridation, fluoridated toothpastes, the use of sugar substitutes and possibly the medical usage of systemic antibiotics (the mutans streptococci are killed by most antibiotics), the prevalence of decay has declined dramatically in the United States and in other countries. This decline can be measured by the fact that dental schools have been closing in the United States (nine schools) and in Europe, and most other schools have decreased their enrollments. But while dental decay is declining, the demographics of the population have changed with an increase in individuals over 65 years of age. This has important implications for dentistry.

At the beginning of the 20th century about 50% of the individuals over 65 years of age were without teeth (edentulous). At the beginning of the 21st century there are many more people over 65 years of age, and only about 20% of them are without teeth. This percentage will decline even more, perhaps to 10%, as the baby boomers reach 65, as they were the first generation to truly experience the life-long benefits of fluoride. If we compare January 2000 with January 1900, there is about a 24 -fold increase in individuals over 65 who have teeth. This translates to many more adults who will be seeking dental care, especially periodontal care, than perhaps anytime in the history of dentistry. Of particular concern would be the development of root surface decay in individuals with reduced salivary flow as a result of certain medications. See chlorhexidine in the caries section. These demographics indicate that the dentist of the 21st century will be focusing his/her treatments on adults. If periodontal inflammation is shown to be a risk factor for either coronary heart disease or stroke (see Dental Disease and Coronary Artery Disease), then it will be considered a modifiable risk factor, as it can be treated. This means that the dentist and the patient will both be concerned with the treatment of periodontal disease, and the treatment choices that are available (see Non- Surgical Treatment of Periodontal Disease).

Patients have a Choice!

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