I've been losing teeth one by one for about 25 years now. Mostly uppers. I got a partial denture about seven years ago, and little by little my dentist has added teeth to it until now it has as many teeth as I have left in my head.

The basic problem seems to be an exceptionally aggressive bone infection that eats away at the tissue that holds my teeth in. And try as we might, with surgery, aggressive, frequent (and more expensive) "periodontal" cleanings, antibiotic rinses, special toothbrushes, the best my dentist and I have been able to do is temporarily abate its progression now and then — but then it would reassert itself, and another tooth would get added to the partial.

I blame my Mother. I'm of the opinion that my situation is genetic. I recall that Mom had a "bridge" before she was 50, and my progression seems to be following hers at an only slightly slower pace. My sister seems to have gotten my Dad's mouth (at least dentally); neither of them has had anywhere near the problems experienced by Mom and me.

As a result, I've tried to pay attention, as much as one can without reading professional journals, to the technologies that dentistry develops. And I have to say that I am quite astonished — and horribly disappointed — that dentistry seems to be locked into a mechanical mindset (as opposed to a medical/biochemical one); indeed, while its techniques and equipment have become orders of magnitude more sophisticated, the basic technologies of dentistry — drilling, extraction, prosthetics — haven't changed all that much since the days of George Washington's wooden teeth. Even the current "cutting edge" of dentistry, dental implants, is almost totally mechanical; they drill holes in your skull (!), insert titanium bolts (!!), and attach a denture to the bolts (!!!). Yikes! Dr. Frankenstein, call your service. I mean, my hip or my knee, maybe, but my mouth?

The major paradigm shift in medicine since then, of course, has been germ theory. And modern dentistry does understand that what we're dealing with is, at root (sorry), infection, typically bacterial. OK, welcome to 1885. Modern dentistry's consequent emphasis on hygiene would seem to be the exception that proves the above rule.

But that's where dentistry has appeared to stop. The only developments that seem to come out of dentistry are, essentially, prophylaxis. Better cleanings, treatments that harden enamel, even the kinds of surgery available, like deep scaling, work only to prevent or temporarily abate the infection; they're not meant to cure the infection. I mean, there's nothing wrong with prophylaxis, fundamentally, but once you've actually contracted the infection, it's limited. 

In 25 years I don't think my dentist has ever been able to suggest a pharmaceutical approach to my problem. Not that we haven't discussed it, I've brought it up fairly regularly, he never has anything new to report, at least not in that area. Indeed, I've read Discover magazine regularly for about the same time, and I can't recall a single "health and medicine" article that discussed teeth.

Where are the anti-mouth-infection drugs? Where are the vaccines against bone-destroying oral bacteria? I envision something that would be injected into my body, maybe even into my mouth (under appropriate anesthesia), that will stop the infection. Not abate it, kill it. I'd do it again every year, if necessary, no problem there, if it keeps my teeth in. Why does there seem to be virtually no research (none that makes news, anyway) in this area?

One thing that might get in the way is that everyone's personal fauna is a little different; your mouth bacteria and my mouth bacteria are different enough so a vaccine for one might not work for the other, kind of like why we need a new flu vaccine every year, or why a vaccine against the common cold (which is anything but "common") isn't practicable. But a potential I do see discussed in Discover, however, is using genetic engineering to custom-design cancer drugs to the particular cancer; perhaps a similar approach could be taken with one's individual oral pathogens. 

Clearly, anything that would come along now or soon would be too late for me (unless it involved regrowing one's teeth)(hey, sharks do it). My future lays with implants. I think, of course, in my uniquely empathetic way, of those that will follow me, those of you out there in your 30s or 40s who are just now beginning to have annoying, and expensive, problems with your teeth. Ask your dentist.

If there are any dentists of dental students out there in my vast reading audience who would care to enlighten me about the current frontiers of dental pharmacology, please comment. If you want to include a link to an article, marvelous, but please also summarize what it says, and then make your case. I'll be happy to put it in a post, if it's interesting enough.

(By the way, George Washington didn't have wooden teeth. Anyone who's kept a toothpick in his mouth for more than 10 minutes knows how soft wood gets when wet. Washington's dentures were most likely made of bone, perhaps with some kind of metal understructure.)