by Trish Walraven

The Dramatization:

At first it was small. The outbreak began in Florida’s Tampa Bay Area as local hospitals noticed an influx of patients with complaints of turquoise discolorations of their lips and aversion to simple carbohydrates. Once case histories were correlated it was noticed that all those who were affected had either recently received an inoculation of a mutant version of Streptococcus mutans at their dentist’s office or had been in close contact with someone who had.

Initially the culprit was thought to be excessive consumption of blue raspberry slushies, but by the time the CDC discovered that an organism was responsible for these symptoms and that it was bacterial in origin and highly contagious the disease had spread far beyond Florida and had affected millions throughout the US and abroad.

There have been no reports of mortality, save the demise of the soft drink and candy industries. Sugar consumption has plummeted as more of the population becomes infected by this new strain of bacteria which was originally created to cure the problem of dental decay. Because persons who are affected display a noticeable change in their appearance, blue lips have become a strong signal of exclusion due to the fear surrounding this epidemic. However, as more evidence points to the positive outcomes of having been infected, the “blue look” is currently trendy in the larger cities. Blue-lipped patrons that had been banned from public venues such as restaurants and arena events are slowly trickling in, thanks to the assurances from the World Health Organization that this current situation has actually caused more good than harm. The long-term effects will be felt by dentists, who, in the next 30 years, will see an attrition of their necessity as caries becomes extinct, and possibly within the cosmetics industry with a shift in lip color preferences.

The Reality

Um, Yay? It’s been like, since the early 70′s that everyone’s been asking for a caries vaccine. And wouldn’t you know it? A company in the United States is already so ON this. Oragenics first initiated their first Phase 1 Clinical trials in 2005 but were halted by the FDA because of the fear of something happening like the above scenario. Think I’m kidding? Okay, maybe I was being sensational. But there can be genuine risks when you fiddle with a few genes, and the FDA seemed to be mainly concerned with the lack of a plan to eradicate attenuated strains in the test subjects’ children. AHHHHH!

It starts to get interesting when you look at the solution that Oragenics came up with to begin their second Phase 1 testing announced last week: The trial subjects will be inoculated with a strain of S. mutans that cannot survive without the amino acid D-alanine, which is not found in a normal human diet. This means that the subjects will have to feed their germs daily with a mouthwash to keep them from dying.

Are you excited yet? Well, you’d better hold those horses back for a while. A long while. It’s going to take a bunch of time and a lot more money to get this to the market.

The inoculation is designed to be a painless 5-minute treatment with a cotton-tipped swab to deliver the suspension of Oragenics’ patented bacterial strain into a patient’s mouth during routine dental visits. But this one won’t die without feeding. It will live forever.

And what is it supposed to do once it goes viral? Err… bacterial? Oragenics calls this treatment SMaRT Replacement Therapy™ and it promises to:

• Offer lifelong protection against tooth decay caused by S. mutans

• Eliminate the creation of lactic acid by oral bacteria

• Dramatically reduce the ability of S. mutans to cause tooth decay

• Be genetically stable

• Grow at a rate similar to non-genetically-altered S. mutans

• Aggressively displace the native, decay-causing strains of S. mutans and preemptive colonization of its niche

• Not cause any acute or chronic adverse side effects

I think it’s a foregone conclusion that this sort of genetic manipulation is probably the only way we’ll and break caries’ hold on humanity and the loss of teeth caused by decay. We can’t just kill all the bugs in our gut – all the Jamie Lee Curtis Activia commercials have given us TMI about probiotics lately – so it makes sense that this same premise is true in our mouths.

And the raspberry slushie is still your best bet for getting blue lips. Sorry, Oragenics will probably not be helping you there.

We were impressed that when put on the spot between inaugural balls today, President Barack Obama was able to outline his plan to give all people in the United States of America the right to a beautiful, healthy smile. The big question is: just who are his dental advisors?

Obama’s Mastication Initiative for America (MIA)

The people of the United States should realize that teeth are a quality of life issue. The government cannot force a citizen to take care of his or her body, nor should a person be penalized for issues that are beyond their control. We have seen the insurance industry take hold of healthcare and overvalue its services. Furthermore, dentists throughout our great nation have resisted the tide of managed medicine and are now capable of not only improving the quality of their patients’ lives, but even the very length of the average American lifespan.

When we look at the technological advances that have been made in dentistry, we know that now is the time for change. It is this administration’s hope that by combining personal responsibility with expert guidance, my Mastication Initiative for America will fulfill the needs of all Americans, not just the ones barely getting by; not just the wealthy, but every one of us.

The details will be forthcoming when I have more than a few breaths of air between dipping my wife on dance floors, but here is a brief outline of the plan:

1. Participation in the plan is voluntary, both for dental providers and for patients.

2. Payments will be made directly to patients on a yearly basis, with the exception of the Lump Sum plan that is described in line 6.

3. All participating dental practices will engage the use of a government-approved method of data gathering and reporting, to be agreed upon in the future, but possibly a special watermarked panoramic digital image that can be submitted to the Department of Health and Human Resources. This will significantly decrease the ability for fraudulent reporting on patient status.

4. Each person under the age of 30 will be required to have yearly dental images submitted on their behalf for reimbursement by the federal government. There will be a fixed amount allowed per person, regardless of actual care rendered. i.e. $500 per year per person under 30. Under no circumstances will any funds be reimbursed if basic preventive measures were not pursued by the patient or their family.

5. Third Molar Extraction will be considered a medical expense, as will any congenital deformity that is currently considered the arena of oral maxillofacial surgeons, so is excluded from the MIA plan.

6. At the age of 30, regardless of previous dental history, all citizens will be eligible for Dental Implant Screening (DIS). Because of the excellent properties of implants versus natural teeth regarding the elimination of the periodontium and thus the link to systemic disease, it is the MIA’s recommendation for DIS to be implemented before dental disease is likely to permanently affect a person’s whole health. Those who are at risk for losing their teeth, who have already lost teeth, or who simply make the choice of not wanting to maintain their teeth will, at this time in their lives, be given the opportunity to have all their teeth removed and have dental implants placed instead. This is a Lump Sum, and will include a preventive appliance to be worn at night. Any person who has implants with DIS will not be able to participate in the MIA after having implants placed.

7. DIS practitioners will work directly for the government, be well-trained, and well-compensated for their expertise.

8. From the age of 30 onward, payments from the MIA will be based on the number of healthy, maintained teeth that a patient displays in the accepted yearly imaging submitted. Included as healthy teeth: those with no restorations, restored teeth with no active defects, teeth with successful root canal therapy, periodontally involved teeth with no bone loss noted within the past year, and dental implants. Teeth that would not be counted for MIA payments: Broken teeth, retained root tips, teeth with active decay, and teeth showing periodontal involvement that has progressed since the previous submitted image.

This is the plan that will ensure that all Americans will be able to smile proudly, whether it is a God-given smile or one granted to them by choice, and no longer will we as a nation be faced with lost work time, emergency room visits, and other troubles caused by bad teeth. After all, this is the very soil where the “Hollywood Smile” was born, and so I ask you to consider what is best for our country, for our children, and for dentistry in the new economy to come.