My grandfather was mostly toothless by the time he was 50. That's the way it was in the early decades of the 1900s. Back then, at least for people in the lower or middle class, to be old was to be toothless. As for me, I'm determined to avoid my grandpa's fate, so I'm doing what I can to repair my bad teeth. For the last 13 years I've spent more than $24,000 on my pearly whites - and they still aren't perfect. Alas, they never will be! This article contains the best advice I can give a person regarding the care and repair of those troublesome damn pointy things in one's mouth.

Practice Daily Dental Care

Using a high quality, soft toothbrush and the best toothpaste - my dentist recommends Crest - brush you teeth at least twice a day, but definitely before you go to bed, so the food particles won't sit in your mouth all night and wreak havoc. Or, brush after every meal if you possibly can. (Some people actually do this!) When you brush, use an easy circular motion; otherwise, you may damage your teeth and/or your gums. Also floss every day if you can; if not, at least once every other day. And once or twice a week, rub some Glyoxide (expensive) or hydrogen peroxide (cheap) on your gums to keep them clean, firm and hopefully pink. Another thing to do is avoid taking drugs - legal or otherwise - that dry out your mouth, because saliva helps flush food particles from the mouth, and enzymes in it help prevent tooth decay.

Avoid Eating Processed Sugar

The ancient Chinese believed that tooth decay (a.k.a. dental caries) was caused by excessive sexual intercourse. The Chinese would think so, wouldn't they? While the Classic Greeks believed it was an imbalance of "humors" or bodily fluids that caused it. Interestingly, this belief led to people being "bled" to reduce the humors. Believe it or not, bleeding was practiced all the way into the twentieth century. Anyhow, increased consumption of processed sugar in the seventeenth century, particularly in European countries such as England, caused an exponential increase in tooth decay. And we've been gobbling the stuff ever since - the consequences be damned! In particular, avoid sugary gum, hard candy and soda pop. If you must have something sweet to eat or drink, make sure it contains a sugar substitute. What? Give up sugar? You'd have an easier time giving up the Internet, wouldn't you?

Get Regular Checkups

You should get a checkup once every six months, because whatever plaque you missed while brushing and flossing can be chipped or scraped away by the dental hygienist. It's also a good idea to have somebody else give your teeth a good visual examination. And, from time to time, your dentist will want you to have X rays taken of various sections of your teeth. These are a good idea too, but as far as I'm concerned, you'll probably be able to "feel" whatever problems you have without getting X rays, as long as you stay in touch with your mouth. So, if you want to save a little money, refuse the X rays.

Take Care of Problems Sooner Rather than Later

If you have a sudden change in the way your teeth feel, that is, if your teeth presently show an unusual sensitivity to hot or cold, or if you have discomfort or pain while chewing, get to the dentist as soon as possible. What starts out as a cavity can quickly become a root canal or an extraction or a bridge or an implant. Use your credit card if you have to, or borrow the money from your mother, father or girlfriend, but get the work done preferably within days and definitely within weeks. What starts out costing hundreds can soon turn to thousands if you don't act promptly!

Cavities

In the old days, many people thought cavities were caused by tooth worms. Well, there are no worms in your teeth, but there could be plaque around them. Undigested food, particularly starch and sugar, mixes with saliva, creating an acidic substance known as plaque. Plaque causes tooth decay. So, if you develop a cavity, get it drilled out ASAP. Have the cavity filled with silver amalgam - a metal filling - or composite, a tooth-colored plastic resin. (These days, composite material is good enough to be used for filling molars, a procedure which requires great resistance to compression.) Gold fillings are also available but much more expensive. I prefer composite because after the filling is done, the tooth looks perfectly natural, though, keep in mind, each type of filling can eventually crack and have to be replaced; and every time a filling is replaced, some of the tooth is drilled way in the process, degrading your teeth. (Oh, I hate when that happens!) Some dentists use laser drills, which provide more precision and therefore may cause little if any tooth degradation, potentially saving people lots of money. (I have no experience with laser drilling. Perhaps I should try it.)

Toothaches

In the Middle Ages, toothaches were treated with substances such as arsenic, laxatives, raven's dung or mercury, or the patient was bled, sometimes with leeches. Be happy those days are gone for good! Anyway, when you get a toothache, get to a dentist ASAP. In the meantime, you can treat the pain, which can be acute, with acetaminophen, ibuprofen, aspirin or, if you can get a prescription, Vicodin or something even stronger. The problem with Vicodin is that it causes drowsiness, so you shouldn't pop some of it and then drive to the dentist. Also keep in mind that once you get a toothache, you'll probably eventually require a root canal on this tooth. (Ouch, in your mouth and in your wallet, baby!) I also have a problem with "transient tooth pain," an odd sensation that goes intermittently from tooth to tooth. It isn't nearly as intense as a toothache or root canal, but it's there nonetheless. If you have this pain, identify it ASAP, so you won't be running to the dentist every time you experience it.

Root Canals

When tooth decay becomes really advanced, necrosis of the pulp (root or nerve) of the tooth may occur. Antibiotics can slow the infection in the root but not eliminate it. Once the root is damaged, you'll have to get a root canal - eventually, because no procedure or medicine can regenerate it. (After getting the decay drilled out, I waited two years before I got my first root canal but eventually - about four years later - the tooth turned to mush and had to be extracted.) According to an article on WebMD, root canals fail about five per cent of the time. Anyway, in this procedure, the dentist cleans out the pulp, replaces it with a metal pin and then seals the tooth. If you're lucky, the tooth may last a lifetime; it you're not, the tooth could become infected and need more work performed by an endodontist or, finally, extraction. These days, root canals cost over a thousand dollars. Do root canals hurt? My first two didn't hurt at all, but the third one hurt like torture. Unfortunately, I had to get number two and three root canals within six weeks of each other. By the third root canal my resistance to Novocain had increased greatly, so even after three shots of the stuff the pain was acute!

Crowns

Once you have a tooth that's so damaged that it needs additional support (your dentist will advise you when this happens), you'll need to get a crown. Crowns are made of gold alloy or porcelain. Gold crowns are more durable but the sight of them is quite obvious in one's oral cavity. Gold crowns are also more susceptible to hot or cold. Porcelain crowns, however, can look perfectly natural and have virtually no sensitivity. Crowns cost about $1,000 a pop. An article on WebMD says that crowns last from five to 15 years, but I have one (my first) that's lasted nearly 25 years. Keep in mind that once you get a tooth crowned, you can't forget about it, because decay or necrosis can still get at the tooth underneath. (I can tell you're beginning to hate me.)

Extractions

When a tooth is beyond help, you'll need an extraction. Some dentists don't do extractions, so you may have to visit a dental surgeon. For anesthesia, you can get Novocain or receive a sedative intravenously. (When I got two teeth pulled, including a wisdom tooth, I got numbed with Novocain and didn't feel a thing.) However, once the tooth is extracted, you'll have a hole in your mouth to deal with. Missing teeth can cause the remaining ones to move around, creating gaps and possible collisions. How do you fill this cavern? Keep reading.

Bridges

To fill a hole left by an extraction, you'll need to have a bridge put in. There are many different kinds of bridges. The most common one is a Traditional Bridge - which I have - and comprises three teeth in a row. The two outside, or abutment teeth, are used as anchors for the bridge, while a false tooth, or pontic, covers the hole where the tooth was extracted. Bridges cost between $2,000 and $3,000. Please be aware that you probably shouldn't use teeth that have had root canals as abutment teeth, because if one of these root canals fails, you may have to replace the entire bridge! And at this point you might . . . jump off a bridge!

Implants

When bridges can't be used, you'll need artificial implants. Fortunately, I've had no experience with implants, but I know they are very expensive - $2,500 to $5,000 per tooth. Back in the 1970s, I had a friend whose mouth was filled with small teeth prone to decay. He replaced those teeth with implants, costing him approximately $10,000. These days those same implants would cost eight to ten times as much, or more! Unless you're rich or at least upper middle class, pray that you never need any of those damn things.

Night Guards

If you're one of those people who clench, grind or gnash your teeth, then you should use a night guard while sleeping. This thing form-fits to your upper teeth and helps prevent the chipping of teeth. I've used one for a couple years now, and it isn't much of a bother. How much does one cost? My dentist charged me almost $500. Here's a tip. Don't buy one from a dentist. You can purchase one on the Internet for $15 to $25 or, better yet, go to a department store and buy a sports mouthpiece for . . . one dollar. Wow, did I get ripped off! I should have sued my dentist for taking advantage of my ignorance and stupidity!

How to Save Money on Dental Work

I have little advice regarding such a possibility, except that prevention can save you thousands of dollars. Beyond that, you can save money by going to a dental clinic or by purchasing some of that cheap dental insurance with which you have to use "their" dentists. If their dentists are competent, you could save hundreds of dollars; otherwise, you could end up spending even more money in the long run. My dentist charges top-dollar, but he's damn good. The competence of a cheap dentist should always be suspect. Then there's the option of getting the work done in Mexico, where you could perhaps save even more money. But that's a subject for another article.

When to Say "The Heck with It!" and Get Dentures

If, at some point, you realize that keeping your natural teeth in good working order is simply too expensive, you may consider replacing them with dentures. A full set of dentures can cost as little as $500. And if you're indigent and/or collecting SSI, you may be able to get them for free. Dental insurance could also help pay the bill, of course.

Conclusion

If you're fortunate to be born with strong teeth that are resistant to decay, consider yourself lucky indeed. And if you don't even need braces, and your teeth are movie-star white, then you're darn near as good as nobility. But if you're like me and millions of other poor working class schmucks and have average teeth at best, be ready for a lifetime of trouble, pain and expense. Maybe you ought to do yourself a big favor right now and get them all yanked. Better yet, to save money, do the job yourself. Get some pain-killers, a pair of pliers, listen to a little AC/DC . . . At any rate, whatever you do, I'm pulling for you!