straine

Search

blog

Straine-On-Success — Simple Dental Treatments May Reverse Decay

Published on April 13, 2016

Your dentist may be giving you more fillings than you need.

A recent study led by Wendell Evans at the University of Sydney supports growing evidence that early tooth decay, before a cavity forms, can often be arrested and reversed with simple treatments that restore minerals in the teeth, rather than the more typical drill-and-fill approach.

The randomized, controlled trial followed 19 dental practices in Australia for three years, then researchers checked up on the patients again four years later. The result: After seven years, patients receiving remineralization treatment needed on average 30% fewer fillings.

“This is quite important,” Mary Hayes, a clinical spokeswoman for the American Dental Association, says about the study, published in December in the journal Community Dentistry and Oral Epidemiology. “We have traditionally taken a surgical approach, removing decay and replacing it with a filling,” says Dr. Hayes, a dentist in Chicago. “You’re changing the paradigm to give ground to therapeutic approaches.”

In the study, patients in the experimental group with early decay received a fluoride varnish to the site. Dentists also gave those patients fluoride varnish preventively two to four times a year, and encouraged them to brush well and avoid sugary snacks between meals.

Tooth decay, or caries, is caused by bacteria that thrive on sugars in the mouth and produce acids. Left in contact with a tooth, the acids draw out minerals, creating microscopic pores. Decay progresses slowly, and it may take years for a full-blown hole, or cavity, to form; until that point, it can still be reversed. Mineral-containing saliva is constantly working to replenish the teeth, and fluoride aids remineralization.

After a filling, more than 60% of people will return to the dentist with new decay within the next two years, says John Featherstone, dean at the University of California, San Francisco, School of Dentistry. “Two-thirds of the population. That’s huge,” Dr. Featherstone says. “So you need to build into the treatment plan a therapeutic regimen.” He says dentistry’s traditional drill-and-fill response to tooth decay is similar to a doctor who, upon seeing a patient with a red, swollen arm, recommends cutting the arm off.

Among other treatments to arrest tooth decay that researchers have investigated is Xylitol, a natural sweetener used in some candies that has been shown to help prevent bacteria from making the acids that cause tooth decay. Prescription antibacterial rinses seem to help but need further study, researchers say. For biting surfaces prone to decay, plastic sealants applied by a dentist prevent nutrients that would feed bacteria from getting into grooves on tooth surfaces.

The advantages of fewer fillings go beyond avoiding the dreaded anesthetic injection and drill. Fillings don’t last forever and eventually need to be replaced, says Mark Wolff, chair of cariology at New York University College of Dentistry. Each successive filling is going to be bigger than the last, progressively weakening the tooth. “The key is avoiding the first one,” he says.

Dr. Wolff recalls a time his two children came home from college, one with four areas of decay and the other with one. “I looked at the X-rays and was quite horrified,” he says. “They’d gone off to college with not the slightest evidence of decay. We put them on fluoride, a calcium-containing toothpaste, and Xylitol,” he says, and the teeth remineralized over the next two years. “Neither of my children have any fillings,” he says.

An excessive amount of fluoride is toxic, but research has shown that in the amounts used in dentistry and found in water supplies, fluoride is safe and helps prevent cavities, Dr. Wolff says.

There is a substantial body of research supporting remineralization as a treatment for early tooth decay, and little opposition in the dental profession, says Margherita Fontana, a professor of cariology at the University of Michigan School of Dentistry. Tradition, however, has been an obstacle to widespread use of the treatment. “For older generations [of dentists], it just feels wrong to leave decay and not remove it,” Dr. Fontana says. “That’s how they were trained.”

Reimbursement is another obstacle. Insurance typically covers application of fluoride varnish in children, but not adults. The cost ranges from $25 to $55, according to the American Dental Association’s Health Policy Institute. Other preventive treatments also generally aren’t covered.

Dr. Featherstone says he advises patients at high risk for decay to seek preventive treatment. “For $100 a year you can have the therapy and save yourself a crown for $1,000,” he says. Over-the-counter fluoride rinses also provide some benefit. “If you have new decay every so often, you’re high risk, it’s as simple as that,” says Dr. Featherstone. According to the National Institutes of Health, 20% of the U.S. population gets 60% of all caries.

In a study, Dr. Featherstone and two colleagues, Benjamin Chaffee and Jing Cheng, looked at the effectiveness of nonsurgical therapies for tooth decay in a retrospective analysis of more than 2,700 patients’ records at the dental clinic at UC, San Francisco. All patients were at high risk for tooth decay.

The findings, published in September in the journal BMC Oral Health, showed patients who took home anti-caries agents at two or more dental visits had 20% to 40% fewer new decayed teeth over 18 months.

Dr. Featherstone led a randomized clinical trial of 231 adults, with about half of them treated by dentists prescribing both antibacterial and fluoride treatments for any tooth decay before a cavity had formed. The rest of the patients were treated by dentists who continued their usual care. The need for fillings after two years in the new treatment group was 24% less than in the regular-treatment group, according to the study, published in 2012 in the journal Caries Research.

Back to Posts »