Archive for the ‘TOOTH DECAY’ Category

No-drill dentistry stops decay, reducing need for fillings, says Sydney Uni study

Associate Professor Wendell Evans from the faculty of dentistry, Sydney University at Westmead.

Tooth decay occurs slowly enough to be stopped, even reversed, reducing the need for fillings by 80 per cent in high-risk patients, a new study by Sydney University says.

The results are good news for the estimated 15 per cent of Australians who avoid treatment because they have a phobia about going to the dentist

dental work in womans mouth image

Early decay can be stopped and reversed before cavities form, the study says. Photo: Luis Ascui

Knowing they wouldn’t face the drill was important to patients coping with the phobia, said Associate Professor Wendell Evans, lead investigator of the seven-year oral health study into “no-drill dentistry”.

He said the results signalled a need for Australian dentistry to move away from the traditional “fill and drill” approach.

“It’s unnecessary for patients to have fillings because they’re not required in many cases of dental decay,” he said.

dental decay early signs image

The white patches, such as those on the two front teeth, indicate decay that can be stopped. Photos: Sydney University

For a long time, it was believed that tooth decay occurred rapidly and the best way to stop the rot was to remove it, even in earlier stages, and to fill the cavity.

“However, 50 years of research studies have shown that decay is not always progressive and develops more slowly than was previously believed.

“For example, it takes an average of four to eight years for decay to progress from the tooth’s outer layer [enamel] to the inner layer [dentine].

dental decay tooth image

“That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling,” Professor Evans said.

“A tooth should only be drilled and filled where an actual hole in the tooth [cavity] is already evident,” he said.

The study was published in Community Dentistry and Oral Epidemiology on Monday.

Researchers compared more than 1000 patients at 22 dental practices in NSW and the ACT. Some were in areas with fluoridated water, some without.

Half were treated conventionally. The others were treated using the Caries Management System, a preventive approach used on teeth where decay has been detected but has yet to form a hole.

The new approach included:

▪ Application by dentists of high concentration fluoride varnish on teeth showing signs of early decay.

▪ Advice on how to brush teeth better.

▪ Restriction of between-meal snacks and beverages containing added sugar.

▪ Monitoring according to the level of risk.

After seven years, the need for fillings was reduced by 30 to 50 per cent in average patients using preventive care compared with patients treated with conventional methods.

High-risk patients – those who required as many as two fillings a year – had an 80 per cent reduction, Professor Evans said.

There was plenty of research to illustrate that fluoride and other preventive measures reduced decay, which hadn’t been translated into practice.

Dentists had became institutionalised to deal with decay by drilling and filling, he said.

He called for prevention to be introduced as a new area of specialisation for dentists so there was a career pathway.

The cost of the no-drill approach is about the same for most people, and a little more for high-risk patients.

Phobia of the dentist’s drill is so common that it stops people from visiting the dentist.

A new study by King’s College London in the British Dental Journal found an average of five talking therapy (cognitive behavioural therapy) visits was effective in reducing or eliminating fear.

Three-quarters of the group studied had a “dental phobia”, while the rest had a specific fear of one aspect of dentistry, such as injections or the drill.

Of all the patients, 79 went on to have dental treatment without the need for sedation, while 6 per cent had their dental treatment under sedation.

Eithne Irving, deputy chief executive of the Australian Dental Association, said: “Research such as this contributes greatly to the evidence base that underpins contemporary dental care in Australia and the ADA will be promoting these findings among its members.

“Professor Wendell is correct in saying that prevention is a key plank in the fight against dental disease and this is why the ADA continues its efforts on oral health promotion through activities such as Dental Health Week and community access to fluoridated water supplies.

“Preventive dentistry is the backbone of modern dental practice and this research will provide further evidence of the benefits of this approach for patients.

“At the end of the day, there is no substitute for patients having regular check-ups and practising good oral hygiene behaviours such as brushing twice daily, flossing once a day and reducing their exposure to sugary foods and drinks.

“Prevention is always better than a cure.”


Henry Sapiecha