Cavity Cops Dis 'Drill and Fill'

Cavity Cops Dis 'Drill and Fill'

By Sean MartinWebMD Medical News

March 28, 2001 (Bethesda, Md.) -- To significantly improve dental health in the U.S., we need to develop more sophisticated strategies than to simply "drill and fill" cavities when they appear.

That's the gist of a consensus statement released today by an expert panel of dental experts convened by the National Institutes of Health.

Dental caries -- tooth disease -- may not be killing anyone, and it may be diminishing as a threat, but it remains a serious public health problem. Nearly 20% of children between the ages of 2 and 4 have experienced the disease, and just 5% of adults are free of the disease.

"[There is] the potential to bring your child to the dentist to prevent the disease ... rather than filling the holes that develop when we wait too long," says Michael Alfano, DMD, chairman of the expert panel. "But in order to do that, we need better diagnostic techniques. The problem is that right now, our techniques are really not sensitive enough to pick up these early [infections] before they actually cavitate the tooth."

X-rays can be helpful in diagnosing early disease, says Alfano, dean of New York University College of Dentistry in New York City, but better methods need to be tested. "There are some exciting new developments that suggest the dentist may soon be armed with ways to know ... and then intercede to prevent [teeth] from ultimately requiring a filling.

"Filling a tooth is expensive, invasive, and weakens the tooth," he says. "Other than restoring the tooth to function, which is necessary when it does have a hole in it, it's not necessarily a good result."

Remineralization, which can restore tooth enamel if disease is caught at an early enough stage, is a promising option. "Identification of early caries lesions and treatment with nonsurgical methods, including remineralization, represents the next era in dental care," the report states.

"We think it is just a higher standard of care that ultimately should result in fewer repeat visits," Alfano says. "One of the things that keeps dentists busy today is they are replacing old fillings."

"The next breaking area of dental technology has to do with remineralization, and we are looking at the possibilities of regrowing dental or natural tooth material as a filling material," Matthew Messina, DDS, a practicing dentist and spokesman for the American Dental Association, tells WebMD. "But that is not in the everyday toolbox of the average dentist right now."

Eliminating the need for dental crowns, bridges, and moldings could cut dental expenses, but major perception changes are crucial, the report stresses. Dentists lack reimbursement incentives to keep their patients from getting to the point of needing cavity fixes.
"The tendency is to compensate dentists only for doing fillings, and the reality is that a dentist can do so much more to prevent these conditions," Alfano says.

"The insurance companies are not, as a whole, as interested in preventive techniques, and that's one of the areas that's going to have to be adjusted," Messina tells WebMD.

Panel member Alan Lurie, DDS, of the University of Connecticut School of Dental Medicine, pointed out that controlling the amount of sugar that children eat is important in preventing disease. And according to the report, sugarless chewing gum with xylitol (a type of sugar that doesn't seem to promote tooth decay) also is effective in preventing caries. However, the gum is not yet widely available in the U.S.

The panel did note that brushing teeth with fluoridated toothpaste and widespread community water fluoridation have made significant dents in dental caries in recent decades. Moreover, dentists have been effective in preventing some disease by "sealing" teeth with plastic film.
"The awareness with parents of the value of taking their kids to the dentist on a regular basis and starting at a young age has really grown, along with proper brushing," Messina tells WebMD. "We're producing a generation of kids that has had very little experience at the dentist, and a very low decay rate."

"The reduction in dental caries is as much as two-thirds in the past 30 years," Alfano says, "so we've been doing something right as a society."
At the same time, he says, "We've got pockets of disease in economically underprivileged and minority individuals that need to be addressed."

The panel noted that low socioeconomic status is linked to a higher risk of tooth disease. For adults and the elderly, it said that risk factors include poor oral hygiene, a lack of adequate salivary flow, and gum recession.
The expert panel also lamented that scientific research on tooth disease often has been flawed. Future dental care advances may be dependent on higher standards, it warned, calling for a new focus on tooth decay research.

"Despite the fact that it just about affects everybody in this room, caries is not life threatening, so in terms of garnishing a lot of attention both public and in terms of funding for research, it is at a slight disadvantage," says panel member Ian Coulter, PhD, from the University of California Los Angeles School of Dentistry.

The panel's consensus statement can be found online via http://www.webmd.com/click?url=http://consensus.nih.gov.

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