'No Drill' dentistry prevents 50% of fillings - February 2016

Kid at the dentist

Good Health Care

A new study has revealed that tooth decay (dental caries) can be stopped, reversed, and prevented without the need for the traditional 'fill and drill' approach that has dominated dental care for decades.

The results of a seven year study, found that the need for fillings was reduced by 30 to 50 per cent through preventative oral care. Associate Professor Wendell Evans of the University of Sydney says, "It's unnecessary for patients to have fillings because they're not required in many cases of dental decay," Evans states, "This research signals the need for a major shift in the way tooth decay is managed by dentists -- dental practice in Australia needs to change. Our study shows that a preventative approach has major benefits compared to current practice.

"For a long time it was believed that tooth decay was a rapidly progressive phenomenon and the best way to manage it was to identify early decay and remove it immediately in order to prevent a tooth surface from breaking up into cavities. After removing the decay, the affected tooth is then restored with a filling material -- this process is sometimes referred to as 'drilling and filling'.

"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).

"That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling."

Wendell Evans and his team have developed a process they called, Caries Management System (CMS) - which is a set of defined protocols which cover the assessment of decay risk, the interpretation of dental X-rays, and specific treatment of early decay (decay that is not yet a cavity).

The 'no-drill' CMS treatment involves four aspects:

1. Application of high concentration fluoride varnish by dentists to the sites of early decay
2. Attention to home tooth brushing skills
3. Restriction of between-meal snacks and beverages containing added sugar
4. Risk-specific monitoring.

Professor Evans states, "A tooth should only be drilled and filled where an actual hole-in-the-tooth (cavity) is already evident," he said.
"The reduced decay risk and reduced need for fillings was understandably welcomed by patients," Professor Evans said. "However, patients play an important role in their treatment. This treatment will need a partnership between dentists and patients to be most successful."

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