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Dentistry without the drill
December 20, 2015, 3:05 pm
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New research s suggesting that a ‘no-drill’ approach can halt tooth decay in many cases. An Australian team's seven-year study found that the need for fillings fell 30 to 50 percent if patients used preventive care after the first sign of tooth decay.

The findings highlight "the need for a major shift in the way tooth decay is managed by dentists," study lead author Wendell Evans, an associate professor at the University of Sydney, said in a university news release.

Many people believe that even the smallest sign of tooth decay warrants a filling. But Evans said that the decay does not always progress and often develops more slowly than widely 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)," he said. "That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling."

The no-drill approach developed by Evans and his colleagues has four aspects: application of high-concentration fluoride varnish to the site of early tooth decay; attention to home tooth-brushing skills; no between-meals snacks or drinks with added sugar; and regular monitoring.

Tests of this approach on patients at a number of general dentistry practices "showed that early decay could be stopped and reversed, and that the need for drilling and filling was reduced dramatically," Evans said.

In April, the U.S. FDA approved a new compound, sodium diamine fluoride that can reverse or stop ‘significant’ cavities without the need for drilling.

But will the dreaded drill become obsolete? Not anytime soon, Evans said, because advanced cavities need filling. Still, "a tooth should only be drilled and filled where an actual hole-in-the-tooth (cavity) is already evident," he said.

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