Cavity Cops Dis 'Drill and Fill'
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.