A University of Sydney 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 the seven year study, published today
in Community Dentistry and Oral Epidemiology, found
that the need for fillings was reduced by 30 to 50
per cent through preventative oral care.
"It's unnecessary for patients to have fillings
because they're not required in many cases of dental
decay," said the study's lead author, Associate
Professor Wendell Evans of the University of Sydney.
"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."
Professor Wendell Evans and his team developed the
Caries Management System (CMS) - a set of 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 CMS treatment 'no-drill' 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.
"The CMS was first tested on high risk patients at
Westmead Hospital with great success," said
Professor Evans.
"It showed that early decay could be stopped and
reversed and that the need for drilling and filling
was reduced dramatically.
"A tooth should be only be drilled and filled where
an actual hole-in-the-tooth (cavity) is already
evident," he said.
The CMS treatment was then tested in general dental
practices in New South Wales and Australian Capital
Territory. The Monitor Practice Program (MPP),
funded by the National Health and Medical Research
Council of Australia (NHMRC), confirmed that after
seven years, decay risk was substantially reduced
among the CMS patients and their need for fillings
was reduced by 30 to 50 per cent compared to the
control group.
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 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."
For more information
Community Dentistry and Oral Epidemiology
The Caries Management System: are preventive effects
sustained postclinical trial?
Link...
The University of Sidney
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