Dentists Have Better Ways To Prevent Cavities In Adults : Shots

Vidhya Nagarajan for NPR

If the high-pitched purr of a dentist’s drill digging into your molar terrifies you, that’s good news! There might be fewer fillings in your future. A painless way to prevent cavities in adults is gaining traction.

“Okay, Alice, we’re going to apply the fluoride varnish to your teeth,” says Marion Manski, director of the dental hygiene program at the University of Maryland’s School of Dentistry. Fluoride varnish is standard for children’s teeth, but Manski’s patient Alice Clash is 91 years old. Like many elderly patients, Clash is taking drugs that cause dry mouth, which puts her at high risk of tooth decay.

So Manski takes a thin brush and a small pot of yellowish liquid and paints the varnish on Clash’s teeth. “We know that saliva helps us wash away bacteria and food in the mouth,” says Manski. “The fluoride varnish will help.”

One way fluoride helps is by penetrating the tooth enamel and drawing in the calcium and phosphate that are naturally present in saliva. The minerals promote the natural healing process of the teeth and make them more resistant to future tooth decay. But there are other theories about how fluoride works. It strengthens tooth enamel before the tooth erupts, which is why it is so important for children. And it attacks the acid-producing bacteria in the mouth. One study shows that fluoride makes it difficult for these bacteria to adhere to teeth.

It takes about a minute and the fluoride treatment is complete. Some patients are also given a prescription for a concentrated fluoride gel that can be used at night.

“These preventive approaches work just as well in adults as they do in children,” says Norman Tinanoff, professor of pediatric dentistry at the University of Maryland. He says part of what makes fluoride treatments popular with adults is personalizing dental care and creating a personalized treatment plan for each patient. To do this, you need to weigh a patient’s risk of developing cavities.

One of the biggest proponents of this approach is John Featherstone, Dean of the University of California at the San Francisco School of Dentistry. Featherstone has developed a comprehensive way of measuring a person’s risk of tooth decay or tooth decay. It includes testing the levels of bacteria in the mouth, as well as examining dietary habits, medical conditions, medications, salivation, and a history of tooth decay. When Featherstone put his patients on personal treatment plans, he found the strategy worked.

“It really proved that the drilling and filling didn’t fix the disease,” says Featherstone. “Putting in a filling repairs the hole in the tooth, but it doesn’t concern the bacteria in the rest of the mouth.” Most bacteria are friendly, but a few bad actors can cause cavities. These guys feed on sugar and expel acid that eats away at tooth enamel.

Traditionally, dentists were taught that the only way to deal with tooth decay was to drill it out. That’s still important in some cases, Featherstone says, but without fixing the underlying bad bacteria problem, patients keep coming back for more fillings. Featherstone saw another way. “It’s a bit like your car is starting to rust,” he says. “If you can stop the rust before the rust goes right through the body of the car, you are in good shape.”

Like rust, tooth decay is a slow process. A full-fledged cavity is a hole that needs to be repaired. But if you notice tooth decay early on, Featherstone says, fluoride treatments like varnish and concentrated toothpaste and gels can reverse it.

“In the past, we believed that tooth decay was a rapidly progressing disease, but research shows that it progresses slowly,” says Wendell Evans, associate professor of dentistry at the University of Sydney, Australia. He recently published a study that found that using these techniques reduced the need for fillings in adults by 30 to 50 percent.

As striking as these results may be, the concept is not new. This switch to a preventive model of dentistry has been in preparation for decades. “Some of the things in our study have been known for 50 years,” says Evans, referring to the use of fluoride treatments.

“Prevention has always been a part of the dental world,” says Richard Valachovic, president of the American Dental Education Association. “What we’re seeing is a generation change,” says Valachovic. As dentists understood the microbiology of the mouth better, more effective prevention techniques followed.

But the cost was a problem. Insurance companies routinely pay for fluoride treatments for children, but not as much for adults. The National Association of Dental Plans couldn’t give a definitive answer on coverage, but calls to some individual freight forwarders and dental offices suggest it depends entirely on the nature of your plan. Some high-end plans cover two fluoride treatments per year, while cheaper plans typically don’t cover any. If you’re paying out of pocket, a varnish treatment costs between $ 23 and $ 55, compared to a filling between $ 86 and $ 606, according to the American Dental Association.

Cost could also be a factor for dentists. Featherstone and Wendell say that some dentists may be reluctant to use the preventive methods because they fear that they will lose money by performing less costly procedures.

At this point in time, Featherstone says two-thirds of dental schools in the United States are teaching some kind of disease management model based on thorough risk assessment. And he expects that at some point all dentists will follow a prevention protocol.

“It’s going to happen,” says Featherstone. “It’s only a matter of time.”

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