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Dental Cavities

Dental caries leads to cavities.

Does it seem that no one cares about tooth decay anymore? Are all the dentists and patients really just concerned about appearance and esthetics? I recently attended a conference convened by the National Institute of Health (NIH) that was a fast-paced, hard-hitting series of presentations by 36 of the world's top researchers to an impartial panel. It resulted in an independent report written as a NIH consensus statement. In short, that means a big group of important people looked at a whole lot of scientific papers on this topic and agreed on a few things. And yes, it appears someone still does care about tooth decay and there are some surprising findings to report.

It is pretty widely agreed that there are two main groups of bacteria that cause tooth decay -- Streptococcus mutans and lactobacillus. If these are present in a mouth, the chances for getting decay are greater. Stated another way, if they are not present you will not get decay. Evidence indicates that in many populations, these bacteria passed from a mother, who had high levels of the bacteria, to her infant children; the exact same strains were traced from mother to child in a specific time frame. In the U.S., almost 80 percent of children have had a tooth filling by age 18. A foreign observer at the conference asked the panel why they thought that fact contrasted with the opposite statistic in his country of 80 percent of 18 year-olds not having any fillings.

It seems research on the bacteria transmission from mother to child was carried out mostly by researchers with the same thick Scandinavian accents. They also seem to have discovered that using chewing gum sweetened with xylitol will help to decrease the bacteria that cause tooth decay as well. In all fairness, they have had anti-bacterial gels and varnishes for quite some time that may have helped them to achieve this remarkable statistic. The obvious fact is that treating tooth decay as an infection has paid off for those countries. In the U.S., we have some catching up to do.

A cavity is a hole in a tooth. Pretty simple, just about anyone could find that, right? Caries is the process involving bacteria and sugar that weakens the tooth, maybe not a hole yet, but to the point that it has a change in appearance or microscopic structure. Many times, a filling is required to restore a tooth to a sound structure for function after the decay process has been initiated. This is where it gets tricky. Previous thinking was it only took about a year or so before that happened. Now it seems the whole process may take from two to four years. It could be due to more fluoride making teeth resistant or better dietary or dental hygiene habits, they just don't know. The point is that dentists may be able to detect this decay process at a much earlier stage. "Great," you say, "that means I get more cavities filled sooner -- that's not good news!" But, science is learning that the sooner this process is detected, the better the chances of not having to fill a tooth at all! Sounds crazy, huh!

By using new technologies like quantitative light fluorescence, laser fluorescence and digitally imaged transillumination, your dentist may detect the decay process at a point where it can actually be reversed by various techniques, avoiding fillings altogether. It gets even better; the tooth that is remineralized can be up to 10 times more resistant to future decay. With this new technology, a worst-case scenario may be that a small filling has to be placed. Because it will be so small, it will not significantly weaken the tooth and set the tooth up for the life cycle of breakdown and repair that results in root canals and dental crowns. The use of the dental explorer and X-rays are currently the diagnostic tools of choice, but these may soon appear as ancient as tooth extraction forceps and belt-driven hand pieces for performing state-of-the-art dentistry.

Presently, 20 percent of the population gets at least 60 percent of known cavities. The groups at highest risk are children and many older adults who suffer from severe root decay. New techniques for determining individual risk and setting individualized care programs (e.g., setting check-ups every three months or 18 months based on need instead of twice a year) will result in better use of the dollars set aside for dental care and better care for the groups with the greatest need. This disproportionate presence of disease in certain segments of the population is a major problem. After earlier detection, the most promising treatments that we can look forward to are wider use of dental sealants, fluoride varnishes and antibacterial gels and varnishes that will aid in the remineralization of affected tooth surfaces. The evidence indicates it is now time to move from the surgical model of care for tooth decay. We have come a long way from the days of surgically removing the tooth when it gets a cavity to educating the public that it is better to have a filling placed and saving the tooth. Now the time has come to educate the public and the dentists that it may be better not to surgically treat the tooth surface, but to extend prevention and treatment of tooth decay to remineralization and conservation of tooth structure by non-surgical methods.

Within my own practice, we monitor bacteria levels on all new and existing patients who present with multiple or chronic areas of tooth decay. We offer techniques to allow the patient to control this infectious disease and begin the remineralization process. Being committed to treating dental diseases, such as tooth decay and gum disease, as infections has helped us deliver the best that dental medicine has to offer. I feel this approach will truly allow me to provide all patients with true dental health at the highest level. I know there are many who suffer from chronic decay problems who are looking for answers beyond constantly having their teeth filled. There are many dental schools around the country and world where this new approach is being studied and implemented.

Remember, only a dentist can diagnose your dental problems and offer the right dental treatment planning for you. If you need a dentist, call us at 1-866-970-0441 to be connected with one today.

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