Researchers in Australia found in a seven-year study that not all tooth decay is created equal: In many cases, decay can be treated, stopped and reversed, preventing the traditional "drill and fill."
Using fluoride, improving brushing, and changing diet, part of what researchers called the Caries Management System, or CMS, can stop and reverse decay before it causes cavities in teeth. Once a cavity is visible, the tooth my be drilled and filled, they said.
"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," Dr. Wendell Evans, an associate professor at the University of Sydney, said in a press release. "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."
The researchers recruited 19 dental practices to use either the CMS or traditional drill-and-fill practice, following patients for a three-year randomized clinical trial and following up with them two and four years after the end of the trial.
Over the course of the full seven-year monitoring time, researchers reported that decay was reduced in CMS participants by 30 to 50 percent.
The four-part CMS -- application of high concentration fluoride varnish by dentists on early decay; attention to tooth-brushing skills; restriction of snacks and beverages containing sugar; and risk-specific monitoring -- was judged successful, though researchers said its success puts a lot of responsibility on patients.
"It showed that early decay could be stopped and reversed and that the need for drilling and filling was reduced dramatically," Evans said. "A tooth should be only be drilled and filled where an actual hole-in-the-tooth [cavity] is already evident."
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