If the loud thud of a dentist’s drill as it drills into your molar terrifies you, good news! Fewer fillings may be in your future. A painless way to prevent tooth decay in adults is gaining traction.
“Okay, Alice, we’re going to put the fluoride varnish on your teeth,” he says Marion Mansky, director of the dental hygiene program at the University of Maryland School of Dentistry. Fluoride varnish is standard practice for children’s teeth, but Manski’s patient, Alice Clash, is 91 years old. Like many elderly patients, Clash takes medications that cause dry mouthwhich puts her at high risk for tooth decay.
So Manski takes a thin brush and a small container of yellowish liquid and paints the polish on Clash’s teeth. “We know that our saliva helps wash away bacteria and food in the mouth,” says Manski. “The fluoride varnish will help it.”
One way that fluoride helps is by penetrating the enamel and drawing out the calcium and phosphate that are naturally present in saliva. Minerals enhance the natural healing process of teeth and make them more resistant to future tooth decay. But there are other theories about how fluoride works. It strengthens the enamel before the tooth erupts, which is why it is so important for children. And it attacks the acid-producing bacteria in the mouth. A study shows that fluoride makes it harder for these bacteria to stick to teeth.
It takes about a minute and the fluoride treatment is done. Some patients are also given a prescription for a concentrated fluoride gel that can be used at night.
“These preventative approaches work just as well in adults as they do in children,” he says Norman Tinanoff, professor of pediatric dentistry at the University of Maryland. He says part of what makes fluoride treatments popular for adults is a move to make dental care personal, with an individualized treatment plan for each patient. To do this, you need to weigh a patient’s caries risk.
One of the biggest proponents of this approach is John Featherstone, dean of the University of California, San Francisco School of Dentistry. Featherstone found an integrated way count a person’s risk for caries, or caries. It includes checking the level of bacteria in the mouth and looking at eating habits, medical conditions, medications, saliva flow and tooth decay history. When Featherstone put his patients on personal treatment plans, he found it strategy it worked.
“It really turned out that drilling and filling didn’t fix the disease,” says Featherstone. “Putting in a filling fixes that hole in the tooth, but it doesn’t address the bacteria in the rest of the mouth.” Most bacteria are friendly, but some bad actors can cause tooth decay. These guys feed on sugars and expel the acid that eats away at the enamel.
Traditionally, dentists were taught that the only way to treat tooth decay was to drill it. That’s still important in some cases, Featherstone says, but without fixing the underlying problem of bad bacteria, patients just keep coming back for more fillings. Featherstone saw another way. “It’s a bit like your car starting to rust,” he says. “If you can stop the rust before the rust goes right through the body of the car, then you’re in good shape.”
Like rust, tooth decay is a slow process. A full cavity is a hole that needs to be fixed. But if you catch rot early, Featherstone says, it can be vice versa using fluoride treatments such as varnish and concentrated toothpaste and gel.
“We used to think that tooth decay was a rapidly progressive disease. But research shows that it progresses slowly,” he says. Wendell Evans, associate professor of dentistry at the University of Sydney in Australia. He recently posted one study that using these techniques reduced the need for fillings in adults by 30 to 50 percent.
As impressive as these results may seem, the idea is not new. This shift toward a preventive model of dentistry has been underway 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 part of the world of dentistry,” he says Richard Valachovich, president of the American Dental Education Association. “What we’re seeing is a generational shift,” Valachovich says. As dentists better understand the microbiology of the mouth, they have pursued more effective preventive techniques.
But cost was an issue. Insurance companies usually pay for fluoride treatments for children, but not as much for adults. The National Association of Dental Plans I couldn’t give a definitive answer about coverage, but calls to some individual carriers and dental offices suggest that it depends entirely on the type of plan you have. Some higher-end plans cover two fluoride treatments per year, while cheaper plans tend to cover none. If you’re paying out of pocket, a veneer treatment costs $23 to $55, compared to a filling, which ranges from $86 to $606, according to American Dental Association.
Cost could also be a factor for dentists. Featherstone and Wendell say some dentists may be reluctant to adopt preventive methods because they worry they’ll lose money if they do less expensive procedures.
At this point, Featherstone says, two-thirds of US dental schools teach some kind of disease management model based on a thorough risk assessment. And he expects that at some point all dentists will follow a preventive protocol.
“It will happen,” Featherstone says. “It’s just a matter of time.”
