Posts for tag: tooth decay
Dental caries (tooth decay) is a leading cause of tooth loss. But with prompt diagnosis and care we can often stop it before it causes too much damage.
The traditional treatment approach is simple: remove all diseased tooth structure and then restore the tooth with a filling. But this otherwise effective treatment has one drawback: you may lose significant healthy structure to accommodate a suitable filling or to make vulnerable areas easier to clean from bacterial plaque.
That's why a new treatment approach called minimally invasive dentistry (MID) is becoming more common. The goal of MID is to remove as little of a tooth's natural enamel and dentin as possible. This leaves the treated tooth stronger and healthier, and could reduce long-term dental costs too.
Here's how MID could change your future dental care.
Better risk assessment. MID includes a treatment protocol called caries management by risk assessment (CAMBRA). With CAMBRA, we evaluate your individual tooth decay risk, including oral bacteria levels, the quality of saliva flow to neutralize mouth acid, and sugar consumption. We then use our findings to customize a treatment plan that targets your areas of highest risk.
New detection methods. The real key to fighting tooth decay is to find it before it can destroy tooth structure with the help of new diagnostic technology. Besides advances in x-ray imaging that provide better views with less radiation exposure, we're also using powerful dental microscopes, lasers and infrared photography to show us more about your teeth than we can see with the naked eye.
"Less is More" treatments. In contrast to the dental drill, many dentists are now using air abrasion rather than a dental drill to remove decayed tooth material. Air abrasion emits tiny material particles within a pressurized air stream that leaves more healthy tooth structure intact than with drilling. We're also using new filling materials like composite resin that not only resemble natural tooth color, but require less structural removal than other types of fillings.
Using MID, we can treat tooth decay while preserving more of your natural teeth. This promises better long-term outcomes for future dental health.
If you would like more information on new treatments for tooth decay, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Minimally Invasive Dentistry: When Less Care is More.”
The basics for treating tooth decay have changed little since the father of modern dentistry Dr. G.V. Black developed them in the early 20th Century. Even though technical advances have streamlined treatment, our objectives are the same: remove any decayed material, prepare the cavity and then fill it.
This approach has endured because it works—dentists practicing it have preserved billions of teeth. But it has had one principle drawback: we often lose healthy tooth structure while removing decay. Although we preserve the tooth, its overall structure may be weaker.
But thanks to recent diagnostic and treatment advances we’re now preserving more of the tooth structure during treatment than ever before. On the diagnostic front enhanced x-ray technology and new magnification techniques are helping us find decay earlier when there’s less damaged material to remove and less risk to healthy structure.
Treating cavities has likewise improved with the increased use of air abrasion, an alternative to drilling. Emitting a concentrated stream of fine abrasive particles, air abrasion is mostly limited to treating small cavities. Even so, dentists using it say they’re removing less healthy tooth structure than with drilling.
While these current advances have already had a noticeable impact on decay treatment, there’s more to come. One in particular could dwarf every other advance with its impact: a tooth repairing itself through dentin regeneration.
This futuristic idea stems from a discovery by researchers at King’s College, London experimenting with Tideglusib, a medication for treating Alzheimer’s disease. The researchers placed tiny sponges soaked with the drug into holes drilled into mouse teeth. After a few weeks the holes had filled with dentin, produced by the teeth themselves.
Dentin regeneration isn’t new, but methods to date haven’t been able to produce enough dentin to repair a typical cavity. Tideglusib has proven more promising, and it’s already being used in clinical trials. If its development continues to progress, patients’ teeth may one day repair their own cavities without a filling.
Dr. Black’s enduring concepts continue to define tooth decay treatment. But developments now and on the horizon are transforming how we treat this disease in ways the father of modern dentistry couldn’t imagine.
More than likely your great-grandparents, grandparents and even your parents had a common dental experience: when one of their teeth developed a cavity, their dentist removed the decayed portion (and maybe a little more) through drilling and then filled the cavity. In other words, treatment was mainly reactive—fix the problem when it occurred, then fix it again if it reoccurred.
You may have had similar experiences—but the chances are good your dentist’s approach is now quite different. Today’s tooth decay treatment is much more proactive: address first the issues that cause tooth decay, and if it does occur treat it with an eye on preventing it in the future.
This approach depends on maintaining equilibrium between two sets of competing factors that influence how your teeth may encounter tooth decay. This is known as the caries balance (caries being another name for tooth decay). On one side are factors that increase the risk of decay, known by the acronym BAD: Bad Bacteria that produce acid that dissolves the minerals in tooth enamel; Absence of Saliva, the body’s natural acid neutralizer; and Dietary Habits, especially foods with added sugars that feed bacteria, and acid that further weakens enamel.
There are also factors that decrease the risk of tooth decay, known by the acronym SAFE: Saliva and Sealants, which focuses on methods to boost low salivary flow and cover chewing surfaces prone to decay with sealant materials; Antimicrobials, rinses or other substances that reduce bad bacteria populations and encourage the growth of beneficial strains; Fluoride, increased intake or topical applications of this known enamel-strengthening chemical; and Effective Diet, reducing the amount and frequency of sugary or acidic foods and replacing them with more dental-friendly choices.
In effect, we employ a variety of techniques and materials that inhibit BAD factors and support SAFE ones. The foundation for prevention, though, remains the same as it was for past family generations—practice effective oral hygiene by brushing and flossing daily and regular dental cleanings and checkups to keep bacterial plaque from accumulating and growing. Your own diligent daily care rounds out this more effective way that could change your family history of tooth decay for you and future generations.
As we age we become more susceptible to dental diseases. A common but often initially unnoticed problem for seniors is root decay.
We’re all familiar with tooth decay in the crown, the visible tooth above the gum line. Bacteria feeding on leftover sugar in the mouth produce acid, which at high levels erodes the teeth’s protective enamel. This forms cavities and, if untreated, deeper infection within the tooth that could reach the bone via the root canals.
But decay can also directly attack a tooth’s roots below the gum line. Roots are made of dentin and covered by a very thin layer of mineralized tooth structure called cementum. Cementum, which is much softer than enamel, is often lost because of its thinness, thus exposing the root’s dentin. This can make the area more susceptible to decay than the enamel-covered crown. Normally, though, the roots also have the gums covering them as added protection against bacterial infection.
But gum recession (shrinkage), a common experience for people in their later years, can expose the root surfaces. As a result, the roots become much more susceptible to decay. And an ensuing infection could spread more quickly into the interior of the tooth than decay originating in the crown.
That’s why it’s important to remove the decayed material and fill the root cavity to prevent the infection’s spread. While similar to a crown filling, the treatment can be more difficult if the root cavity extends below the gum line. In this case, we may need to perform a surgical procedure to access the cavity.
There are other things we can do to help prevent root cavities or limit their damage. We can apply fluoride varnish to strengthen the teeth and provide extra protection against cavities, or prescribe a fluoride rinse for use at home. We can also keep an eye out and treat periodontal (gum) disease, the main cause for gum recession.
The most important thing, though, is what you do: brush and floss thoroughly each day to remove bacterial plaque and limit sugary or acidic foods in your diet. Preventing decay and treating cavities as soon as possible will help ensure you’ll keep your teeth healthy and functional all through your senior years.
“Less is more” is a truism for much of life. It’s also an important feature of an emerging approach to treating tooth decay known as minimally invasive dentistry (MID).
MID updates another revolution in dental care that occurred in the early 1900s. Treating decay took a quantum leap thanks to techniques developed by Dr. G. V. Black, considered the father of modern dentistry. Dr. Black’s approach (known as “extension for prevention”) involved not only removing decayed tooth structure, but also adjacent areas deemed vulnerable to decay, which made them easier to clean. On the downside, though, it also created larger than normal fillings.
As the practice prevailed through much of the Twentieth Century another weakness became apparent—the approach could not guarantee a treated tooth would not experience decay again. This became the real impetus toward MID—to find more comprehensive ways to treat decay with as little impact on the tooth structure as possible.
These efforts received a real boost from emerging technology. This was especially true in diagnostics with the rise of new devices like intraoral cameras and techniques like laser fluorescence that can enable dentists to detect decay much earlier. It’s now possible to catch the disease at an earlier stage before substantial damage to the tooth occurs.
MID has also led to new treatments that preserve more of the tooth structure. Traditional drilling is increasingly giving way to air abrasion, the use of a fine particle stream of aluminum oxide, glass beads or baking soda directed precisely at decayed structure and minimizing damage to healthy structure. We’re also using new filling materials like composite resin for restorations after treatment that are strong yet still life-like and attractive.
We also can’t forget the role of the twin daily hygiene practices brushing and flossing to remove bacterial plaque, the main source of dental disease. And regular dental cleanings and checkups round out the MID approach, helping to ensure that decay doesn’t get too far. The end result of this revolutionary approach: your teeth can experience less impact from treatment and remain healthier and more attractive in the long-run.
If you would like more information on minimally invasive dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Minimally Invasive Dentistry: When Less Care is more.”