DRILL BABY DRILL

Research shows there are better alternatives to the dreaded dentist drill

The familiar sound of a dentist’s drill makes my hair stand even as I think about it. Despite evolving technologies that have allowed better preventative care and quicker fixes for decaying teeth, the old-fashioned drill-and-fill method remains popular for treating cavities. It seems medieval, but it works.

Maybe not as well as new alternatives, though. That’s the conclusion of a seven-year study conducted by dentists at the University of Sydney, published today (Dec. 7). They believe that methods to prevent tooth decay could go a long way before a dentist has to intervene with the drill machine.

Tooth decay begins when acids etch the enamel and allow bacteria inside. If the bacteria remain for long, they can eat into the tooth and reach the dentin, a layer that separates the enamel from the root of the tooth. When that happens, dentists have to perform a root canal, which involves cutting blood supply to the tooth and stopping infection from spreading.

Wendell Evans of the University of Sydney developed a “caries management system” to reduce the number of drill-and-fill cavities. It involves regular monitoring of teeth to catch decay early. Once found, a dentist applies fluoride varnish and asks the patient to change certain behaviors, such as better brushing technique and cutting down on snacking.

According to Evans, it can take between four and eight years for decay to progress from the tooth’s outer layer (enamel) to the inner layer (dentin). It is in this period that he believes his caries (aka cavities) management system can act to save the patient’s teeth from going under the drill. Compared to those undergoing conventional treatment, those under the caries management system were 30% to 50% less likely to need fillings at the end of the seven-year study.

Evans is not the only one worried that dentists may be wielding their drills a little too often. In a separate 2010 study, James Hamilton of the University of Michigan found that early fillings using an air drill—which is supposed to be less painful than a metal drill—were no more effective at stopping tooth decay than no treatment. Instead, early drilling can often exacerbate the decaying process by harming the enamel.

Others think technology might hold the answer. Nigel Pitts, a dentist at King’s College London, has a developed a method to accelerate the process of rebuilding the tooth enamel. He applies a tiny electric current to affected area of a tooth which attracts minerals in a solution to quickly adhere to the tooth. This way, he claims, patients could go beyond damage control and actually heal their teeth without ever hearing a drill.

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