'No Drill' Dentistry Can Prevent Tooth Decay: Study

Common dental procedures regarding tooth cavity issues have been using the “drill and fill” approach for years, but now this approach might be replaced by a simple method called “prevention.”

A seven-year study, which is published in Community Dentistry and Oral Epidemiology, has found that tooth cavities can be prevented, thus eliminating the need to drill the cavity hole and put in some filling.

"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," study author 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],” he explained. “That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling."

Evans and his team developed the Caries Management System (CMS), which is a set of principles that covers different areas in dental health: assessment of decay; interpretation of dental X-rays; and specific treatments needed for early decay.

This involves four aspects, namely: the use of flouride; home tooth brushing skills; lowering or restricting sugar in-between meals; and risk-specific monitoring.

The team tested whether the CMS was effective in comparison to traditional “drill and fill” approaches by recruiting 19 dental practices for a three-year randomized trial and, also, following up with them two and four years after the trial.

It was found that, after the seven-year period, the CMS participants had a 30 to 50 percent reduce in tooth decay compared to the traditional “drill and fill” participants.

“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.”

The study results indicated a need for traditional dental practices in Australia to shift more towards prevention than cure. Although the CMS might mean that people will need to be more responsible for their personal dental health, the effects are obviously worth the effort.

“This research signals the need for a major shift in the way tooth decay is managed by dentists – dental practice in Australia needs to change,” Evans said. “Our study shows that a preventative approach has major benefits compared to current practice.”