Mar. 20, 2000 GAINESVILLE, Fla.---To fill or not to fill? A University of Florida Dentist is spreading the word that early stages of tooth decay can be treated and sometimes even reversed without resorting to the drill.
The approach to preventing fillings not only saves patients money and anxiety in the short run, it also promotes overall oral health and can head off a lifelong cycle in which a tooth is first filled then repaired again and again in the years to come.
"Once the filling process begins, it leads to replacement fillings that get bigger each time the tooth is filled," said Dr. Douglas Benn, an associate professor of oral and maxillofacial surgery and diagnostic sciences at the UF College of Dentistry. "On the average, dentists need to replace fillings every eight to 11 years. The final result after many years may be loss of the tooth. Most people don't think ahead about this process."
Through a new user-friendly Web site, Benn encourages patients, health educators, physicians and even those involved in the administration of dental care to rethink tooth decay and cavities then take a course of action.
The site, called "How to Heal Tooth Decay and Avoid Fillings," can be found at http://oralsurgery.dental.ufl.edu. It serves as a reference for managing decay in the permanent teeth of individuals age 6 and older. Instead of immediately drilling and filling decayed teeth, Benn suggests dentists monitor the decay in an effort to avoid or delay fillings.
"If dentists can identify tooth decay early in the disease process, they can work with patients to either stop the disease progression or help the tooth repair itself," Benn said.
Some steps patients can take include cutting back on sugar, brushing regularly with a fluoride toothpaste, chewing sugar-free gum three to five times a day and rinsing at night with a fluoride rinse. Dentists also can help by applying fissure sealants (liquid plastic painted on teeth) to protect teeth without cavities and prescribing chlorhexidine rinses to kill bacteria.
"The bottom line is that many fillings can be avoided altogether or delayed," Benn said. "The result could be a 50 percent reduction in the numbers of fillings needed."
A National Health Spending Trends report produced by the United States Health Care Finance Administration indicates that $53.8 billion was spent on dental services in 1998, with approximately $30 billion related to searching, monitoring, preventing or treating the damage from decay. Those costs include examinations, X-rays, topical fluoride, fissure sealants, fillings, crowns, root canals, bridges, implants and dentures.
"Outcome (success) of dental decay treatment is largely unknown since many dentists record treatment provided, not details of controlling or reversing decay progression," Benn said
The site conveys the anatomy of a tooth, how bacteria affect teeth and what patients need to do to work with their dentists. Illustrations, factoids and definitions also can be found on the site. For example, the site provides definitions of decay and cavities, words that Benn says are commonly misused. While many people use the word cavity to mean decay at any stage, Benn notes that true cavities or holes develop very late in the disease process.
"A cavity cannot repair itself and needs a filling," Benn said. "On the other hand, decay is a bacterial infection that produces acid that typically over several years dissolves calcium from below the tooth surface.
Saliva contains calcium that can remineralize or repair the weakened tooth substance, possibly avoiding the need for filling decay in enamel or the outer dentin. Fluoride in toothpaste and drinking water aids in this repair process. All of these facts are illustrated in the site."
Benn, a strong advocate of prevention, emphasizes that patients should not assume the role of the dentist and that all patients cannot be treated in the same manner.
"Patients must understand that dentists are the only ones who know the health of teeth," Benn said. "Patients can talk to their dentist about keeping an eye on a patch of decay and possibly coming in more often for check-ups and X-rays."
At the same time, however, patients must be responsible for their own day-to-day care.
"Their dental care habits, diet and visits to the dentist all play a part in their care," Benn said. "If they do not work with the dentist to avoid decay or remineralize the tooth, then the dentist's only option is to recommend filling the tooth."
Preliminary results from a questionnaire on the site indicate that patients and dentists are willing to agree to have their decay monitor over time to avoid fillings.
Dr. Miles E. Kuttler, associate professor of restorative dentistry at Nova Southeastern University's College of Dental Medicine, said Benn's site reflects the future of dental education.
"Dr. Benn's Web site is a giant step toward the future of dentistry. In a clear and organized way, he leads the motivated consumer/patient through the current science-based knowledge of dental decay. He makes a realistic argument for the conservative treatment or non-treatment of dental decay and helps the consumer/patient make informed decisions about their dental health," Kuttler said. "It may take a generation of new dentists to fully implement this medical approach to dental care. However, it wouldn't be such a bad idea for practicing dentists and dental auxiliaries to also visit the Web site."
University of Michigan School of Dentistry Professor Amid I. Ismail agrees that dentists and students can benefit from the site.
"It can be a highly valuable tool for dentists to promote oral health in clinical practice. It pioneers the dissemination of simple, scientific and useful dental health information using the Web," Ismail said.
Visitors to the Web site are asked to fill out the brief, anonymous questionnaire. Benn can be reached by e-mail at email@example.com.
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The above story is based on materials provided by University Of Florida Health Science Center.
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