Over the last century effectively treating a decayed tooth has often required removing any decayed structure with drilling and then filling the remaining cavity. While this approach does save teeth that might otherwise be lost, it can also result in a fair amount of healthy structure removed in the process.
But continuing advances in dentistry are now making possible a new approach to tooth decay treatment that preserves as much of the healthy portions of tooth as possible. This new way is often referred to as minimally invasive dentistry (MID).
The primary goal of MID treatment is to intercept and treat decay as early as possible to minimize tooth damage. It begins with helping patients identify their own individual risk factors for decay such as the presence of disease-causing bacteria, the adequacy of their saliva flow, or their lifestyle and dietary habits. We then recommend changes or preventive measures to reduce those risks.
The next step in MID is using various diagnostic technologies to find decay as early as possible. X-rays continue to play a major role, but dentists are also using dental microscopy to magnify the earliest forms of decay. Many also utilize laser fluorescence, infrared photography and optical scanning to further “see” decay difficult to detect with the naked eye.
In regard to treatments, MID adopts the adage “less is more.” If caught early enough, we can encourage the re-mineralization of enamel that acid has eroded with CPP-ACP, a substance acquired from milk, or strengthen teeth with topical fluoride applications. Instead of the dental drill, many dentists now turn to air abrasion for decay removal, equipment that emits a fine stream of abrasive particles that harms less healthy structure than a drill.
And if lasers continue to develop at their current pace, we’ll be able to use this technology to perform much more precise decay treatment than possible with manual instruments. As a result, we’ll be able to treat decayed teeth with less invasive means to preserve as much healthy structure as possible.
As these and other developments continue, MID promises a bright future for preventing and treating tooth decay. As a result, there’ll be less tooth structure loss and more attractive and healthy smiles.
If you would like more information on the latest techniques for treating 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.”
Some moviegoers have been known to crunch popcorn, bite their fingers or grab their neighbor’s hands during the intense scenes of a thriller. But for one fan, the on-screen action in the new superhero film Black Panther led to a different reaction.
Sophia Robb, an 18-year-old Californian, had to make an emergency visit to the orthodontic office because she snapped the steel wire on her retainer while watching a battle scene featuring her Hollywood crush, Michael B. Jordan. Her jaw-clenching mishap went viral and even prompted an unexpected reply from the actor himself!
Meanwhile, Sophia got her retainer fixed pronto—which was exactly the right thing to do. The retention phase is a very important part of orthodontic treatment: If you don’t wear a retainer, the beautiful new smile you’re enjoying could become crooked again. That’s because if the teeth are not held in their new positions, they will naturally begin to drift back into their former locations—and you may have to start treatment all over again…
While it’s much more common to lose a removable retainer than to damage one, it is possible for even sturdy retainers to wear out or break. This includes traditional plastic-and-wire types (also called Hawley retainers), clear plastic retainers that are molded to fit your teeth (sometimes called Essix retainers), and bonded retainers: the kind that consists of a wire that’s permanently attached to the back side of your teeth. So whichever kind you use, do what Sophia did if you feel that anything is amiss—have it looked at right away!
When Black Panther co-star Michael B. Jordan heard about the retainer mishap, he sent a message to the teen: “Since I feel partly responsible for breaking your retainers let me know if I can replace them.” His young fan was grateful for the offer—but even more thrilled to have a celebrity twitter follower.
If you have questions about orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Importance of Orthodontic Retainers” and “Bonded Retainers.”
You can't go wrong with an early start caring for your child's teeth and gums. In fact, dental care should begin in earnest when their first tooth appears.
You should begin by gently cleaning your infant's gums and new teeth after each feeding with a clean, water-soaked washcloth or gauze pad. Once they start eating solid food, you should transition to a soft-bristled brush with just a smear of fluoridated toothpaste. Around age 2, you can increase that to a pea-sized amount and begin teach them to brush for themselves.
The next important element in your child's dental care is beginning regular dental visits around their first birthday. There are good reasons to begin visits at this time. There primary teeth should now be erupting in earnest and you'll want to begin prevention measures against tooth decay if needed. You'll also want to get them used to going to the dentist early in life: if you wait a year or two later, they may not respond well to the unfamiliar surroundings of a dental office.
There are also a number of things you can do to support hygiene and dental visits. You should not allow your child to sleep with a pacifier covered or a bottle filled with anything but water. Milk, juices and other sugar-containing liquids will raise the risk of tooth decay. And speaking of sugar, limit their consumption to meal times: snacking constantly on sugar can create an environment ripe for decay.
Of course, dental disease isn't the only hazard your child's teeth may face. Accidents can happen and your child's otherwise healthy teeth could be injured. So, make sure they don't play too close to hard furniture or other features around the house they could fall on. If they should begin playing contact sports, invest in a custom mouth guard — avoiding an injury is well worth the cost.
Getting into dental care with your children as soon as possible will set the foundation for good oral health. And the example you set will stick with them as they take on their own dental care when they're older.
If you would like more information on caring for your child's teeth, 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 “Top 10 Oral Health Tips for Children.”
Root canal treatments are an essential part of dental care — countless teeth with deep decay would be lost each year without it. Now, this traditional dental care procedure is advancing to a new level of precision through lasers.
Root canal treatments have a simple goal: access a tooth's infected pulp and root canals, clean out the infected tissue and fill the empty pulp chamber and canals with a special filling. Once filled, the access is sealed and a porcelain crown later placed for additional protection against re-infection.
In the traditional procedure, we perform these steps manually with a dental drill and hand instruments. We may also need to remove a good portion of tooth structure, both healthy and infected tissue. A laser, on the other hand, is a highly focused beam of light with the ability to interact with healthy and infected tissues differently: destroying infected tissue while having no effect on nearby healthy tissue. The end result: we may be able to remove less healthy tissue with lasers than with the conventional procedure.
Lasers are also helpful with softening and precisely molding the filling material within each canal's particular shape. And, early reports seem to indicate a higher degree of comfort for patients (less drill noise and need for anesthesia), less bleeding and faster recovery times than the conventional approach.
But as a tool for root canal treatments, lasers do have a couple of disadvantages. While light travels in a straight line, root canals are rarely straight — conventional instruments with curved designs usually accommodate odd canal shapes better than a laser. Lasers can also raise temperatures within a tooth that can damage healthy tissue, both within the pulp and outward into the dentin.
Still, lasers for root canal treatments appear promising with some dentists using a combination of lasers and manual techniques to garner benefits from both approaches. While you won't see lasers replacing the traditional root canal treatment anytime soon, the future looks bright for more efficient ways to treat deep tooth decay.
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.
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