Mouthwash Could Eliminate Carries

[KSDental]

Read the story here:

http://losangeles.cbslocal.com/2011...t-bomb-against-cavities-tooth-decay/#comments

If this new mouthwash is effective and carries is virtually eliminated, will this greatly diminish the need for dentists?

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[Streetwolf]

It's hard enough getting people to BRUSH 2x a day... I doubt you'll get most of the population to use a mouthwash as often as it's required to prevent cavities. If it even does 100% prevent them.

Plus there's always developmental abnormalities (e.g. missing teeth), periodontal disease, malocclusions, trauma, staining, other esthetic concerns, etc.

 

[flapaTron]

It's hard enough getting people to BRUSH 2x a day... I doubt you'll get most of the population to use a mouthwash as often as it's required to prevent cavities. If it even does 100% prevent them.

Plus there's always developmental abnormalities (e.g. missing teeth), periodontal disease, malocclusions, trauma, staining, other esthetic concerns, etc.

a non-compliant patient is a non-compliant patient.

 

[Bereno]

Even if it was used, I am quite sure that S. Mutans would develop a resistance to it in say, 5-10 years or so... They have a tendency to do that haha

 

[yappy]

I also wonder if an acid forming bacteria may take its place once S. Mutans is no longer inhabiting its niche. Also - complience: I've tried multiple times to get as many people as possible taking fish oil. Even with showing them scientific lit. and buying them great stuff for christmas/birthdays etc. I sometimes still see it bottled up never taken. People dont do what is best for their health even if you make it really easy.

Even if it was used, I am quite sure that S. Mutans would develop a resistance to it in say, 5-10 years or so... They have a tendency to do that haha

 

[cjb04]

Exercise and portion control can help manage most cases of obesity, and yet we still have an epidemic. The issue at hand is patient compliance, not availabilty of successful treatment options. Dentistry will be just fine.

 

[yappy]

For a LOL check out the comments below the article. Seems that we dont need to worry about this because; according the comments, the ADA and FDA will never let this therapy see the light of day. Because you know... dentists are evil!

 

[Msmouth]

I couldn't open the article, but completely killing off a bacteria could bring forth a candida infection. It's been seen with overuse of Listerine and Peridex.

 

[Insipidipisin]

I couldn't open the article, but completely killing off a bacteria could bring forth a candida infection. It's been seen with overuse of Listerine and Peridex.

Unfortunately, for us dentists, candida is not synonymous with caries.

 

[fug]

I'm surprised this thread hasn't attracted more attention by now.

I just read the article directly from the November issue of Caries Research, and if this mouth rinse proves to be as effective in long-term clinical trials as it was shown to be in the 4-day pilot study described by the authors, the dental profession may be in for a squeeze. Obviously the sky is not about to fall, especially not for currently established and practicing dentists, but what about for those of us just entering school and in the future?

The non-compliance argument sounds like a weak one to me, especially considering that this study's findings show a significant reduction of S. mutans, lactic acid and enamel demineralization after just one rinse performed at the beginning of the 4-day trial period.

Also keep in mind that, although the results obtained from this study are stellar, the technology being utilized here is still relatively new. Criticizing minor kinks in this rinse's efficacy or potential side effects at this point would be like criticizing the Wright brothers for failing to equip the seats in their airplane with TVs and satellite radio.

This is all just food for thought. What do others think about how this could affect the dental profession?

 

[KSDental]

I'm surprised this thread hasn't attracted more attention by now.

I just read the article directly from the November issue of Caries Research, and if this mouth rinse proves to be as effective in long-term clinical trials as it was shown to be in the 4-day pilot study described by the authors, the dental profession may be in for a squeeze. Obviously the sky is not about to fall, especially not for currently established and practicing dentists, but what about for those of us just entering school and in the future?

The non-compliance argument sounds like a weak one to me, especially considering that this study's findings show a significant reduction of S. mutans, lactic acid and enamel demineralization after just one rinse performed at the beginning of the 4-day trial period.

Also keep in mind that, although the results obtained from this study are stellar, the technology being utilized here is still relatively new. Criticizing minor kinks in this rinse's efficacy or potential side effects at this point would be like criticizing the Wright brothers for failing to equip the seats in their airplane with TVs and satellite radio.

This is all just food for thought. What do others think about how this could affect the dental profession?

I agree. This topic deserves a lot more discussion. What will this mean for the current generation of dental students? Is the dental industry due for dramatic changes in the near future?

I've heard various things. Some people say that the mouthwash may not be as effective at preventing carries after years of usage. This is because the bacteria will become resistant or another acid producing bacteria will take the place of S. Mutans. In that case, the demand for dentistry will not change much.

However, if tooth decay is virtually eliminated then this would definitely change the industry. We probably wouldn't need as many dentists as we have now. Future dentists would have to focus on other dental problems such as gum disease and oral diagnosis. It's hard to predict how that scenario would pan out. Is it still a good idea to encourage people to pursue this field with so much uncertainty?

 

[flapaTron]

Future dentists would have to focus on other dental problems such as gum disease and oral diagnosis.

nope. gingivitis / periodontal disease only exists because of the caries process. the gingiva does not just inflame itself (perhaps excluding certain diabetics) without a precipitating factor, e.g. oral bacteria.

if humans could be free of cariogenic bacteria, you would basically eliminate any need for restorative dentistry.

and yes, this is plausible with the development of vaccines and other products (it's purely a matter of time and funding (which is getting increasingly difficult to come across these days)).

 

[Insipidipisin]

nope. gingivitis / periodontal disease only exists because of the caries process. the gingiva does not just inflame itself (perhaps excluding certain diabetics) without a precipitating factor, e.g. oral bacteria.

if humans could be free of cariogenic bacteria, you would basically eliminate any need for restorative dentistry.

and yes, this is plausible with the development of vaccines and other products (it's purely a matter of time and funding (which is getting increasingly difficult to come across these days)).

S. mutans does not equal periodontal pathogen.

 

[KSDental]

S. mutans does not equal periodontal pathogen.

Yes, this is what I think as well. As far as I know, periodontal disease and carries are two separate diseases. I think periodontitis has a completely different disease process. It is caused by a different set of bacteria. Someone can correct me if I am wrong.

 

[flapaTron]

S. mutans does not equal periodontal pathogen.

never stated that s mutans caused periodontal disease........in fact, p gingivalis is the most implicated source

 

[HupHolland]

nope. gingivitis / periodontal disease only exists because of the caries process. the gingiva does not just inflame itself (perhaps excluding certain diabetics) without a precipitating factor, e.g. oral bacteria.

if humans could be free of cariogenic bacteria, you would basically eliminate any need for restorative dentistry.

and yes, this is plausible with the development of vaccines and other products (it's purely a matter of time and funding (which is getting increasingly difficult to come across these days)).

I beg to differ. 70% of what dentists do is replacing previous restorative dentistry. While much of this may be due to recurrent caries, restorative fracture and microleakage makes up a good percentage as well.

In addition, there is non-carious loss of tooth structure due to bruxism (attrition), toothpaste abrasion, toothbrush recession and erosion. This loss of tooth structure is rampant in the population but is often overlooked as dentists tend to tx the carious processes first as this is how we were trained.

If (and that's a big if) caries were eliminated, there will still be plenty of restorative dentistry to go around.

Hup

 

[Insipidipisin]

never stated that s mutans caused periodontal disease........in fact, p gingivalis is the most implicated source

You said periodontal disease only exists because of the caries process. That's untrue.

 

[flapaTron]

I beg to differ. 70% of what dentists do is replacing previous restorative dentistry. While much of this may be due to recurrent caries, restorative fracture and microleakage makes up a good percentage as well.

true true. but when we are replacing faulty restorations, is it not often because they were undermined by caries? Poor mechanical retention or resistance is one thing, but what % of patients do you see that need faulty resotration for non-caries related issues (i'm not saying they don't exist, i'd just argue that the majority are because of undermining caries).

In addition, there is non-carious loss of tooth structure due to bruxism (attrition), toothpaste abrasion, toothbrush recession and erosion. This loss of tooth structure is rampant in the population but is often overlooked as dentists tend to tx the carious processes first as this is how we were trained.

true. but in our fun little hypothetical situation of "no more cariogenic bacteria", i'd argue that there'd be a huge over-supply of dentists per buxism case in a given population.

If (and that's a big if) caries were eliminated, there will still be plenty of restorative dentistry to go around.

again, fair point. but using our hypothetical scenario, restorative dentistry would necessarily taper off as the # of untreated patients decreases over time (which is kind of what the op was alluding to).

 

[Insipidipisin]

flapaTron - what about the millions who currently have access to toothpaste & toothbrushes, but still present everyday with rampant caries and periodontal disease? How many people do you see that are morbidly obese, but are armed with the information on how to eat healthy & exercise?

Unless you vaccinate, people aren't any more likely to follow a mouthwash regimen than they are a typical homecare regimen. It is true that without restorations, many dental procedures would become a memory, but we're still a ways from that reality.

 

[flapaTron]

You said periodontal disease only exists because of the caries process. That's untrue.

what i should have stated was "caries is highly implicated/associated with periodontal disease"

from the journal of periodontology:
"Today, it is widely accepted that microbial dental biofilms are the principal aetiological factor of periodontitis." [Tooth loss in periodontally treated patients. A long-term study of periodontal disease and root caries, 2011]

i'm saying they are inexorably related.

 

[Insipidipisin]

what i should have stated was "caries is highly implicated/associated with periodontal disease"

from the journal of periodontology:
"Today, it is widely accepted that microbial dental biofilms are the principal aetiological factor of periodontitis." [Tooth loss in periodontally treated patients. A long-term study of periodontal disease and root caries, 2011]

i'm saying they are inexorably related.

I disagree. The quote you've linked is for root caries. Further, it is stating that the biofilm is implicated in periodontitis. That quote has little to do with S. mutans.

 

[flapaTron]

flapaTron - what about the millions who currently have access to toothpaste & toothbrushes, but still present everyday with rampant caries and periodontal disease? How many people do you see that are morbidly obese, but are armed with the information on how to eat healthy & exercise?

Unless you vaccinate, people aren't any more likely to follow a mouthwash regimen than they are a typical homecare regimen. It is true that without restorations, many dental procedures would become a memory, but we're still a ways from that reality.

see post #3 where i stated "a non-compliant patient is a non-compliant patient."
you can't force a patient take care of themselves even when you offer the best solutions. this is not an 'access to care' debate. it's about the potential to end caries altogether.
for the record, i'd be for a caries vaccine for this very reason (but as stated above this is not going to come to fruition in the immediate future).

we already have a caries vaccine, it's called a toothbrush

 

[flapaTron]

I disagree. The quote you've linked is for root caries. Further, it is stating that the biofilm is implicated in periodontitis. That quote has little to do with S. mutans.

anecdotaly then, tell me, what % of patients are you seeing who have periodontal disease and DO NOT have any caries?

certainly, correlation does not equal causation, but, again sir, i say they are still related.

 

[Insipidipisin]

anecdotaly then, tell me, what % of patients are you seeing who have periodontal disease and DO NOT have any caries?

certainly, correlation does not equal causation, but, again sir, i say they are still related.

I've seen plenty of patients who don't floss, but don't have interproximal or occlusal caries, either. Certainly, the greater the extent of periodontal disease, the more likely you are to see caries, but it usually extends onto the softer root surfaces. Since they are different pathogenic pathways, they don't always present together or in the proportion together that you would expect. How many patients have rampant caries in the absence of periodontal disease?

 

[flapaTron]

I've seen plenty of patients who don't floss, but don't have interproximal or occlusal caries, either. Certainly, the greater the extent of periodontal disease, the more likely you are to see caries, but it usually extends onto the softer root surfaces. Since they are different pathogenic pathways, they don't always present together or in the proportion together that you would expect. How many patients have rampant caries in the absence of periodontal disease?

again, anecdotally (for the minimal amount it's worth), the patients i've seen have presented simultaneously with both some degree of periodontal disease (e.g. generalized marginal periodontitis) and caries. i will concede that the pathogenesis are different, but they are inexorably related [insert misquoted pubmed article here]

 

[Insipidipisin]

again, anecdotally (for the minimal amount it's worth), the patients i've seen have presented simultaneously with both some degree of periodontal disease (e.g. generalized marginal periodontitis) and caries. i will concede that the pathogenesis are different, but they are inexorably related [insert misquoted pubmed article here]

Fair enough. It's good to have a degree of suspicion of one in the presence of the other.

 

[yappy]

I read the material and I am ashamed to say that as a predent I got an automatic "disapointment" feeling lol. Just because I have enjoyed the shadowing and always thought of dentistry as a stable career to go into. Maybe this technology will put a huge dent into dentists work? I really have no idea - that is the hard part.

There seems to be so many changes to alot of science/health care fields. Research has always paid bad, engineering is going to china, doctors are getting screwed by reform, and pharmacists and dentists seem to be getting eliminated via technology. It wouldnt be so bad if these educations were not so freaking expensive. What are we to do?

 

[KinKs]

I hate when people write garbage in black and white and seek to defend it. Caries and Periodontal disease are often unrelated. Caries is a disease process that affects tooth structure. Periodontal disease affects alveolar bone and the mechanism by which the tooth is attached to bone evidenced by bone loss, attachment loss, BOP etc.

A better argument is that caries and perio are correlated as they both can be caused by poor hygiene. As for a cause and effect relationship, there is none.

Let us please end this silly argument about caries causing perio and get back to the real topic of this thread.

 

[Msmouth]

I hate when people write garbage in black and white and seek to defend it. Caries and Periodontal disease are often unrelated. Caries is a disease process that affects tooth structure. Periodontal disease affects alveolar bone and the mechanism by which the tooth is attached to bone evidenced by bone loss, attachment loss, BOP etc.

A better argument is that caries and perio are correlated as they both can be caused by poor hygiene. As for a cause and effect relationship, there is none.

Let us please end this silly argument about caries causing perio and get back to the real topic of this thread.

I've seen this time and time again.....People come in with rampant decay or several carious lesions and their gums are as healthy as can be.
The opposite is true.....I see moderate to severe periodontitis in people who have never had decay in their lives.
This is because they are caused by different pathogens and those pathogens thrive in different environments......acidic vs. basic.

Just to add: We can recommend prescription fluoride rinse....Prevident....it's a once a week rinse. I've seen it do wonders for my worst decay patients....but there are those that are non-compliant. I don't see why compliance is not an issue.....it just is and always will be.
Let's not forget that this rinse will probably only be recommended for those 12 and older? Kids will have to just rely on straight up prevention.

Time and time again we see the studies showing that diet and exercise is the answer to our weight issues. How many of us choose the salmon and salad over the cheeseburger? How many of us go to the gym or walk daily? The answer is staring us in the face but that doesn't mean we'll do it.

 

[drkmgk]

I hate when people write garbage in black and white and seek to defend it.

yeah and your "i shall not be moved" signature really speaks to that

i think alot of good points were raised in this thread. there are still alot of unknowns about the exact ways that the 2 are related.

 

[flapaTron]

I read the material and I am ashamed to say that as a predent I got an automatic "disapointment" feeling lol. Just because I have enjoyed the shadowing and always thought of dentistry as a stable career to go into. Maybe this technology will put a huge dent into dentists work? I really have no idea - that is the hard part.

There seems to be so many changes to alot of science/health care fields. Research has always paid bad, engineering is going to china, doctors are getting screwed by reform, and pharmacists and dentists seem to be getting eliminated via technology. It wouldn't be so bad if these educations were not so freaking expensive. What are we to do?

fo real. healthcare is no different from any other field in terms of the effects of technological advancements and their impacts on the work force. this mouthwash is just one of those examples where (again, if patient compliance could be ensured) technology will impact the role of dentists. there will be other dentifrices/vaccines/what-have-you's that will inevitably come to market in the future that will prove EVEN MORE efficacious than this mouthwash (perhaps so much so that patient compliance is not even a critical factor) - to expect otherwise would be short-sighted. from a public health perspective, i feel that it's our responsibility as dental professionals to endorse these kinds of technologies, but looking at the sizable amount of student loans (actively accruing interest no less), it does make one think about the cost-effectiveness of dental education vs practicing dentistry in the long run.

just my opinion (before Kinks tries to bust my balls for spewing more "garbage" )

 

[KSDental]

Another thing to remember is that if restorative dentistry were to decline the traditional business model for dentists could be tweaked. We could decrease our overhead and adjust fees. This could allow us to remain profitable.

 

[Screwtape]

Aren't there already plenty of products that greatly reduce levels of S. mutans in the mouth (regular mouthwash, chlorhexidine mouthwash, heck I'd bet a quick swish of 2% hydrogen peroxide would do the trick too)? Also what about lactobacillus and the other lactic acid bacteria that lead to dental caries?

 

[fug]

Aren't there already plenty of products that greatly reduce levels of S. mutans in the mouth (regular mouthwash, chlorhexidine mouthwash, heck I'd bet a quick swish of 2% hydrogen peroxide would do the trick too)? Also what about lactobacillus and the other lactic acid bacteria that lead to dental caries?

These products don't selectively target S. mutans-- they reduce the populations of many different kinds of oral bacteria, so that when they recolonize the mouth, there is relatively little competition against the proliferation of any one kind.

By selectively targeting only S. mutans, this new mouth rinse preserves all other existing populations of oral bacteria, allowing them to fill in the gap left behind. This theoretically makes it much more difficult for S. mutans to recolonize the mouth, which would explain why the effects of just one use of this rinse are so long-lasting.

 

[canuck1]

Had to create an account for this!

I just applied to dentistry (Canadian timeline), saw this and got a little discouraged, although this is definitely great news for the general public..

Along with this mouthwash coming to light and a potential dental caries vaccine (read it on wiki) how does dentistry look like in the future? Would love to hear from any dentists or dental students

Now I absolutely love everything about dentistry and have worked hard to get to this position! But from what I have read, I am little nervous that in the near future, with all these advancements, dental skills will be less valuable.

In reality no one knows what will happen, just curious to see what others think