"No drill" dentistry. Thoughts?

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CareerNumTwo

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http://www.sciencealert.com/no-drill-dentistry-shows-fillings-aren-t-needed-in-many-cases

The article hit my newsfeed today. However it isn't the first time I've heard about the concept. Made me wonder a couple things... 1) how is this topic addressed during the dental education? 2) how could this affect dentistry as a profession?

Excerpt from the article:
"The findings of a new seven-year study by Australian researchers suggest that many of us have nothing to worry about, with research into 'no drill' oral care techniques showing there's often no need for the traditional 'fill and drill' approach that has defined dentistry for decades.

"It's unnecessary for patients to have fillings because they're not required in many cases of dental decay," said Wendell Evans of the University of Sydney. "This research signals the need for a major shift in the way tooth decay is managed by dentists… Our study shows that a preventative approach has major benefits compared to current practice."

According to the researchers, tooth decay is not the rapidly progressive phenomenon that dentists long believed it was. Because dentists used to think decay was fast-moving, the conventional practice was to identify early decay, remove it immediately to prevent the tooth's surface breaking up into cavities, and fill up the hole that was left with filling.

But decay is not always progressive, say Evans and his team, and even when it is, it develops more slowly than dentists used to think. "For example, 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 said. "That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling."

Developing a set of protocols they call the Caries Management System (CMS), the researchers say tooth decay can be stopped, reversed, and prevented long before a drill comes into play.

Through assessments of decay risk, interpretation of dental X-rays, and risk-specific monitoring, signs of early decay that haven't yet created cavities are detected and treated with a high-concentration fluoride varnish, rather than resorting to more invasive means.

Publishing their findings in Community Dentistry and Oral Epidemiology, Evan and his colleagues showed that decay risk was reduced by 30 to 50 percent among patients who received CMS."

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I think this article will gain more traction with the general "self-informed" public than with dentists, because it appeals to the masses. It appeals to the general public that doesn't like going to the dentist (they admit that in the first sentence of the article), and since cognitive biases are an inherent part of the general public's decision making, they may read too strongly into this.

"For example, 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 said. "That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling."
-This may include micrographic analysis of caries. By the time we can clinically detect enamel caries, I highly doubt it is 4-8 years away from reaching the dentin. And by the time we can radiographically detect caries, they are large enough to need restoration. Many dental students are fortunate enough to work with very conservative faculty that would leave surface stains alone until they are cavitated. At that point, enamel caries should be restored.

Frank cavitation cannot be reversed. Most patients don't come in to see us until there is frank cavitation and/or sensitivity/pain. So this article is more about overdiagnosis and overtreatment, which is a problem in the mindset of the dentist.

Just my 0.02
 
We practice this a lot at my school. I can't tell you how many sealants I've done that were initially treatment planned to be filled. We've always been taught that preserving tooth structure is priority. So if decay hasn't progressed into dentin, we put our best efforts to remineralize the decay
 
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Behavior change almost never works. People who are over weight would rather have surgery than go on a diet, and if they can't have surgery they'd rather just be heavy. People who have cavities would rather get fillings, crowns, rcts and extractions than give up sugar, soda and brush and floss daily. There are some people who do not fit this pattern and they should be given the option of behavior change and commended if they follow through with it, but it's the minority of patients.
 
So if decay hasn't progressed into dentin, we put our best efforts to remineralize the decay
I thought once demineralization causes a cavity in the enamel layer, then no amount of remineralization can restore the original enamel form?
 
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I thought once demineralization causes a cavity in the enamel layer, then no amount of remineralization can restore the original enamel form?

Not all demineralization leads to cavitation. Think about non-cavitated lesions like white spot lesions we see in ortho patients. The plaque stagnation leads to demin, but once braces are removed, hygiene to those areas usually improve. Improved hygiene combined with fluoride remineralizes the lesion.
Also, think about why we don't do drilling intervention on incipient caries, whether active or arrested. There's been a lot of literature lately suggesting that topical fluoride application can remineralize those incipient lesions. This is also why we place sealants on incipient decay of pits and fissures. A good seal can arrest caries progression and perhaps prevent operative intervention down the road.
 
I saw this on reddit, and the comments there are absurd. From what I've seen, this concept is nothing new, and my dentist frequently talks about remineralization. Also the domain this article is hosted on screams sleezy consumer report meant to drum up view counts
 
But decay is not always progressive, say Evans and his team, and even when it is, it develops more slowly than dentists used to think. "For example, 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 said. "That is plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling."
Primary teeth apparently have not read the script.
 
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