Treating Tooth Decay - More Than a Filling!

People will see a new attitude in dental offices. Dentists are learning that it is not enough to treat tooth decay with a filling or an extraction - the surgical model. Now, dentists ask questions. Does this patient take medications that dry their mouth? Does this patient have medical conditions that put their teeth at risk such as gastro-esophageal reflux or rheumatoid arthritis? Does the patient's diet make them more susceptible to tooth decay? While this is not new, dentists are become more expert and systematic in their approach. CAMBRA, Caries Management By Risk Assessment, is a new system to aid dentists in diagnosis and treatment of high risk patients. Dentists refer to treating decay this was as the medical model.

Tufts University School of Dental Medicine is on the forefront of this new paradigm in dental care. Dental students fill out a simple questionnaire for each. Does the patient have active tooth decay? Does the patient have xerostomia (dry mouth)? Are there any chalky white spots that indicate early decay? Does the patient have heavy plaque (a thick white coating of bacteria)? Patients receive a score of low, moderate, high or extreme risk. Then, students prescribe risk reduction materials depending on the level of risk.

There are only a few kinds of products that help prevent tooth decay. The simplest products increase saliva. Mints and chewing gum sweetened with Xylitol prevent decay by increasing the production and by killing decay causing bacteria. Xylitol is a natural sugar alcohol. Chewing gum and sucking on mints increases production of saliva. Saliva cleans away food particles and bacteria. Calcium in saliva hardens teeth.

Fluoride that children swallow in drinking water hardens layers of tooth enamel as it forms. Adults need fluoride products at a much higher concentration to be effective as a topical treatment. Fluoridated water contains 0.7 parts per million (ppm) of fluoride. Regular toothpaste (Crest, Colgate, and Aquafresh) contains 1500 ppm of fluoride. Prescription toothpaste (Prevident 5000 plus) contains 5000 ppm of fluoride.

The fluoride treatments of childhood have become much more common for adults. Now, dentists are likely to apply fluoride varnish with 22600 ppm of fluoride. Even though this is a very high concentration of fluoride, the amount of fluoride is very small. The advantage of varnish over foams and gels is that the varnish stays on the teeth for hours instead of minutes.

A newer treatment for patients who are prone to tooth decay is to use rinses and pastes that contain high concentrations of calcium. Acid from food, drink, stomach acid and bacteria weaken the surface of teeth. Calcium will strengthen or remineralize teeth. Most of these products require a prescription.

Caphosol is a calcium and phosphate rinse based on research by a former Dean of Tufts University School of Dental Medicine. Rinse with this product a few times a day to both remineralize teeth and moisten soft tissue.

MI paste is another relatively new product. Tufts University dental students supply this product to many of their high risk patients along with Xylitol mints and prescription fluoride toothpaste. MI paste is a highly concentrated calcium paste. Patients smear it on their teeth before bed like peanut butter. The longer it remains on the teeth the better.

One more prescription product for caries risk management is an antimicrobial mouth rinse. People who have a high rate of tooth decay benefit from using an antimicrobial rinse to reduce the level of decay causing bacteria. While Listerine and products like it are effective, chlorhexidine gluconate (Peridex and Perioguard) is the most effective rinse.

When your dentist diagnoses tooth decay, expect a lot of questions and a list of recommendations. Conversely, patients may ask their dentist or hygienist for the latest recommendations for decay prevention.