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No drill dentistry shows fillings aren't needed in many cases.

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Drilling and filling may be on the way out of dentistry.

"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.

"[The CMS] showed that early decay could be stopped and reversed and that the need for drilling and filling was reduced dramatically," said Evans. "A tooth should be only be drilled and filled where an actual hole-in-the-tooth (cavity) is already evident."

Patients also need to get involved to make the most of CMS, paying attention to their tooth-brushing skills at home, and restricting between-meal snacks and beverages that contain added sugar. But if you can abide by these rules and help make the system work, up to half of the cavities (and drilling) in your future could be eliminated, so surely it's worth making a few small sacrifices?

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Top Reddit comment:

These are not new findings; this is what I was taught in dental school 5 years ago. I think it's worth pointing out that the cavities they're talking about are very early cavities.

Basically cavities start out as demineralization of the enamel on the surface of the tooth and then work their way inward. As long as the demineralization is confined to the enamel, studies show that these lesions can be remineralized with fluoride and good oral care. However, once the lesion reaches the dentin, it can no longer be remineralized and requires a filling.

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