Drill and fill no more

By Kelly Jirsa

Drill and fill no more
Evidence suggests that the 'drill and fill' model is no longer a viable approach to oral health care.

A seven-year study by Sydney University has confirmed that ‘No-drill’ dentistry stops tooth decay, challenging the traditional ‘drill and fill’ approach.

The research done by the university and published recently in Community Dentistry and Oral Epidemiology, has found that through preventative oral health care, the need for fillings is reduced by 30 to 50%.

“This research signals the need for a major shift in the way tooth decay is managed by dentists – dental practice in Australia needs to change. Our study shows that a preventative approach has major benefits compared to current practice.”

Wendell Evans, Associate Professor at the University of Sydney.

The firm belief held for eons was that to attack early decay with drilling to remove the source, and then fill was best approach to restore the tooth and prevent further decay. Evidence suggests though that the early signs of decay may not be a precursor to further breaking down of the tooth. Furthermore the research suggests that monitoring and care is the best way of heading decay off at the pass.

Through their research findings the team at Sydney University have developed the Caries Management System (CMS), “a set of protocols which cover the assessment of decay risk, the interpretation of dental X-rays, and specific treatment of early decay (decay that is not yet a cavity).”

The “no-drill” treatment involves four “aspects”; they are:

  1. Application of high concentration fluoride varnish by dentists to the sites of early decay
  2. Attention to home tooth brushing skills
  3. Restriction of between-meal snacks and beverages containing added sugar
  4. Risk-specific monitoring.

In practice on patients at “high risk”, adoption of the aspects have shown decay is halted and reversed with the need for drilling reduced drastically, even in patients with holes in their teeth. When tested in general dental practices over seven years, studies showed the need for fillings reduced by 30 to 50% compared with the control group of patients.

It is clear from the extensive study that employing the CMS treatment, which essentially involves taking control of your own oral health and monitoring with your dentist, is the best approach. As Professor Wendell Evans says, “patients play an important role in their treatment. This treatment will need a partnership between dentists and patients to be most successful.”






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