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First published December 2004 in UCSF Magazine
Teeth are everywhere these days and with 190 billion of them chomping, cutting and shredding away their time in 6 billion human heads, it's no wonder. From whitening products to reality-show reconstructions, these 32 bits of enamel, nerve and dentin have become the latest platform for cosmetic renewal
But as John Featherstone, chair of the department of Preventive and Restorative Dental Science in the UCSF School of Dentistry knows, teeth are far more than a fashion trend. Teeth are essential to our health and keeping them alive -- and in place -- an essential part of dentistry. The need has never been greater: Dental caries (tooth decay) is now the most common chronic disease in children, setting the stage for serious problems in adults. And for all the attention asthma has received, there are now five times as many children in the US with bad teeth than there are shaky lungs. This is to say nothing of the health con-sequences in the 25 states that have decided to either eliminate or reduce dental services to adult Medicaid patients. Still, the expansion or preservation of care aside, what new could there possibly be to say about a mature profession that, to the casual observer at least, is all drill, fill and bill?
Plenty, it turns out. "Last year, in two articles in the California Dental Association Journal, we put the dentistry profession on notice," says Featherstone, a former physical chemist who has become a national voice for the "new" dentistry. "When it comes to caries, we've gone as far as we can with brushing, flossing and fluoridated water. For too long we've been treating symptoms. Now we need to use chemical treatments to treat the underlying infectious disease."
Featherstone calls his model "caries balance" and along with the term "minimally invasive" explains that both principles will underpin the dental practices of the near future. The ultimate goal of new dentistry will be to neutralize the acid-producing strains of oral bacteria that, if given the chance, literally burn holes in human teeth.
Envision this: On your first office visit, a dental assistant takes your medical history. Next comes a clinical exam that evaluates your oral health, specifically the status of your gums and the general degree of tooth decay. The next stop is critical. Patients, including children under 5, undergo what Featherstone calls a caries risk assessment. Now a checklist, but soon to become an analytical software program, its goal is to zero in on any factors that might give bacteria an edge. Examples include easily bleeding gums, recently removed orthodontic appliances, a high-sugar diet, white spots on the teeth and, for young children, the mother's degree of decay. "Decay is transmissible from mother to child," Featherstone notes.
Those found to be high-risk patients would then have their saliva tested for bacterial load. (The calcium and phosphate in saliva make this underrated liquid the primary buffer against oral bacteria.) Depending upon the results of the test, which employs monoclonal anti-body probes and takes only minutes, patients would be prescribed one of several antibacterial or concentrated fluoride treatments. Follow-up visits would monitor the progress against the bacteria and, if necessary, the dentist would draw up a plan to fix the damage that cannot be reversed.
Notice that drilling and filling do not appear anywhere on this list. "The goal is to detect early, intervene early and remineralize. If all goes well, drilling would never be necessary." To repeat: no drilling, ever. If it sounds too fantastic, consider that Featherstone, one of the world's leading experts on the chemistry of dental decay, has already created a laser treatment that by heating up tooth enamel alters its composition and makes it more acid resistant. Moreover, dental researchers at UCSF also are exploring early detection tools that include a three-dimensional image of decay. And while many of these new tools and techniques remain experimental, where possible, they are being integrated into the School of Dentistry's Parnassus Clinic and made part of the students' curriculum.
Indeed, it is the young professionals who Featherstone expects will pick up his challenge and open practices that incorporate both the caries balance philosophy and the tools that underlie it. "There are laser dentistry practices popping up now in American cities and the caries balance concept is already well established in Scandinavia," says Featherstone. Over time, he predicts, the transformation will occur naturally as younger dentists assume the positions left by their retiring colleagues. But will the new dentistry prove to be cost-effective, particularly given the high cost of lasers? Featherstone -- recent co-winner of Sweden's Ericsson Prize for research in preventive dentistry and the recipient of several other national and international awards -- does not hesitate. "The insurance companies are watching and waiting. But look at it this way. It costs about $1,000 for a crown. If you can avoid that procedure, you can do a lot of prevention and still come out ahead."
Source: Jeff Miller |
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