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The Dentist’s Drill May Soon Become Obsolete

[DIGEST: Engadget, Telegraph, Medical Daily, Newsweek, NYT]

Few look forward to the dentist’s chair. And if you have a cavity, that visit could involve a needle in the gum and cheek followed by some uncomfortable drilling. A competent dentist could treat your cavity, but the filling — white, silver or expensive gold — will remain, or at least until it needs to be replaced, and the process starts all over again.


What if we could actually heal the tooth--painlessly? In the future, that may be possible.

Researchers at King's College London have developed a technique called Electrically Accelerated and Enhanced Remineralization that does just that. A device called a "healing hand piece" is placed over the cavity and emits a small electrical current that promotes the remineralization of the tooth, driving calcium, phosphate, and other substances back into the enamel. The process costs the same as a filling, and can also be used to whiten teeth.

"The way we treat teeth today is not ideal. When we repair a tooth by putting in a filling, that tooth enters a cycle of drilling and re-filling as, ultimately, each 'repair' fails,” said Dr. Nigel Pitts, from King's College London's Dental Institute.

A Scottish company called Reminova Ltd is trying to bring the technology to the marketplace, and believes with adequate funding the process could be available to consumers within three years. (In the U.S., due to the different regulatory environment, that timeline may be longer.) This could mean the end of the traditional drill-and-fill.

Root canals, too, could someday be a distant memory. Researchers at the University of Nottingham and Harvard University have developed a type of dental filling that encourages tooth regrowth. This filling is installed in the traditional manner, via drilling. However, once it’s in the tooth, it stimulates stem cells to encourage the growth of new dentin, the material that makes up the tooth. This could prevent the decay from spreading, which in some cases

leads to the infection responsible for root canals.

“Existing dental fillings are toxic to cells and are therefore incompatible with pulp tissue inside the tooth,” said Adam Celiz, a Marie Curie research fellow at the University of Nottingham. “In cases of dental pulp disease and injury a root canal is typically performed to remove the infected tissues.

“We have designed synthetic biomaterials that can be used similarly to dental fillings but can be placed in direct contact with pulp tissue to stimulate the native stem cell population for repair and regeneration of pulp tissue and the surrounding dentin.”

Techniques that encourage teeth to heal themselves have the potential to save consumers not only from pain but from the long-term damage associated with dental problems and repairs. But for some patients, avoiding the pain of the drill is reason enough to try something new.

Another no-drill treatment option involves painting an afflicted tooth surface with an antimicrobial liquid called silver diamine fluoride, or SDF, that halts the progression of cavities. It has been used by dentists in Japan for decades, and has been available in the U.S. for the past year under the name Advantage Arrest. It is approved by the FDA for adults age 21 or older as a tooth desensitizer, but has been used “off-label” to stop or prevent cavities.

“Being able to paint it on in 30 seconds with no noise, no drilling, is better, faster, cheaper,” said Dr. Richard Niederman, the chairman of the epidemiology and health promotion department at the New York University College of Dentistry.

But there is one significant downside: The process darkens the tooth, leaving a permanent black spot where the treatment has been applied. This may be acceptable for back molars, in baby teeth or in nursing home patients, but the majority of patients may hesitate before trying the process on a visible tooth. The treatments that encourage healing will be a more appealing option, when they become available in the next few years.