The need for dental fillings can be reduced by 30 to 50 percent through preventative oral care, a new Australian study suggests.

The seven year study, published in Community Dentistry and Oral Epidemiology, challenges the current “fill and drill” practice in dental care to address tooth decay or dental caries.

Instead, the researchers hope to introduce a preventative approach, which will result to major benefits compared to the traditional method. Their findings signal the need for a major shift in the way tooth decay is managed by dentists, according to the team.

Tooth decay was long believed to be a rapidly progressive phenomenon, and dentists manage it by a process referred to as “drilling and filling,” researchers at the University of Sydney say. For this method, dentists identify early decay and remove it immediately in order to prevent a tooth surface from breaking up into cavities. After removing the decay, the affected tooth is then restored with a filling material.

However, the team found that in most cases, it is unnecessary for patients to have fillings, says the study’s lead author, Associate Professor Wendell Evans of the University of Sydney.

He points out that research studies spanning 50 years have shown that decay is not always progressive and develops more slowly than was previously believed. For example, he says, it takes an average of four to eight years for decay to progress from the tooth’s outer layer or enamel to the inner layer.

This means there is still plenty of time for the decay to be detected and treated before it becomes a cavity and requires a filling, Evans notes.

Evans and his team developed the Caries Management System or CMS, a set of protocols which cover the assessment of decay risk, the interpretation of dental X-rays, and specific treatment of early decay, or decay that is not yet a cavity.

The CMS treatment “no-drill” involves four aspects: the application of high concentration fluoride varnish by dentists to the sites of early decay; attention to home tooth brushing skills; restriction of between-meal snacks and beverages containing added sugar; and risk-specific monitoring.

The CMS treatment yielded positive results when it was first tested on high risk patients at Westmead Hospital, Evans reports. “It showed that early decay could be stopped and reversed and that the need for drilling and filling was reduced dramatically. A tooth should be only be drilled and filled where an actual hole-in-the-tooth is already evident,” he says.

It was also trialled in general dental practices in New South Wales and Australian Capital Territory. After seven years, decay risk was confirmed to be substantially reduced among the CMS patients and their need for fillings was reduced by 30 to 50 percent compared to the control group, according to the team.

One in two children aged 12 year old had tooth decay in their permanent teeth, according to the Australian Institute of Health and Welfare. Three in 10 adults aged between 25 to 44 years old, on the other hand, had untreated tooth decay.

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