21st century dentistry

I had to have my last remaining wisdom tooth pulled on Friday. It was not, I hardly need add, something I enjoyed.

But the number of teeth that have to be pulled in the future (from everyone, I mean, not just me) may be lower than the number being pulled today, thanks to new advances in dentistry.

Last week, scientists presented the American Association for the Advancement of Science annual meeting in Boston with the results of research that hold the promise of almost eliminating tooth decay–using nothing more than a special mouthwash.

The human mouth, dark, wet, and warm, is paradise for bacteria. In a recently brushed mouth, 1,000 to 100,000 bacteria live on each tooth. In a dirty mouth, 100 million to one billion bacteria live on each tooth–which means the number of bacteria can easily exceed the number of people on the planet. Many of these bacteria are friendly; but one particular type, Streptococcus mutans, feeds on sugar and produces lactic acid, which eats away at the teeth.

Professor Jeffrey Hillman of the University of Florida attacked this problem by genetically altering Streptococcus mutans so that it no longer produces lactic acid. When rat mouths were treated with the genetically altered bacteria, it replaced the normal bacteria–and the rats didn’t develop tooth decay even when they were fed a high-sugar diet. The altered bacteria is genetically stable and harmless.

Professor Hillman expects that a single treatment would take less than five minutes, would cost less than $200, and would last a lifetime. Brushing and flossing would still be necessary to avoid a build-up of plaque, which can lead to gum disease, but old-fashioned cavities would be almost eliminated.

We haven’t reached that Nirvana-ish state yet, but we’ve still got things pretty good, dentistry-wise, thanks to recent and upcoming advances.

Until recently, the only way to cut away decayed tissue from a tooth was the dental drill, which dates back to the 1700s. Today there are other choices, including the YAG laser and the microair abrasion unit.

The laser vaporizes decayed tooth tissue. It is usually (though not necessarily) painless, and it doesn’t emit that nerve-shattering whine of a drill. It’s also a bit more precise. Unfortunately, it can’t be used on teeth which already have fillings (because the filling heats up); it’s also, by a factor of more than 100, more expensive.

The microair abrasion unit is essentially a tiny sandblaster; it uses a high-pressure stream of aluminum oxide particles to cut away decayed tissue. There’s no heat, unlike the laser, so it can be used on teeth that already have fillings; and it, too, is usually painless. However, most dentists say it doesn’t yet completely replace the drill, although it’s ideal for small cavities and fillings in children.

Sometimes you can avoid cutting away the decayed tooth tissue at all: dental gel actually dissolves the decayed tissue by breaking down protein layers in the decayed portion of the tooth. It also contains sodium hypochlorite, an anti-bacterial agent.

In no particular order, here are some other new or on-their-way dental technologies:

Sealant. This plastic material is applied to the chewing surfaces of the permanent back teeth and bonds into the depressions and grooves, forming a barrier to plaque and acid. The American Dental Association says it is virtually 100 percent effective at preventing tooth decay.

Regeneration. Texas University researchers have grown mice teeth in the test tube; someday they hope to be able to regenerate teeth in the human mouth.

Cadcam technology. A camera the size of a ballpoint pen provides a detailed image of the exact size and shape of the necessary repair.

Digital radiography. This uses less-powerful X-rays than traditional X-rays, and takes only a minute or two to produce the picture, displaying it on a screen.

Invisilign. In this new process for straightening teeth, a computer model of the teeth is created, then used to produce a series of 30 or 40 clear, strong plastic mouthguards, each of which pushes the teeth a little closer to the final desired alignment.

Cell Demodulated Electronic Targeted Anesthesia. This has the potential to replace novocaine. It uses two electrodes placed on the backs of the hands and one near the treatment site. High–frequency signals drawn to the electrode in the mouth change the polarity of the nerve-cell walls, so that they can’t transmit pain impulses.

Who knows? With so many new techniques and technologies, maybe, in a few years, convincing people to go to the dentist won’t be so much like…well, like pulling teeth.

Permanent link to this article: https://edwardwillett.com/2002/02/21st-century-dentistry/

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