This Won't Hurt a Bit (page 2 of 3)

Stopping Cavities Before They Start

A decade ago, most dentists looked for cavities, and when they found one, they filled it. But “replacing the tooth structure with a filling is never as good as your own tooth structure,” says Domenick Zero, DDS, director of the Oral Health Research Institute at Indiana University School of Dentistry. Now dentists are starting to spot tooth decay early enough to stop cavities in their tracks. Several devices help. The most popular is Diagnodent (and the newer Diagnodent Pen, left). Marketed by KaVo Dental Corporation in Lake Zurich, Illinois, the instrument shines a tiny laser beam over a tooth’s surface and detects the differences in reflected light between healthy and decaying enamel. But dental plaque and sealants can also trigger the device, which could lead to overtreatment.

In a few years, there may be a better detection method. A CAT scan-like technology called optical coherence tomography, now in the prototype stage, will create a holographic image of the entire mouth on a computer screen. Telltale tiny white dots on teeth signal microscopic pits in the enamel, which could be sealed or treated to prevent cavities and restore the natural teeth.

Soon dentists may also be able to kill tooth-decay bacteria harmlessly with a device by CurOzone that delivers a quick pulse of ozone. European dentists already use the device, known in the United States as HealOzone, but the FDA is reserving judgment until clinical trials prove its effectiveness.

Meanwhile, dentists can help prevent cavities by giving their patients prescription-strength, high-fluoride toothpaste that alters chemical conditions in saliva, providing minerals that help re-form and harden enamel. Fluoride varnishes may work as well, but the FDA has not yet approved them to treat tooth decay. Other popular products contain xylitol, a sugar substitute derived from birch bark, which starves the bugs that rot teeth. Xylitol is now available in candies, gums, mints and even wipes for babies’ mouths. Clinical trials suggest, but do not prove, that it helps rebuild enamel.

Laser Improvements
Lasers, too, can make visits to the dentist easier. Two types of soft-tissue lasers have been used since the early 1990s to minimize bleeding and infection during minor gum surgery. Hard-tissue lasers, which the FDA approved in 1997, can vaporize the damaged tooth tissue inside a cavity while leaving healthy tissue intact, thereby preserving more of the tooth than a dental drill can. And experimental lasers that can do still more are on the way, says Donald Coluzzi, DDS, of the University of California, San Francisco, past president of the Academy of Laser Dentistry.

One method, called Photo-Activated Disinfection (PAD), could help dentists treat periodontal disease by wiping out tissue-destroying bacteria in hard-to-reach tartar below the gum line. First, they would add a blue dye to the space between tooth and gum, which would make bacteria sensitive to light. Then they’d shine a red laser beam that leaves just one in 10,000 bugs standing. The British company Denfotex already markets this technology to prevent the recurrence of root canal infections. Dr. Coluzzi predicts that it will soon help periodontists save gum, teeth and bone—without surgery.

Few dental operations happen in a garage. But California race car engineer Craig Jull needed a new tooth fast. Jull and a team of mechanics were working with Jesse James, host of the Discovery Channel show Monster Garage, to pull off one of the show’s trademark mechanical makeovers, converting a 1964 Lincoln Continental into an open-road racer. While Jull reshaped the car’s body, a fast-spinning grinder caught his shirt, rode up to his face and snapped off an incisor. The team had just seven days to complete the car makeover, so Jull kept working, at one point calling his injury “a flesh wound” through a jack-o’-lantern smile.

On day six of the makeover, Gary Glasband, DDS, of Long Beach strode into the garage and snapped pictures of Jull’s mouth with a small camera. Then he sat down in front of a piece of dental equipment that looked like a PC on wheels, tapped at a keyboard and scrutinized a three-dimensional image of Jull’s broken tooth on the screen.

Within minutes, he had designed a crown that would fit Jull’s broken tooth perfectly. Fifteen minutes after that, an attached milling unit had carved the crown out of a block of solid, tooth-colored ceramic. Dr. Glasband fine-tuned the shape, donned a mask and gloves, and glued the crown to Jull’s tooth in less than a minute. The mechanic was good to go. The technology that Dr. Glasband used is called CEREC.

New ways to reattach teeth that have been broken, fractured or knocked loose mean that they can be saved more often and replaced more easily. Traditionally, dentists had just two options with a broken tooth like Jull’s. They could reattach it if the patient had been lucky and smart enough to recover the broken tooth, stick it in milk or saliva, and hightail it to a dentist. More often, they would replace it with a temporary crown, then months later, a permanent crown.

Today, though, dentists can rebuild broken teeth in one visit, using composite, a hard plastic resin that contains minerals and re-creates the color and hardness of a real tooth. The quickest method might be the GlasSpan Single Use Trauma Kit, introduced last February, which uses braided glass fibers and plastic resin to splint a loose or broken tooth to its neighbors, allowing it to reattach. It takes a dentist less than ten minutes, compared with the two hours to secure a tooth the old-fashioned way, with orthodontic wire. Jonathan Scharf, DMD, the Exton, Pennsylvania, dentist who founded GlasSpan, has used the kit to help a seven-year-old girl whose four front teeth came loose when she fell face-first onto the pavement.

• Healthy Heart
• • Breakthroughs
• • Fight Disease
• • Dental Hygiene
• Healthy Habits
• Heart Disease

• How Your Dentist Can Save Your Life
• The dentist may be the most important doctor you see this year.
• 
• 3 Surprising Ways to Keep Your Teeth Healthy
• Your toothbrush isn't the only weapon capable of protecting your teeth -- your diet helps too!
• 
• 22 Ways to Maintain a Healthy Smile
• 22 secrets for pearly whites.
• 

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