‘No-drill’ techniques can treat tooth decay just as well, study finds | Hacker News Reader

‘No-drill’ techniques can treat tooth decay just as well, study finds

washingtonpost.com

139 pointse15ctr0n67 comments

This title is a little bit misleading, because a large part of the solution is having a healthier and less sugary diet consistently for 4-8 years. If patients could do that, they likely wouldn't have cavities in the first place.

It does seem like there is a general movement away from drilling happening, though, which is good!

This approach looks more promising to me:

http://www.theguardian.com/society/2014/jun/16/fillings-dent...

What I never understood is why in these days we are not able to have a product that would be spread on the teeth (let's say a yearly application) to protect them from most of the major aggressions.

Each time I had a tooth "cured" (i.e. drilled), this "cure" weakened the structure of the tooth so much that it broke with a period of 6 to 24 months. And once the inside was removed with drilling and the outside has broken, what's left? Nothing: goodbye tooth, hello hole.

I am pretty sure that they would have lasted longer if they had not been cured (supposing I could stand the occasional pain, but in half of the cases, pain was not even about to start, a tiny decay was just detected by visual inspection). But now, I have to plan to start eating more soup soon.

> Each time I had a tooth "cured" (i.e. drilled), this "cure" weakened the structure of the tooth so much that it broke with a period of 6 to 24 months.

The article's points aside, there is something seriously wrong here. For contrast, my newest filling is over fifteen years old and all are still going strong. Drilling is still highly problematic, but shouldn't be directly responsible for your teeth crumbling in such a short time frame. Various other conditions can weaken teeth and make them more susceptible to damage.

> What I never understood is why in these days we are not able to have a product that would be spread on the teeth (let's say a yearly application) to protect them from most of the major aggressions.

If I understand what you're talking about, this is already a thing, and not particularly new either. Lasts much longer than a year too.

http://www.webmd.com/oral-health/sealants

Fascinating; how come I've never heard of this? It seems like the sort of thing dentists would advertise.

I have dental sealants but my insurance doesn't cover them because they're considered unnecessary, so I pay out of pocket to get them renewed every once in awhile. Maybe patients are reluctant to do that.

In Germany you can get sealant applied once a year or so as part of standard health care until 18 years of age. IIRC each application takes about 15 minutes at the dentist and one hour of no eating or drinking afterwards.

I had this done during youth, never had it reapplied since, and so far, now heading towards my mid-thirties, never had an issue with my teeth. And, of course, I regularly brush my teeth about once or twice a day.

My dentist checks once a year to see how far the sealant has worn off. I could get it reapplied if necessary but not for free this time. I'll strongly consider paying up though when faced with the choice since this treatment worked out very well for me.

Do your teeth feel any different with the sealant applied?

Slightly but you get used to it quickly. It also depends on how good a job your dentist does, there will be high spots that need to be ground down.

Really? I'm in the USA hear and I have sealants, but have never noticed any difference in feel compared to before (I had them applied in my teens). It sounds like yours were put on REALLY thick. Mine were only put into the indents of my back teeth, so maybe that is the difference?

Typically sealants are applied to the permanent molars of children, and remain in place at least through young adulthood. Apparently there are some risks involved with old sealants. My dentist blamed a partially-eroded sealant for a cavity I got in my thirties.

That happened to me as well. Apparently, worn-off sealant can create tiny gaps and cracks that are difficult to clean and accumulate bacteria.

The only thing a dentist can give you that actually lasts a lifetime is a gold crown. Everything else needs to be fixed at least once in a decade.

The crown may last forever, but the underlying tooth may not. I've had several crowns replaced over the last few years as the tooth underneath gets slightly exposed and a cavity forms. The only thing that seems durable is implants, and those are pricey.

I had never even heard of them and i've been going to the dentist roughly yearly my whole life so... yeah.

Sealants are generally applied on adult molars and premolars as a child. If you've not had cavities before there generally is no point in having sealants.

For the shadier dentists (and they exist), sealants don't bring in as much money as a root canal.

For everyone else, it doesn't help with cavities between the teeth where a lot of people get cavities. The sealants just sit on the upper side of the tooth.

It's not just about pain, a cavity that hits the root can wind up killing you. Significant amounts of bacteria can make their way directly into your bloodstream and to your heart or brain, and you're done.

It's not quite that simple. Bacteria invades the body all the time via poor gum health. It rarely leads to sudden blood poisoning that is fatal. Most often, bacteria form mass of blood vessel bound "goop" that cause scarring of the blood vessel that can lead to anything from blood clots to aneurysm. It's true the finding about how bad gum health can lead to these diseases is only about 5 years old. It was expected before but now there is good proof related to it.

> Each time I had a tooth "cured" (i.e. drilled), this "cure" weakened the structure of the tooth so much that it broke with a period of 6 to 24 months. And once the inside was removed with drilling and the outside has broken, what's left? Nothing: goodbye tooth, hello hole.

I went to a few different dentists a few years ago, and they all said I needed a crown. This was not in my budget, so I went to my grandparent's long-term dentist, who they'd been going to since the 1960's. He was 80+ years old, and was happy to use his tools to sand down my old prosthetic tooth.

He was a cheery old fellow, who still practiced dentistry to take care of his long-term patients who didn't want to go anywhere else. And he gave me the best advice for picking a dentist that I've ever heard:

1. Make sure your dentist's drill is water-cooled - that it sprays water on the tooth that's being drilled. Tooth nerves that get heated die, and then you need more dental work...

2. Never go to a dentist who hasn't been out of school at least 10 years, because young dentists tend to have loans to pay off, and they have an incentive to sell you dental work that you might not really need.

My brother told me about how he got hit with a dental up-sell once. His new dentist told him that he had "micro-cavities" that needed to be filled. My brother was like, "huh? They don't bother me..." But he went along with what the professional recommended. Did he really need that extra work? He doesn't know... But now he has micro-fillings that will probably fall out some day.

I broke my tooth at the lake when I was 12, and have had a prosthetic tooth ever since. I broke the prosthetic tooth off one evening, had it glued back on by a dentist. With the layer of glue, it was just slightly too long, and it started to hit on my other teeth.

The nerves in your teeth shrink as you age. The difference between the nerve size of my root canal'd tooth and its neighbor is incredible. (Did I really need that root canal? My parents could afford it, it was what the professionals recommended, so it's what I got. A friend of mine had a very similar break in the same tooth, but her parents couldn't afford a root canal, she never got it, and still has a nerve on her capped' tooth.)

Your advice is odd. There are high speed and slow speed handpieces. Slow speed handpieces are not water cooled and the RPMs do not get high enough to do damage to the nerve. High speed handpieces can damage the nerve and are always water cooled (at least if you buy them these days in America).

You're opinion on not going to a dentist who has graduated in the last few years is amusing. In America, most dentist get paid on either production or collection. Payment based on production is getting paid a percentage based on the treatments you bill the patient for, while collection is getting paid a percentage on what you actually collect (which is generally lower because of insurance, etc). Also, If a dentist just bought into a practice or bought an existing practice, that dentist has anywhere from 200K-1MM in loans. This likely outweighs whatever they might have paid for dental school. Because of this, almost all dentists are incentivized to "sell you dental work you might not really need." However, there are good dentists and bad dentists as there are in all professions. As with your primary care physician, it's best to build a relationship over many years with somebody you know and trust.

I'd also like to point out that dentistry, like computers, changes. New materials and techniques are invented all the time. In the dental profession, continuing education is required, but there is a lot of flexibility and most of it is just showing up to the class. This means recent graduates have less experience, but they might have improved technique and more recent technical knowledge.

I can't speak to your personal anecdotes, but I've met a lot of bad dentists too. I don't yet have a good filter for determining a good dentist or a bad dentist.

(Disclosure: Take this for what it is worth. My wife graduated from a top dental school and I know a huge number of dentists. )

Do you have any pointers at all on picking a dentist? I'm currently trying to find one, and aside from Yelp (not very helpful) I have no way to make heads or tails of anyone...

In general, I would talk to family and friends and get a recommendation on a personable dentist that will actually take time with you. Word of mouth is really your best bet.

I would try and stay away from larger practices where a dentist owns multiple offices. Not that there is anything wrong with multiple practices, but it's a broad filter for getting rid of dentists who are overly profit focused.

I would only go to a dentist that thinks amalgam is perfectly safe to use. Largely because there is no science to support otherwise and removing amalgam fillings actually releases more mercury. I like medical providers to believe strongly in science.

In many states you can look a dentist up with the state dental board and see if any action has been taken against the dentist by the board. For example, North Carolina's can be found here: http://www.ncdentalboard.org/license_verification.htm and you can also find out if they've ever had their license suspended.

Here's a slight hack that involves a little effort: call up the dental offices in your area and ask them who covers the dentist's emergencies when they are out of town.

This should give you an idea of who is respected among the dentists themselves.

A friend works at the local school of dentistry. They all know who the good dentists are. Off the record, of course.

Also, my dentist teaches at the local school, and he's been fantastic.

It exists, you can slowly remineralise your teeth:

https://en.m.wikipedia.org/wiki/NovaMin

Because a non-human ingredient becomes part of the teeth, I like to pretend that I become transhumanist every time I brush my teeth!

>What I never understood is why in these days we are not able to have a product that would be spread on the teeth (let's say a yearly application) to protect them from most of the major aggressions.

That's a sealant, which is something we do have. I've had a few of my biting surfaces sealed, and it seems to have cut down on the number of cavities. Just once, though, not every year.

You do have to have sealant re-applied periodically.

It can depend, though of course genetics are probably a factor. I had sealant applied when I was a teenager, but never since. I'm now 38; still - at least, as of my last dentist visit a couple of months ago - no fillings.

It's not genetics. It's all diet and hygiene.

Awesome. I like you.

Sometimes I think it would be just nice to get all teeth removed and get brand new proper ones within a days worth visit. Would make things much easier.

I've thought about this as some kind of future tech thing, wherein instead of braces, everyone just gets a full set of perfect teeth, possibly even just one long gap-less tooth for top and bottom with a standard set of surfaces. That way, no more flossing and much less chance of getting food stuck in places and causing problems.

And here's where tech goes boink. Teeth are living things, and the teeth, gums, and jaw are an integrated living system, not just interchangeable machine parts. The jaw in particular interacts with the teeth in a way that maintains bone density and health.[1]

Likewise, modern implants are a huge improvement over prior tech (e.g. bridges), esp. for bone loss, but still aren't a 100% tooth analogue.

[1] http://www.texasdentureclinic.com/blog/2013/12/06/bone-loss-...

My friend was talking about this recently. He is trying to put together the money to get a new tooth fitted, and mentioned that there is talk of having insurance cover replacement teeth for young people due to the fact that not having teeth can severely weaken the jaw over the course of your life. Not such a big deal when you're 80 and your teeth are falling out, but when you're 25 it has potential to become a big problem.

I guess my question is why would insurance care? If the bone in your jaw weakens and causes severe problems, it'll likely be your medical insurance that covers it.

I can't see a dental insurance giving a crap.

This is US/Canada specific of course. Any country that has single payer dental/medical coverage would care.

Not to put words in his mouth, but I think the above poster was referring to having medical insurance cover said dental costs because the loss of bone in the jaw would cause other medical complications down the line in young people.

That's how I took it, but don't dentists normally put the implants in? If dental insurance is paying for the implants and medical insurance is paying for the bone damage, there isn't a lot of incentive for the dental insurance to pay for expensive implants.

Maybe that's exactly how it will work out, but I hope not.

Thanks, that's very interesting. I think it's very easy to look at something and say "oh, well we could make this better!" without fully understanding the implications.

Well, GP wasn't talking about pulling out all his teeth and replacing them with implants today. It's just an idea for future biotech.

It's certainly conceivable that once we've figured out exactly how teeth affects the health of the jaw and gum, we'll be able to create implants that emulate the effect when combined with some sort of drug and/or regular treatment.

Besides, we'll need to do that sooner or later if we're going to aim for an average lifespan of 100 years or more. Biological teeth just don't last long enough.

It's not even a new idea. My late great aunt had all her teeth removed when she was 21 and dentures fitted.

Yeah. There used to be a time, not that long ago, when people would routinely get their first dentures as a wedding gift.

You can do that, but it is very very expensive.

If you are serious about it though and you want a reasonable price, take a trip overseas and have it done there.

This is terrible advice. When teeth are removed, the bone of the jaw has to remodel, which takes months. If you get fitted for dentures right after your teeth are removed your dentures will fit poorly. A good dentist will offer you a temporary denture that is cheap and of lower quality material while your bone is re-modelling then after a few months they'll make a high quality set that will fit much better.

Not really overnight thing though, right? Its painless and long procedure. Never heard of this being something that can be done within day or two (complete procedure).

There are cheap places that offer dentures in a day, or a few days but you wouldn't want to go to one of these places. When your teeth are pulled your bone has to remodel which takes several months. This guarantees that dentures done shortly after getting your teeth pulled will not fit.

Generally, the dentist will take a preliminary impression, that is used to make a custom tray. This custom tray is used to make a final impression. Then the dentist will make rims that shows the lab where the teeth should go. The lab uses the final impression plus the rims to make a wax try-in that has teeth so the dentist can make sure the teeth are where they are on the denture and the patient approves. Once the wax try-in is adjusted by the dentist, the lab takes it and makes the actual denture for the patient. It generally takes several appointments.

It's possible to have it done in a couple days.

But yeah, like the other comments have noted, this probably isn't very wise. I didn't mean to offer real advice, just say that it's essentially possible, with tons of pain and considerable amount of money.

In the end, you probably just want to hold on to those natural teeth.

I have always hoped for big advancements in dental care and the ability to improve teeth. I have a lot of anxiety-inducing cosmetic issues with my teeth but the cost to get anything done about it is incredibly prohibitive and not covered by insurance.

If it's the price of orthodontia, it may be cheaper than you think. Ask two for a price. They almost always offer a payment plan, and if you can, demand at least a 10-20% discount for a full payment in cash up front.

I'm waiting for the day they can simply grow new teeth for you in a petrie dish and pop 'm back in your mouth.

That makes two. My teeth are terrible. When I was a kid and people would warn me about sugar I would always argue that in the future we'd just be able to replace our teeth. Any day now...

I'm starting to think my bad teeth are going to kill me before stem cells get around to regrowing them for me.

I'd rather they grew them in vivo. Implanting a fully functioning tooth would still be a difficult operation.

Adults occasionally grow a third set of teeth. Maybe it will someday be possible to trigger a person to grow a new set of teeth.

better link: http://sydney.edu.au/news-opinion/news/2015/12/07/_no-drill_...

Was trying to get more specific details about the alternate treatment, but information seems limited to:

- 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

- Risk-specific monitoring.

Basically, if caught early, your teeth can remineralize themselves if you provide the right conditions.

I have hope that this is true. So much of the treatment and prevention is focused on protecting the surface of the teeth which is certainly a major consideration. However, there are health conditions that seem to effect the teeth and enamel that are not born from a tooth problem. A symptom of celiac is holes in the enamel. I don't know if these heal though after the diet is adjusted for celiac.

Bones can heal so it seems to follow (to me anyway) that perhaps teeth can heal too. Again, I hope this is true. I agree that conditions would have to be right in order for it to happen.

There are 'those people' that never get cavities. Would be interesting to know what's going on there.

Absolutely. Here's a lifehack for when a small new cavity that doesn't even hurt (much, yet) is discovered --- for some 2-3 months:

- cut out all sugar to the best of your ability,

- cut way down on mineral leeches such as phytates, lectins, gluten

- consume plenty of meat, grassfed butter and liver -- all 3 matter here

A neat easy to follow little protocol for remineralization and overall tooth (and bone) hardening.

In a way it's not as convenient as getting a drill for 20 minutes and heading back to the office donut party or the birthday cakes your friends were sharing. It really is about priorities here. Our bodies are in no way incapable of splendid regeneration at any age, the problem? They take a lot of time, and require "the right building blocks", which really are a bit tricky to find out about, and lastly modern diet interferes severely. Yes, somehow the preformed animal Vitamin A from liver does the trick and so does preformed animal Vitamin K2 from grassfed butter where synthetic formulations or plant-sourced supplements don't seem to. Plus the completely-absorbed and readily-utilizable minerals and amino acids from your meat. Don't blame the messenger ;)

For elaboration, see http://wholehealthsource.blogspot.com/2010/12/dr-mellanbys-t...

I keep thinking there should be a way to plug the cavity with something that can be absorbed by the tooth and assimilated into it (like happens with baby teeth). Then cover it up with a cap that can be later removed. Gotta find a way to regrow the enamel under that cap too. Is there some reason teeth can't regrow when damaged?

> absorbed by the tooth and assimilated into it (like happens with baby teeth)

I'm confused. What happens with baby teeth?

> Then cover it up with a cap that can be later removed.

And come back in a few days later when the tooth and the one it meets hurt unbearably. You can't really put a cap on a tooth without grinding away a bunch of enamel first. The cap will make the tooth thicker and cause it to take all the pressure when biting.

I do wish our dental treatments didn't seem so middle ages, though. Drill a hole and fill it with epoxy. :\ That sounds like an appropriate way to fix a boat, not living tissue.

>> I'm confused. What happens with baby teeth?

The roots are used as material for the permanent tooth under it. https://en.wikipedia.org/wiki/Tooth_resorption

Unless I'm missing something, the baby tooth roots aren't really absorbed into the new tooth. The body absorbs the baby roots, but they aren't directly incorporated into the adult teeth. Rather the pressure from the adult teeth causes the baby roots to be absorbed.

Correct me if I'm misunderstanding, though.

> Is there some reason teeth can't regrow when damaged?

Same reason hair or fingernails can't - no cells in the exposed area. Plus, evolutionarily we're a lot less prone to tooth damage than many other animals. Without all the refined sugars modern humans eat, they've generally been quite serviceable throughout the reproductive years.

Hopefully smart people working in this area can learn to regrow them from stem cells, so once a tooth cannot be repaired any longer, it can be popped out and a new can grow in your gum in its place.

http://www.credentis.com/en/innovation/

This is what everyone here seems to be after. A toothpaste with this technology came out this July. But it's only sold in Switzerland.