Dentists to replace drills with plasma jets | Hacker News Reader

Dentists to replace drills with plasma jets

crunchgear.com

25 pointscwan19 comments

I'm currently in the middle of dental school, and unfortunately this technology can't completely replace 500,000 rpm air turbine drills (a technology that is, to correct the article, NOT from the 1880s).

Here's the problem: bacteria (specifically, the acid they produce from metabolism of sugars) demineralize the hydroxylapatite of enamel (the stuff covering your teeth). Enamel is not biologically viable and therefore does not have the ability to _regenerate_. But it can, under certain circumstances, _remineralize_. SO, eliminating harmful bacteria using plasma technology WOULD give portions of enamel the opportunity to remineralize.

Unfortunately, if a caries lesion ("cavity") penetrates to the point that it reaches underlying, vital tooth structure (dentin, pulp), then surgical removal of the infected tooth tissue is the only way to effectively treat the growing lesion. Bacterial control by plasma at this point would be insufficient to keep the structure of the tooth crown sound. Thus, you need a drill to cut away tooth structure.

Furthermore, I object to the article's use of "sterilize". It's important to understand that epithelial or mucosal surfaces covering the human body can never be sterilized ("all living organisms eliminated except prions"). The bacterial load can only be reduced, never eliminated.

Then again... this article is a TechCrunch production, so what do we expect?

Then again... this article is a TechCrunch production, so what do we expect?

Expecting the author of a bit piece on a tech site to have knowledge of dentistry is a bit of a stretch (don't get me wrong - I loved your insight). Even the BBC's writeup - http://news.bbc.co.uk/1/hi/health/8470827.stm - doesn't go into such detail.. but this feels like yet another trendy, but baseless, snipe at TechCrunch.

Nobody expects a journalist/blogger to have a knowledge of dentistry. But at what level of professionalism do we expect them to track down a dentist for a quote?

It sounds like the mechanism of action of the plasma might be (irreversible) electroporation. Basically, the electric fields created by plasma can tear small holes in the cell membranes/walls of the bacteria.

I took the liberty of following the link to slashdot and from there to livescience.com where I found a much more interesting article:

http://www.livescience.com/technology/plasma-jets-dental-dri...

http://news.ycombinator.com/item?id=1108455

Am I the only one here who's never been to a dentist? From my perspective, it seems like they do more harm than good with the drilling, scraping, filling, etc. People I know who go seem to end up "repeat customers", with all kinds of "problems".

I tried not going to the dentist during grad school, yes. (More out of absent-mindedness than with any definite plan.) I spent perhaps four or five years dentist-free.

My reward was a series of extremely painful toothaches followed almost immediately by a bunch of very expensive root canals and crowns.

Let me assure you: Once your toothache starts, your time as a dentist-denier is going to come to a fast end, one way or another. They hurt a lot. Not to mention the fact that if you get an abscessed tooth it can literally threaten your life.

Of course, you don't necessarily have to have the dental insurance and the well-paying job that I had when my dental emergency arrived. Instead you can elect the more traditional option: Have all the offending teeth pulled out. Then you may eventually need dentures. [1] I'm told that dentures are no fun whatsoever. I have had no reason to regret spending money on dentistry instead.

Of course, if you literally never touch soda or sugar, brush your teeth carefully, and are blessed with better genetics than mine you might get lucky...

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[1] Pulling one tooth can have a negative effect on neighboring teeth, as the bone loss under the empty space causes the neighbors to loosen and slip. That's why people who lose permanent teeth tend to get crowns or bridges.

I think genetics is the main factor. I've known a few people who never floss, brush once a day in the morning, eat pretty much whatever they want, go to dentists once every five years, and never have cavities. On the other hand, I'm very careful to floss before sleep and brush twice a day, but I still end up with a cavity or two every year.

In my continuing review of the dental primary literature and frequent consultation with dentists (my professors), I have found that genetics actually play a minor role in the frequency that an individual develops dental caries lesions.

More important factors include: (1) frequency and dose of fluoride (2) bacterial ecology of the mouth (possibly related to genetics, but also inextricably linked to the environment to which the individual has been exposed since birth) (3) FREQUENCY of meals -- look up "Stephan Curve" or the unethical "Vipeholm Study" if you are interested in this...

I tend to get cavities every now and then, but always have very little plaque build-up. In fact, when I went on one 4-year hiatus from the dentist, the assistant cleaning my teeth said it looked like I had just recently had them cleaned. She said it probably had to do with the chemical makeup of my saliva being more plaque-resistant that average. Funny thing is my mom always gets similar comments when she goes to the dentist. We live very far away from each other and have very different diets. Based on that, I would conclude that the bacterial ecology of the mouth and related chemical composition of saliva, are probably quite genetic.

Also, based on the fact that my dad has horrible luck with his teeth (cavities, root canals, etc), and dminor's comment (http://news.ycombinator.com/item?id=1108895) in this thread saying that they have very different luck with their teeth from their brother, I would venture to guess that it may have a lot to do with the mother's side of the genetics (being linked to the X chromosome that gets passed down). In dminor's case, they could have received one X from their mother and their brother have received genetic makeup from the other X, which could explain their differences in dental hygiene at least partially. If it were Y-linked, then I'd obviously have much closer luck to my dad's, and those two brothers would be much closer in results to each other, since there is only one Y to be given from one parent.

Of course, this is all nothing more than educated conjecture. I'm probably totally off base and it's likely much more complicated than that. For all I know, these results could be all coincidence, and the genetic characteristics could be totally unrelated to the sex-giving genes. (In other words, I have no dental training and nothing more than a curious, inquisitive disposition.)

In my continuing review of the dental primary literature

I would love a post about your most interesting findings. Looking into the Vipeholm Study now.

http://wholehealthsource.blogspot.com/2009/03/preventing-too... fingers diet as the main factor instead. Perhaps when these people eat what they want, what they want generally jibes with this advice.

My brother and I grew up eating the same foods, but he had 17 fillings by college, whereas I had none. Our dad is a dentist (and now my brother as well), so we had pretty good oral hygiene growing up.

You've never been to a dentist? Whoa. Where are you from?

I imagine, to some extent, that there it is the best interest of dentists to have you come in regularly, but I have to imagine that the research says that going to the dentist prevents all kinds of tooth and gum problems.

Do you have high salivary flow, by any chance?

Crunchgear is just re-writing the article here: http://www.livescience.com/technology/plasma-jets-dental-dri...

Having undergone some fairly extensive oral surgery just last week in order to combat a major infection that got out of hand before I was even aware of its existence, and also having a fear of dentists in general, I'm not sure if I find the thought of plasma jets being fired into my mouth comforting or terrifying. Either way, I think I prefer to remain unconscious during the procedure.

Really though, even if it's not a good solution for serious dental problems, if it can provide a pain-free, fear-free (that drill just terrifies a lot of people, honestly), quick means of dealing with minor tooth decay, then perhaps more people will seek treatment earlier, before things get out of hand.

I still think the number one factor in individuals not seeking proper dental care, however, is cost and the fact that it's just so hard to get good, affordable dental insurance (or any dental insurance at all). We could go on for hours about the flaws in our healthcare system in the US and about how hard it is for many people to get insurance, but getting dental insurance is even more difficult in a lot of cases.

Sadly, I don't think adding plasma and lasers is going to drive the cost down any, at least not for several years. Not that this, in any way, means I think we should stop innovating, because innovation is going to lead to better care and, hopefully, eventually, more affordable care.

A good friend of mine was part of the pioneering team that initially researched this stuff over at the Technical University of Eindhoven in the Netherlands. See this article from 2006: http://www.newscientist.com/article/mg19125586.200-plasma-ne...

I can remember getting pretty freaked out when he was explaining it to me.

There have been alternatives to the drill for quite some time. My dentist uses "air abrasion" to clean out the cavities before filling them. This is a pain-free and numbing-free method of dentistry.

Per WebMD: http://www.webmd.com/oral-health/guide/air-abrasion

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