Years ago when I was contemplating going to dental school, there was rumor that the occupation of dentist would soon become obsolete. Like a typewriter repairman or a switchboard operator, someday fixing cavities would be a thing of the past. Public water fluoridation, sealants and six-month cleanings were all that was necessary to rid humans of this disease and scientists were touting a vaccination for the bacteria that caused tooth decay.
The promise of a generation without tooth decay was on the horizon. And yet, tooth decay occurrences appear to be on the rise. Every day in my practice, we diagnose tooth decay in the mouths of our patients. The decay is found on the chewing surfaces, between the teeth where the floss goes (or should go), and on the root surface or side surfaces of teeth. Sometimes it is around existing fillings or the edges of crowns, but just as often it is in places on the teeth without dental work.
As dentists, we are educated and trained in the “surgical model of medicine” – how to repair teeth with dental fillings, root canals and crowns once they are decayed. However, the curious scientist in my personality was observing this epidemic in my patients occurring right under my watch and wanted to know why. Just advising people to brush, floss and use fluoride seemed archaic in our high tech society. And more than that, it just isn’t working. Teaming up with David Bloomfield, a brilliant engineer and scientist, I have begun investigating the mechanisms of tooth decay, with the hope that I can better develop personalized recommendations for my patients.
The process of decay it turns out is incredibly complex. Each individual is different; no person is the same, nor is the environment the teeth are exposed to the same. Variables that affect an individual’s rate of tooth decay include:
- The strength and composition of the individual’s tooth
- The quantity and composition of the saliva
- The pH of the mouth
- The specific bacteria present in that mouth
- The quantity and colonization or organization of the bacteria
- The diet and food source for the bacteria
At Dental Health & Wellness Boston, we are now utilizing a prevention strategy known as CAMBRA (Caries Management By Risk Assessment) in our battle against tooth decay. To assess an individual’s likelihood for tooth decay, the patient and hygienist fill out a questionnaire. Once the data is collected, we can assess areas of the above list that we can influence to prevent or slow down the rate of tooth decay for that individual in the future. As you can see, there are only a few factors of this complex puzzle that we truly can predictably influence in an adult. We focus our efforts towards adjusting dietary habits, implementing homecare strategies and recommending dental products to assist in managing the disease. We also rule out systemic medical problems such as acid reflux, dry mouth, diabetes, etc. that may be under-treated or undiagnosed. Our goal is to do everything we can to help you to keep your teeth healthy for a lifetime.
I hope my research with David Bloomfield into the decay process will someday unlock the mystery of tooth decay. I will keep you updated and informed and look forward to incorporating new state of the art strategies and products that I feel will be beneficial for you, my patients!