New Forms of Dental Treatment

Dental caries are the most common hygiene-related diseases for children, and one of the

most common for adults nationwide (CDC, 2016). Caries, commonly referred to as cavities,

occur when certain types of bacteria produce acid inside your mouth which breaks down the

tooth’s enamel, and if not stopped quickly, will break down the dentin which will lead to

permanent and irreversible damage if not treated. The methods used today, have remained

relatively the same for the past 100 years. While most of the methods are effective there is still is

much room for improvement. It is also imperative that patients know of these new treatments so

that they stay informed and can ask about receiving said treatments. I find this topic quite

intriguing due to the fact that treating caries is one of the most common procedures done by a

dentist.

According to the CDC (2011), 91% of adults have had a cavity in their permanent teeth at

some time in their lives. To go along with that, the NIDCR (​National Institute of Dental and

Craniofacial Research)​ stated that 41% of children 2-11 have an untreated dental caries (2016). It

is quite obvious that dental cavities are one of the most common chronic diseases throughout the

world. Caries form when both the bacteria, and the sugar/carbohydrates in your mouth interact to

create an acid on the surface of the tooth (American Dental Association, 2017). This acid then

eats away at the protective layer of the tooth's enamel thus forming a cavity. If the caries is not

treated promptly the decay could go deep enough that it reaches the pulp or nerve of the tooth.

The most common way of treating a cavity this severe is generally a root canal. When

performing a root canal, the dentist will remove the decay from the surface of the tooth. Then

they will clean and disinfect the surrounding pulp. After the cleaning, the nerve of the tooth is
extracted and filled with certain type of post, so that when the dentist is filling in the gap, the

material has a solid surface to grab a hold of and eventually set to. The most common treatment

against cavities is known as a “drill and fill” technique. If the infection is not severe enough, and

it only is in the enamel or dentin, a filling will typically be done. Generally speaking this

treatment includes drilling out the decayed material caused by the cavity. Then the dentist will

clean the area of decay, and fill it with a certain material, usually amalgam, composite, or

porcelain. If the decay effects a rather large section of the tooth, the doctor will use either a cap

or a crown to cover that area. While these methods are well known and effective, they are also

rather outdated, costly and invasive. Prevention of dental cavities is one of the most common

things that we do. The most common way of preventing caries is by brushing your teeth two

times per day, as well as flossing at least once a day. This brushing helps to both remove plaque,

and help stimulate your gums. Plaque is a clear film that sits atop your teeth if not brushed away.

This plaque contains bacteria and if not removed can result in a dental carie. Improvement in the

way dental cavities are treated is imperative. The outdated “drill and fill” technique is an

expensive, old and simply needs to be revamped. With our advancement of technology, it is

unacceptable for us to be using the same technique we used 100 years ago.

One of new options scientists in Australia are looking at, is the use of a dental vaccine.

Essentially the vaccine would target the specific enzymes produced by the bacterium which

causes the decay in our teeth (Nature.com, 2016). In this targeting, the body creates it own

antibodies to fight this bacterium. If the disease is caught early enough this could completely

eliminate the bacterias chance at creating a carie on the tooth. Standard injection style vaccines

for various diseases or illnesses work by mimicking a weakened disease agent they are trying to
prevent from occuring (History of Vaccines, 2018). Because of this mimicking, the body forms

antigens to help fight the pathogen. Once the disease is wiped out, the bodies immune system is

familiar with that specific pathogen and then once it comes into contact with it again, it can

easily and efficiently wipeout the disease. This vaccine however was tested using a variety of

different routes for administration. One successful route used on both young children and mice

was a topical oral vaccine. When administered, the bacterium did not recolonize for two years

after than vaccine was given. Another route of administration was a typical injection, which

again prevented the bacteria from reappearing for 2 years post vaccine (Journal of Clinical and

Diagnostic Research, 2016). Several other methods, that unfortunately were not successful, were

oral capsules, because of the stomach's acidity, and intranasally. This could be an extremely big

breakthrough if scientists can determine it is safe and successfully bring it to the open market.

This could greatly decrease the number of cavities seen worldwide and especially in

underdeveloped countries where caries are more prominent.

Another new form of treatment being tested is the use of a infiltrant sealant rather than a

conservative sealant method for treating early caries. Traditional sealants work by forming a thin

protective shield on the tooth's surface (WebMD, 2016). This clear plastic coating helps prevent

tooth decay, by not allowing any plaque build up on the tooth's enamel. The placing of a

common dental sealants is one of the quickest and painless operations a dentist can perform. First

the dentist preps the tooth. They do this by completely cleaning the surface of the the tooth,

otherwise the sealant will not cure and adhere to the tooth's surface. Then, they spread a thin

layer of etching gel, which has the purpose of giving something the sealant to stick to

(Animated-Teeth, 2017). Then the dentist must thoroughly rise and dry the etching solution off
the tooth, giving it a chalky appearance. After the gel is dry the liquid sealant material is placed

onto the crown of the tooth with either a small syringe, or a brush. It is then cured using a blue

light and the sealant is complete. These sealants generally last several years before having to be

reapplied (ADA, 2017). This new type of infiltrant sealant is applied the same way as the

traditional sealant. It was tested on 23 volunteers, and was checked annually for three years prior

to administration. However unlike the traditional sealant it actually helps to infiltrate and help

restore already damaged enamel in the tooth (Journal of Applied Science, 2017). It also is

suitable for helping to stop further progression of the caries when applied to non-cavitated pits.

This new infiltrant sealant also held up better after three years, compared to the base sealant,

which showed more wear and tear. This could be a very big advancement for dentistry if it is

established that it is both safe and effective.

The final new method of treatment I discovered is the use of a glass post for intracanal

surgeries. These intracanal surgerys, or root canals, are done on extremely decayed teeth where

the infection or damage has proceeded through the enamel, and the pulp. If the infection is not

treated an abscess could form. A root canal is essentially when the pulp and the nerve of the

tooth is removed. The tooth is then cleaned and sealed (WebMD, 2017). Sometimes however, if

the tooth is severely decayed to the point that the filling product has nothing to grab ahold of, a

post will be implanted. This allows the dentist to use the post as a foundation for the material.

The study I found took 16 patients, with a total of 45 greatly decayed teeth, and tested to see

what material post was most effective and had the longest retention. The materials tested were a

polyethylene​ post, a glass post, and a composite post. A year following the root canal the

subjects were brought back in, in order to determine which groups had the highest retention rate.
At the end of the study it was found that the glass post group had the highest retention rate at

93.3%. While the polyethylene post had a retention rate of 86.7%, and the composite post

finished with a rate of 60% (Journal of Indian Society of Pedodontics and Preventive Dentistry,

2016). It was also shown that the glass post had the least amount of discoloration compared to

both the polyethene, and composite posts. If implemented in higher quantities, the glass post

could make a significant increase in the amount of successful root canals in severely damaged

teeth.

As I analyzed the data I realized that all of the testing and research that was done was all

completed on very small groups of human participants. These treatments all seemed relatively

feasible, but in order for them to be implemented, they need much more testing on larger subject

fields. If they are not done on a larger scale then the evidence to back them up are much less

credible. These treatments will need many more years of testing before they will be seen in

dentistry, let alone be approved by the FDA. I think that each and everyone of these treatments

could be huge for the future of dentistry, they just need more time to be tested and researched.

In conclusion, it is quite obvious that something needs to be done about the current route

for treating dental caries in today's society. We have been using the same old, expensive

treatment for over one hundred years, and in an age of technology and innovation, it is

unacceptable to be using the traditional ‘drill and fill’ technique. All of these treatments whether

it be the dental vaccine, the infiltrant sealant, or the glass intracanal post are showing great

promise in improving the way we treat the world's most chronic disease. But these methods

downfall is exactly the reason we are excited about them. They’re new. The studies backing

them up are using small volunteer pools, which need to be increased before they receive the
attention they deserve. More studies need to be done before their benefits can be used in a

commercial setting. Before we know it, these methods could become a staple of dentistry and

could completely erase the ancient methods of the past.

References

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Alpino, D., Amore, R., Anauate-Netto, C., Borelli Neto, L., & Di Hipolito, V. (2017). Caries

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randomized controlled clinical trial. ​Journal of Applied Oral Science​, ​25​(4), 442-454.

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