Many of us fear going to the dentist on the off chance the dentist will need to drill our teeth. However, a dental care technique devised by researchers at the University of Syndey could stop, reverse, and prevent tooth decay without the traditional “fill and drill” approach.

“It’s unnecessary for patients to have fillings because they’re not required in many cases of dental decay,” said Wendell Evans, lead author of the study and associate professor at the university, in the news release.

It was once believed that tooth decay was a rapidly progressive disease and the best way to manage it was to identify early decay, and remove the tooth surface from breaking into cavities. After removing the decay, the affected tooth would then be restored with filling material, a process which would come to be known as “filling and drilling.” However, Evans explained, it takes four to eight years before tooth decay reaches the inner layer of a tooth. While tooth decay begins to become noticeable on the outer layer of the tooth or the enamel, the time window is sufficient to offer an alternative preventive treatment for the patient.

Enter Evans and his colleagues. They devised a process known as Caries Management System (CMS) technique — a set of protocols which cover the assessment of decay risk, the interpretation of dental X-rays, and specific treatment of early decay (decay that is not yet a cavity). The treatment involves four aspects: application of high concentration fluoride varnish to sites of early decay; attention to home tooth brushing skills; restriction of between-meal snacks and beverages containing added sugar; and risk-specific monitoring. The CMS technique was proven successful when first tested on high risk patients at Westmead Hospital in Sydney.

“It showed that early decay could be stopped and reversed and that the need for drilling and filling was reduced dramatically. A tooth should only be drilled and filled where an actual hole in the tooth (cavity) is already evident,” Evans said.

To observe the effects of this technique on tooth decay, researchers assigned 19 patients at high risk for tooth decay to an experiment or control group for three years in general dental practices in New South Wales and Australian Capital Territory. Follow-up studies were conducted at two and four years after the clinical trial. After seven years, tooth decay reduced dramatically by 30 to 50 percent in patients in the CMS program compared to the control group.

However, the researchers stress there needs to be open communication between dentists and their patients to reduce decay risk and the need for fillings. “…Patients play an important role in their treatment. This treatment will need a partnership between dentists and patients to be most successful,” Evans said.

Patients can make the most of CMS by paying attention to their tooth-brushing skills at home, and restricting between-meal snacks and beverages that contain added sugar. For example, when a tooth is exposed to acid frequently — in foods or drinks that contain sugar and starches — the acid build-up will cause the enamel to lose minerals, according to the National Institute of Dental and Craniofacial Research. A white spot can appear where minerals have been lost, which is a sign of tooth decay. The enamel can repair itself by using minerals from saliva, and fluoride from toothpaste or other sources.

The CMS technique could help the 92 percent of adults with tooth decay in their permanent teeth in the U.S. This suggests it is imperative to start adapting more oral care practices at home. The prevalence of untreated decay in permanent teeth is highest among adults between the ages of 20 to 34 years — a population that has most of their teeth.

When it comes to tooth decay, prevention may be the best idea.

Source: Evans W et al. “No-drill” dentistry stops tooth decay. Community Dentistry and Oral Epidemiolog. 2015.