Don t drill, baby, drill

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New technology in dentistry might seem like an unquestionably good thing. But as dentists are using these technologies more and more often to detect and treat problems that may not need to be treated, patients and some dentists are becoming concerned.

An article in today s New York Times presents diverging perspectives on the question of using new technologies to detect incipient carious lesions or microcavities and then fill them as though they were actual cavities so as to prevent more serious problems later on.

These mini-lesions have only reached the initial stage of some structural damage to the tooth s enamel, whereas a cavity involves both the deterioration of the enamel and of the layer below the enamel (the dentin). Often, a microcavity will not lead to any sort of problem. Yet in a 2010 National Institutes of Health survey, 63 percent of dentists said that they would treat this type of microcavity, even if the patient s dental hygiene was otherwise good. At a cost of $88 to $350 per filling, this potentially unnecessary treatment can be costly.

On one side of the debate, Dr. Douglas Young, a dental diagnostician from the University of the Pacific, thinks that it does not make sense to just watch and wait upon detecting these early signs of decay. He says, If you were to go to a physician and he were to diagnose risk factors for heart disease, the physician would take action and treat the early signs of the disease and try to prevent future disease.

In response, ACSH Advisor and dentist Dr. Chic Schissel had the following to say:

Incipient carious lesions pose no danger and can remain in that state for a lifetime without progressing to the point where treatment is required. As some of the quoted experts pointed out, a filling is not necessary unless decay has progressed through the enamel to the dentin. Periodic examinations will detect these in a timely fashion. The analogy of heart disease is ludicrous. Coronary risk factors often lead to heart attacks, but, as I observed in a half-century of dental practice, microcavities in teeth, periodically checked, never lead to disease.To imply that an unfilled microcavity threatens to require a root canal and possible loss of the tooth is, to put it most gently, erroneous. That the American Dental Association hasn t condemned this outrageous practice is shameful. It s akin to telling a patient, You have a tooth. A tooth is a risk factor. The tooth may develop a cavity; it may even require a root canal. To avoid this I ll extract the risk factor."