Dentists Can Treat Cavities Without Using a Drill

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Reprinted with permission of McGill University's Office for Science and Society. The original article by Ada McVean B.Sc. can be found here. 

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What if your dentist could apply a gel to your cavities (or dental caries) that would soften necrotic tissue but leave your healthy dentin alone, allowing the affected tooth tissue to simply be scooped out?

So-called chemomechanical methods of removing cavities are not new. They were initially marketed in the 1970s, but their original designs had some serious problems. Caridex was one of the first, but it required heat, specialized equipment, large volumes of product (200-500 mL) and tasted bad.

Luckily the creators of Carisolv were able to address many of these issues. Carisolv contains three different amino acids that can interact with the collagen that makes up dentin. Degraded collagen allows these amino acids to enter its structure and bind to it, softening it, while healthy collagen is unaffected. Only a few drops need to be applied to a tooth, and after a minute or so the softened dentin can be scraped away using a special tool.

Another product, Papacarie uses a slightly different approach to dissolve diseased dentin. Papacarie contains papain, an enzyme that can break down collagen. However, healthy tooth tissue contains an enzyme that will render papain useless, ensuring that only carious tissue is dissolved. Papacarie is applied to an affected tooth and left for about 30 seconds, after which the cavity can be scraped out using a normal dental spoon.

Both of these methods have the benefit of indicating when there is no more diseased dentin via a colour change. However, their major downfall is the time it takes to use them. Studies have shown that the traditional manual method of cavity removal is much faster (3-4 minutes) than chemomechanical methods (8-9 minutes for Carisolv, 6-7 minutes for Papacarie). However, studies have also shown that chemomechanical methods are more effective than traditional methods at preserving healthy dentin.

Dr. Grant Ritchey, dentist and contributor to Science Based Medicine, explained to me via Twitter that chemomechanical caries excavation could be fantastic for use in patients with teeth resistant to anesthesia, children, or those with anxiety surrounding dental drills, as well as for cavities small enough to make freezing and drilling a hassle.

I’m looking forward to seeing this technology develop further, and seeing its integration into more and more dental practices.