Going to the dentist can be less anxiety-provoking today, thanks to the increasing practice of minimally invasive dental treatments. A growing number of dentists are using techniques that prioritize preventive measures and focus on preserving as much of the patient’s natural teeth as possible.
Such modern technology as digital radiography and advancements in dental materials, including resin composites, sealants and topical fluoride treatments, help dentists perform routine procedures without the use of drills or anesthesia.
“One of the main aspects of minimally invasive dentistry is prevention,” says Norman S. Steward Jr., DDS, FAGD, of Steward & Gaull Dental in Milford. “For example, if an individual has very tiny pre-cavities lesions on an X-ray, which could lead to a cavity, we may opt to treat these lesions topically to prevent further decay. Our focus is on how we can treat the patient conservatively without going in with a drill or demolishing the natural tooth structure.”
In the past, Steward says, dentists were taught to drill out tooth decay and cavities using the practice of “extension for prevention,” formulated by G.V. Black, one of the founders of modern dentistry, known as the father of operative dentistry. “The idea was that if the tooth was mostly filling, it’s not going to decay.” Unfortunately, the preparation required for the filling involved drilling grooves in the undecayed part of the tooth to prevent future cavities, which damaged the tooth structure.
“Today, that philosophy has changed to prevention for retention,” Steward explains. Many dentists now use composite white fillings rather than the traditional silver amalgam fillings. Composites require far less preparation and are held in the tooth by bonding, preserving the tooth surface as well as preventing further decay.
In addition to film radiography, or X-rays, digital radiography also helps dentists identify potential cavities earlier, which can help patients avoid future decay and subsequent dental procedures.
“[With] this advanced technology, we’re able to get a much clearer image that allows us to see small cavities starting that may not be captured on film,” explains Heather Boyle, DMD, the sole practitioner at Family Dental Associates in Dover. “This allows us to be a little more conservative in our treatment practices, because we can spot potential cavities earlier and keep an eye on patients on a routine basis.”
Preventive treatment options include sealants painted onto the surface of the tooth that can help prevent decay, as well as the use of a material called silver diamine fluoride, which is applied directly on the tooth to harden decay once a cavity is identified.
“Silver diamine fluoride is great for kids because it can be used on baby teeth to arrest decay and avoid the need for drilling,” Boyle says. “It’s also beneficial for older patients who may have already had a significant amount of dental work and may have areas of decay far below the gum line, where we wouldn’t be able to place a filling.” The only drawback, she notes, is that the material can discolor the tooth, so it’s typically used on primary teeth and on nonaesthetic areas, such as posterior teeth.
Another minimally invasive technique is atraumatic restorative treatment (ART), which involves using hand instruments to scoop out decay and then seal the tooth with a glass ionomer restoration. This process remineralizes any cavity that might be left in the tooth, Steward says.
In addition, air abrasion, which shoots a stream of aluminum oxide onto the tooth to blast away decay, can also be used without the use of anesthesia or drills. Once decay is removed, the dentist fills the tooth with a sealant or composite resin.
These less invasive techniques focus on preventing oral health problems rather than treating them after cavities appear and symptoms have worsened.
“Our goal is to help patients maintain their natural tooth structure as long as possible,” Boyle says. “While restorative materials are great, nothing is better than your natural teeth. Preventing tooth decay is the most important goal. By focusing on good oral hygiene, cleaning and flossing your teeth on a regular basis, and [scheduling] routine dental visits, you should be able to retain your natural teeth throughout most of your lifetime.”
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