Reality Check
The Future of Dentistry
The first toothbrush was invented in China circa AD 1000 and featured bristles made of horsehair. Since then, dentistry has come a long way: smile-straightening braces have evolved from gold metal to clear plastic, millions of Water Piks have been bought as gifts and never used, and the crinkled toothpaste tube has been reengineered as the freestanding pump. While we happily rot our teeth with chewing gum, scientists continue to develop new technologies that should make each checkup better than the last. The focus, however, is on prevention – so don't forget to floss.
| Cavity-Repairing Toothpaste | Laser-Drilling of Cavities | Effective Cure for Halitosis | Substitute for Dental X-Rays
| Burrell | now | 2010 | 2020 | 2020
| Eichmiller | 1999 | unlikely | 2007 | now
| Fox | 2003 | 2005 | 1999 | now
| Mandel | 2003 | 2005 | 2000 | 2005
| Newbrun | unlikely | unlikely | now | now
| Bottom Line | 1999 | unlikely | 2005 | 2003
In the next few years, a new toothpaste called Enamelon will face off with Crest in the battle for your mouth. The company behind Enamelon promises that the product, which includes calcium and phosphate in its formula, actually prevents cavities by rebuilding the surface of the tooth. Does this signify the death of the dentist's drill? Wishful thinking. All of our experts point out that traditional fluoride toothpastes already decrease demineralization and increase remineralization. According to Eichmiller, newfangled Enamelon-type toothpastes "will most likely function in much the same manner but with much greater efficiency." Unfortunately, Fox adds, "once the caries (tooth decay) progresses to the state of cavitation, or a physical hole in the tooth, you'll need more than toothpaste." Bzzzzzzz….
Forty years since the first air-turbine drills went into service, that high pitched whine still sends shivers down the spine of anyone who has ever had a cavity filled. So what's next? According to Mandel, lasers are currently under study; acceptance will depend on the ease of use, cost, and safety compared with standard drilling. Burrell notes that lasers have even "demonstrated effectiveness at sealing pits and fissures on the biting surfaces of molar and premolar teeth." On the other hand, Eichmiller believes the amount of energy that must be generated to ablate tooth structure is "too large to ensure survival of the tooth vitality." Lasers, adds Newbrun, are more likely to be used to control bleeding.
It's no wonder dentists wear cloth masks – bad breath is most commonly caused by bacteria on the tongue and teeth. That's why a good brush sometimes helps. But a perfect cure for halitosis is unlikely, Mandel says, since "the oral cavity can't be sterilized." Still, Newbrun adds, "the common toothbrush and a tongue scraper are very effective in controlling halitosis." If you're one who enjoys the swish-and-spit routine, mouthwashes that contain zinc compounds are your best bet, Burrell explains. For better results, we'll have to wait for a new antimicrobial. And with a public that's willing to buy into the stigma of bad breath, expect miracle mouthwashes to hit the shelves again and again. "Consumer demand will drive companies to invest heavily in this area," says Fox. Well, that's one way to look at it.
Do you get suspicious when the X-ray technician grabs the remote control and scurries out of the room? While the radiation emitted from dental X ray machines is not harmful in small doses, better image analysis combined with new technologies may reduce patients' exposure time. According to Eichmiller, colored dyes and electronic impedance detectors are useful in locating lesions. In addition, Burrell points out, digital imaging technology like MRI is already in place, but when it comes to dental use, "sufficient resolution would be needed because the early decay lesions are extremely small." Other methods involving fiber-optic systems and ultrasound technology will reach wide-scale acceptance in less than a decade, predicts Mandel. Until then, please bite down and keep your head still.
Kenneth Burrell DDS; senior director of the American Dental Association's Council on Scientific Affairs.
Fred Eichmiller DDS; director of the American Dental Association Health Foundation Paffenbarger Research Center.
Christopher Fox DMD, DMSc; director of global professional relations for the Colgate-Palmolive Co.
Irwin D. Mandel DDS; professor emeritus at the Columbia University School of Dental and Oral Surgery.
Ernest Newbrun DMD, PhD; professor emeritus at the University of California at San Francisco.<
