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Dentist without drills: plans for drill-free dental care

20 July, 2012

Fear of the dentist’s drill may be a thing of the past with a ‘no drill clinic’ on track to be opened early next year.

From 2013, trainee dentists will deliver 'no drill' dental care to patients as part of their clinical training. The 'no drill clinic', will be based within the Westmead Centre for Oral Health, the teaching arm of the University of Sydney's Faculty of Dentistry.

Associate Professor Wendell Evans, a long-time advocate of the regular use of fluoride toothpastes, says the techniques being taught and used will include the application of professional strength fluoride varnish, use of dental sealants, and intensive coaching on tooth brushing techniques.

According to a recent national survey nearly 30 percent of us visit our dentist infrequently, if ever. This reluctance and lax brushing habits have led to higher levels of tooth decay across all age groups.

"People fear their dentist despite the profession being ranked as the one of Australia's most ethical, honest and trustworthy groups," Evans says.

The root cause of this dread in all likelihood is the 'drill'.

Professor Evans has dedicated much of his dental research career to finding a way of removing this fear. Together with his research team he has developed the Caries Management System protocols (CMSP). The protocols, if followed, will relegate the dentists' drill to the bottom shelf, says Evans.

In a study led by Professor Evans and supported by the National Health and Medical Research Council and Colgate-Palmolive, the protocols were trialled at 11 general practices in NSW. The outstanding results after two years  were a 40 percent reduction in the incidence of decay, an almost 50 percent decline in the need for first-time fillings, and more than 50 percent reduction in the number of repeat fillings, even in high risk patients.

"If patients conform to a timely dental care regimen tailored to their risk status, we can reverse the decay," says Evans.

The success of the program inspired the 'no drill clinic' and the teaching of CMSP principles to trainee dentists, says Professor Christopher Peck, Dean of the Faculty of Dentistry.

"Our ambition is to reverse the rate of dental decay in Australia and keep the incidence to minimal levels for future generations. By training our future dentists on how to work with their patients using tooth brushing coaching sessions and a program of motivational interviewing, we hope to instil a life-long commitment to oral hygiene for our patients."

"This 'no drill clinic' component of our study program/curriculum is a demonstration of how research can inform our clinical training and lead to improved outcomes for the Australian community. It also reminds us to challenge the clinical practice as we were previously taught."

"As long as tooth decay is identified before actual cavities have dug into the teeth, they can be stopped, reversed, and future occurrences prevented," says Professor Peck.

Dr Susan Cartwright, Scientific Affairs Manager for Colgate–Palmolive, and dentist, shares the cavity-free ambitions of the Faculty.

"Colgate is committed to raising awareness of and educating Australians on the dangers of poor oral health and the importance of investing in their oral health habits."

"We are extremely happy to be associated with this training initiative, which will see dentists working closely with their patients to develop daily dental health routines.

"Our ultimate goal is to stop decay occurring. It is our belief that prevention is better than cure, and the implementation of these protocols at both the clinic and training levels certainly moves dental care toward  a 'no drill' era."

Source: University of Sydney
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Dr Mark Schwartz | Wednesday, July 25, 2012, 4:27 PM
A noble ambition not matched by the ability of most people to employ long-term preventive strategies including diet modification, regular flossing and follow up dental examination. It is fanciful to believe we can change modern human behaviour just by enthusiasm for a good idea not always shared by the object of that idea. I'm talking over 30 years experience here. I see a majority of my patients requiring active treatment for gross neglect and no amount of oral hygiene instruction is going to treat it. From my observations over the years, many Australians (especially) believe there is a disconnect between their mouths and the rest of their body. Certainly, there is a disconnect between their intra-cranial contents and effective life strategies. Maybe better to develop quieter handpiece and/or call it some high-tech mythical name so we can stop using the word "drill". Just like calling intracoronal dental implantation a "restoration" and stop using the oh so passe 20th century (?19th century) ugly term: "filling". However, good luck trying to create your little Utopia.