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Earlier Interventions in Tooth Decay Seen

The development of new diagnostic techniques to detect early stages of dental caries (tooth decay) may give dentists more options than ever before to stop or reverse decay using noninvasive techniques. This and other findings emerged from a Consensus Development Conference on the Diagnosis and Management of Dental Caries Throughout Life, convened by NIH on Mar. 26-28.

While water fluoridation, the use of fluoride products, dietary modification including sugar restriction, improved oral hygiene and regular professional care have led to dramatic reductions in dental caries over the past 30 years, the disease remains a major public health problem. Nearly 20 percent of children between the ages of 2 and 4 have experienced dental caries, and by the age of 17 almost 80 percent of young people have had at least one cavity — a late manifestation of dental caries infection. More than two-thirds of adults between the ages of 35 to 44 have lost at least one permanent tooth due to dental caries, and one-fourth of those ages 65 to 74 have lost all of their natural teeth.

Early phases of tooth decay are currently difficult to detect. While x-rays can disclose established cavities, particularly those that occur between the teeth, they are not effective in detecting early decay, or caries in the roots of teeth. The panel noted that the ongoing development of more sensitive diagnostic techniques to detect dental caries in its earliest phases will pave the way for the use of noninvasive treatment options to stop or reverse the caries process. Current data support the following treatment options: fluorides; dental sealants; combinations of chlorhexidine, fluoride and sealants; and health education.

Although the panel did not evaluate the evidence for the effectiveness of community water fluoridation, they acknowledged that water fluoridation and the use of fluoridated toothpastes are highly successful in preventing dental caries. They also determined that there is evidence to support the use of fluoride varnishes in permanent teeth, as well as fluoride gels, chlorhexidine gels, sealants, and chewing gum containing xylitol, a sugar substitute. Combined interventions may be more effective in preventing caries in children.

The panel called for a major investment of research and training funds to "seize the opportunities presented." Panel chair Dr. Michael C. Alfano, dean of New York University College of Medicine, also noted, "that for the American people to benefit from these findings, insurance companies will need to change the way they compensate dental providers so that the next generation of conservative therapy can be enjoyed by everyone."

NIDCR and the NIH Office of Medical Applications of Research sponsored the conference; cosponsors included NIA and FDA.

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