No drilling, no filling in painless dentistry By Celia Hall, Medical Editor.
A new way of treating tooth decay which means the end of both the injection and the dentist's drill is being introduced into this country. The method, popular in Australia and Japan, uses a special disinfectant, activated by laser, to kill instead of drill out the bacteria. The tooth can then rebuild itself aided by a porous sealant and a tooth mousse, which is used at home and promotes tooth growth.
The revolutionary "no pain" dentistry is being pioneered by Myles Dakin, a private dentist with practices in Hertfordshire and London. It is possible because dentine, the solid part of the tooth, is porous and because saliva contains calcium which causes tartar.
"This really is the way forward" he said. "What we do is to get the tooth to heal itself. "This technology is easy to use and it is great for the patients. "It changes the whole concept of dentistry. It eliminates 'drill and fill' altogether." The procedure is known as photo-activated disinfection or Pad. Photo-activation of drugs or other compounds is an established technology which has been tried in tackling skin cancers. In dentistry, ozone was first used as the bacteria-killing agent. But Mr Dakin did not like its toxicity.
"Then the new method of disinfection came along and I did the background research and I felt this was safe and the system for the future." First the disinfectant is applied to the decaying tooth and allowed to penetrate, bathing the area of decay. Then the laser is applied to activate the disinfectant. This takes about 90 seconds. The dentist covers the tooth with "nano-porous filling material", which is a sealant and protects the tooth against heat and cold. This lets in minerals such as calcium to re-mineralise the tooth, and fluoride to strengthen it, but keeps out bacteria.
Next fruit-flavoured tooth mousse, derived from milk, is applied daily. This floods the tooth with calcium and phosphate, promoting growth. After about three months, the tooth will have regrown into the cavity, Mr Dakin said. The sealant is left in place. "The material is not quite the same as the original tooth and the tooth is a little darker. But the decay is eradicated completely which I find impressive. Any further decay will be new decay." He said the method was possible because of the coming together of the three new technologies: laser-activated disinfection, protective, porous filling material and tooth mousse.
"I think more dentists are not using this technology because the start-up costs are very high," he added. "You have to buy a medical-grade laser." Molly Barnett, from Royston, near Cambridge, who is almost seven, is one of Mr Dakin's younger patients. All her milk teeth had been completely healthy and Molly was horrified when decay was found in one of her first adult teeth. Her mother, Alison Barnett, said there had been toothache and Molly was very nervous about the visit to the dentist. "He told Molly that he was going to shine a light in her mouth and the whole thing took about a minute," Mrs Barnett said yesterday. "She has an orange 'filling' on the tooth at the back and she is very proud of it. The treatment was three or four weeks ago and there have been no complaints since. "There was no injection, no drilling and no filling."
Suddenly, everybody wants a movie-star smile and cosmetic dentistry is booming. But rushing into treatment could do lasting damage to your looks - and your wallet, warns Jane Corrigan
Back in 1995, the chattering classes were outraged at reports that Martin Amis had spent £20,000 having his teeth fixed. Today, such news would raise barely an eyebrow - not least because the chattering today more than likely emanates from a mouth sparkling with thousands of pounds worth of braces, veneers, crowns or bleaching. It's a paradigm shift, says Dr Ian McIntyre, the ex- president of the British Dental Association. "People are suddenly very conscious of their mouths because having a good smile affects their lives. You can't get a job in Woolworths with gaps in your teeth."
Despite this new obsession, few people go as far as the model Jodie Marsh in their quest for dental beauty. Earlier this month, she endured five hours and £15,000-worth of surgery on Channel Five's All New Cosmetic Surgery Live to acquire a set of perfectly symmetrical, toilet-white veneers on her front teeth - giving a smile, according to a leading cosmetic dentist, "that bears little resemblance to what is human and natural". But, according to Dr Nigel Saynor, president of the British Academy of Aesthetic Dentistry (BAAD), it's only a matter of time before we're all doing it. "The growing trend, according to our members, is for a Hollywood smile with big, film-star, teeth with the central incisors increased in size by a significant two millimetres that mean you suddenly see a huge smile coming towards you," he says. It's a trend that is promoted by the popularity of extreme makeover shows featuring celebrities such as Marsh - as well as the arrival of American-style "dental spas" in UK department stores, including Selfridges, which give the subtle message that having cosmetic dentistry is rather like having a massage or getting your hair done. And if you're not sure where to go, there are pages of cosmetic dentistry practitioners in Yellow Pages and on the internet.
But it's worth listening to some leaders in the profession. They warn that dental work is never like having your hair done. "A dentist should never simply do a cosmetic job. They should be taking into consideration the health of the patient's mouth as a whole," says Dr Saynor.
Many dentists who offer cosmetic work have had no training in the field and sometimes precious little experience. Even membership of BAAD means little more than that the dentist has paid - as well as having lectured or published on the subject. "There are no qualifications for cosmetic dentistry recognised by the General Dental Council simply because it doesn't exist as a specialist field," says Paddy McCullagh, a consultant in restorative dentistry for Hammersmith and Fulham Primary Care Trust. Dentists who advertise themselves as providing cosmetic dentistry services may have done no more than a weekend course by a team of visiting dentists with an interest in heavily marketing their own technology.
The Harley Street dentist, Dr Myles Dakin, one of a handful of UK dentists who have completed postgraduate training in restorative dentistry in the United States and are members of the prestigious American Dental Society of London, says that any dentist can do anything they want. "There's a feeling that, with cosmetic dentistry, one size fits all," he explains. "But the essence of quality dentistry is that it is a bespoke service." Most people, he says, do not realise that dentistry is a team effort, with the quality of the work dependent on the input of laboratory technicians. Underpinning all this is the question of cost. Dr Dakin's laboratory fee for a crown, for instance, is £250, at least double the cheapest fees. "For that, you get a lot," he says, "including technicians working at 250-times magnification, digital photography and qualified ceramicists who interview patients. The result is work that looks natural, mimics a normal healthy appearance and lasts a lifetime."
Cheap isn't always unsatisfactory, says Alan Petrie, a deputy laboratory manager at Edinburgh Dental Institute. "But, with cosmetic dentistry, it's largely a matter of getting what you pay for, because the price relates to the amount of time that is spent on the work. "There are simple checks that anyone contemplating cosmetic dentistry can follow. Experienced practitioners will have a portfolio of before and after pictures demonstrating their work, and will be happy to show it to patients. Before you embark on a course of treatment, says Mr McCullagh, you should make sure that the rest of your mouth is healthy. You should also obtain a written treatment plan that is fully costed before treatment starts, and have a clear statement from the dentist on exactly how long the work is expected to last and what will happen if something goes wrong.
It is also worth checking on the laboratory service. Top-level laboratories will be DAMAS (Dental Appliance Manufacturers Audit Scheme) accredited. A further guide is that the laboratory has an MDA (Medical Devices Act) number - only half of UK dental laboratories have the number. McCullagh says the trick is to get the maximum effect with the most conservative treatment. The result, says Dr Dakin, "should be the restoration of healthy, normal-looking teeth that may be crooked and irregular but still look beautiful - and that doesn't necessarily include the Jodie Marsh look.
© 2004 - 2010 Specialist Dental Partners, Melbourn Science Park, Cambridge Road, Melbourn, Cambridgeshire. SG8 6HB UK.
