For the appropriate patient, Arsenault proposes a treatment plan that requires "a lot of dedication and a lot of education." It relies on neutralizing acidity in the mouth with frequent use of pH-boosting sprays and drops; killing mouth bacteria with xylitol--a sugar alcohol derived from birch trees, and using re-mineralizing toothpastes that stabilize and shore up weakened enamel.
Arsenault teaches dental students and dental colleagues the Caries Management by Risk Assessment (CAMBRA) approach, which uses a patient's history of cavities and dental work, oral hygiene habits and consumption of acid-promoting sugary foods, among other factors, to categorize them as low-risk, moderate-risk or high-risk for developing cavities.
"For each level of risk, there's a bit of an art, and a bit of science to it," Arsenault said Thursday. He described a low-risk, highly motivated patient who came to him a year ago with four small spots in her dental enamel and conscientiously adhered to the recommended treatments. When he examined her teeth earlier this week, the spots had shrunk. "She's thrilled I didn't have to drill this tooth," he said.
Arsenault first learned about CAMBRA at an NYU conference four years ago, where he said that at first, "it sounded like hogwash." But he was quickly won over and brought CAMBRA to Tufts. "We're showing with low-risk patients we can slow down, freeze and reverse" the caries process, he said. With extreme-risk patients, they can fill decayed teeth with materials that release fluoride to safeguard the other teeth.
CAMBRA is now being taught at dental schools. Although the American Dental Association supports a risk assessment approach to dentistry, it hasn't yet taken a position on treating microcavities.
"Evidence-based things are slow-moving," Arsenault said. "It's a momentum thing. It's on its way. We're getting closer."