The Future of Dentistry

— -- Dr. Timothy Rose is the current president of the American Dental Association, so he has plenty of ideas about what the future holds. A gum specialist in Appleton, Wisconsin, Rose has also served on that state’s task force on the future of dentistry.
    The following is a transcript of Dr. Rose’s chat on ABCNEWS.com.

Matt from [209.109.238.48], at 3:00pm ET
I've heard there are "drills" in development at the present time that use a very accurate spray of silica "sand" to actually cut and prepare teeth for filling application. Reportedly, these 'sand-blasters' carry none of the vibration and other creepy effects of an actual drillbit. Care to comment on whether or not these 'drills' are in service here in the U.S. and what the ADA reports regarding their effectiveness?

at 3:01pm ET

Well, they're not really drills. It really is a high-pressure silicate, and they are in use in the U.S., they gone through both ADA and FDA approval. It's a new technology, and they'll be used more frequently in the future.

Brad Parker from duke-energy.com at 3:02pm ET
Will we ever be able to stimulate the jaw's bone structure to spur new tooth growth; in effect, planting a seed for a new tooth to grow?

at 3:02pm ET

I would say yes, eventually. There is a significant amount of work being done in dentisty, and that work will bring to fruition that kind of thing, but it won't happen immediately.

M. Cullum from [204.146.215.242] at 3:03pm ET
Are digital x-rays as good as regular x-rays?

at 3:05pm ET

A digital x-ray is an x-ray taken with a standard x-ray machine, and exposes a sensor and transmits the image to a computer. In many way, they are more sensitive than standard x-rays. From the exposure perspective, it only takes about 10 percent as much radiation to expose a digital x-ray as it does to expose a traditional x-ray on film. In many ways they are better. You can do things with the digital image that you cannot do with an image that appears on film. You can turn it, enhance it, change colors...all of those things are helpful.

Arthur from [149.123.203.139] at 3:05pm ET
Will there be a breakthrough ingredient in toothpaste or mouthwash that will practically repair cavities?

at 3:06pm ET

Maybe someday, but not now. That technology clearly is not here. There is some work being done in the area of using chemicals in mouthwash and toothpastes to regenerate hard tissue, but that research is at its very beginning.

clcoon from dayton5.oh.pub-ip.psi.net at 3:06pm ET
Since flouride has been shown to be health hazard/toxin to people and now requires warning labels on packages, will the ADA re-evaluate its position of recommending it for toothpaste?

at 3:07pm ET

No. The amount of flouride that appears in a toothpaste is well within the safe limits that a human can use. The one concern would be if a child, in an unsupervised way, used an excessive amount of toothpaste and swallowed it. That's way parental supervision is so important.

Richard Bornemann from s29.as1.bsd.erols.com at 3:08pm ET
As an aging baby boomer, what can be done to promote the health of gum tissue other then flossing, brushing, good diet, and regular cleanings and check-ups? I have heard that some vitamins and herbs can be especially effective in promoting the health of these tissues, can you suggest any?

at 3:10pm ET

I don't think there's any sound, scientific research that shows there are any vitamins or herbs that will help. There just isn't any research to validate the claims that are made today.

As people reach that sixth, seventh, and eighth decade of their lives, we will have a significant popluation, 88 million, who will have the majority of their teeth. We've never had a popluation in those age ranges who had their teeth. We are going to find that those people require different kinds of dental care and treatment throughout their life, so that they can maintain their teeth.

Anonymous from dhcp.epa.gov at 3:11pm ET
With all the new technology out why is it that most people have to wear braces approximately two years? Is there any new advances in straightening your teeth without braces or not wearing them just as long?

at 3:12pm ET

Well, realize that the bad bites that require othodontic care have a genetic component to them. Until we can truly manipute how each of inherent those traits from our parents, we'll never be able to manipulate that process to ensure that orthodontics are not necessary.

Paul Getty from clis.com at 3:13pm ET
Do you think Dental Management Companies will have
made the private practice obsolete?

at 3:14pm ET

No. I believe that dental management companies will be a force in future dental care, but I also believe that the vast majority of dentists will be independent practicioners, either by themselves or in small groups.

Alexa from got.net at 3:14pm ET
What is the future of periodontics? Is there a way to reverse gum disease? Are there new and innovative ways to fix pockets that are in view (ie. in your smile) Can you recommend periodontists on the cutting edge in northern Ca?

at 3:16pm ET

I can't recommend anyone, but as a periodontist myself, there are numbers of new technologies that have come into periodontics. We can now regenerate soft tissue and bone, and we have a number of products that are available to be used as part of maintainance care that should help the periodonist and the patient control the patient's periodontal disease.

Charles from csc.ncsu.edu at 3:16pm ET
At a recent dentist visit I got a kind of ceramic
tooth filling instead of a metal filling. Are
these becoming more and more popular everywhere?

at 3:17pm ET

Yes. They are, because they function as well as a a metal resoration in mose cases, and they are clearly more aesthetic. Patients want that kind of procedure done because of the aesthetic component.

Isaac from [128.97.154.152], at 3:17pm ET
I hear there's a new type of whitening ingredient that's due out in February or March, which is supposed to not only whiten teeth, but also make the whitening last longer and not make your teeth so sensitive. What is this new product, and has it been backed up by evidence to support its claims?

at 3:18pm ET

I think only time will tell as to whether it is effective and how long it may be effective after it is used. There are two or three products coming out.

robert maggard from in-tch.com at 3:19pm ET
will dentures be a thing of the past in the future? how can the average person afford the sophisicated treatments of today?

at 3:22pm ET

Dentures hopefully won't be the treatment of choice in the future. Rather, I would hope that implant dentistry and the replacement of teeth will be the treatment of choice. Patients should understand that a denture does not last a lifetime, that it needs constant maintenance and will have to be replaced periodically. The advantage of implant dentistry, once the implants are in place and are integrated, they can be used for a lifetime.

Each patient should evaluate all of their treatment options based on factors to include cost, but not limited to cost alone. Some of the more costly proceedures last longer, and over a moderately extended period of time, are more cost effective than some of the initially less costly procedures that have to be re-done more frequently.

at 3:22pm ET

Dr. Rose, can you tell us a little bit more about how implants work?

at 3:28pm ET

Implants have existed in dentistry for more than 50 years. They came into vogue in the early 1980s. The materials that are used today are a direct offshoot of the work that was done with artificial joint replacement. Most of the metal that is used in joint replacement is titanium, and titanium is the metal of choice of implants.

One of the common misconceptions that patients have is that when they have multiple teeth that have to be replaced, they believe that they have to have an implant for each of those teeth. That generally is not the case. Obviously, when one has a single tooth to replace, a single implant is needed. But when one is replacing 14 teeth, one does not need 14 implants.

Patients are going to prefer to have a stable, fixed appliance in their mouth versus a denture that in many cases is not stable and moves around. Over a period of time, under a conventional denture that rests on gum and bone, the bone continues to shrink, and the denture will become loose. The reason dentures become loose, is not because the dentures change, but because the bony support of the denture continues to change under pressure. And patients can eventually lose enough bone so their dentures cannot become stablized. The advantage to implant dentistry is that the denture does not sit on either gum or bone, rather it sits on the implants and the forces created in functioning with the appliance are transmitted to the implants, thus protecting the adjacent bone.

mike from ext.eastgw.xerox.com at 3:28pm ET
is there a treatment in the works for the problem of receeding gums?

at 3:29pm ET

Yes. Today we are able to regenerate the tissue that has receeded off a tooth by doing a surgical proceedure called a graft. The grafting procedure is meant to cover the exposed root surface with a piece of gum tissue that will eliminate not only the exposed surface of the tooth, but protect that exposed surface of the tooth in the future so that the patient does not have the potential for all of the problems that can occur when the root surface of the tooth is exposed to the oral cavitiy.

chris from del.nj.webspan.net at 3:30pm ET
Is re-mineralization of the enamel possible as suggested by the new toothpaste Enamelon

at 3:31pm ET

Yes, it appears to be. The technology used in Enamelon is a by-product of some technology that was developed by the American Dental Association in the use of calcuim phosphates. Those materials appear to stimulate the regeneration of hard tissues.

George from grandmet.com at 3:32pm ET
Do you think that insurance companies hinder the use of new technologies by favoring payment for older, more common techniquies over something more up-to-date?

at 3:32pm ET

I think the answer is yes in some instances. Insurance carriers have the habit of postponing their acceptance of new technologies, in my opinion well beyond the time when that technology has been established to be both safe and effective.

LARRY LEE from [12.9.187.3] at 3:33pm ET
WILL OZONE EVER BE USED TO KILL
BACTERIA IN THE GUMS AND IN CAVITIES

at 3:34pm ET

I'm not aware of the use of ozone for anything like that. Peroxide (oxygenated compounds) have been used as part of toothpastes and other oral hygiene aides with the belief that they in fact can inhibit or control the growth of bacteria. The long-term use of moderately high concentrations of oxygenating agents can be of some concern, and should probably be discontinued and not used in as frequent a manner as they have been in the past.

Mike_1 from [155.64.202.209], at 3:35pm ET
I recall my grandparents had false teeth back in the '60s. They must have been in their 60s and it seemed common among their peer group. What's the biggest contributor to people keeping their teeth longer these days?

at 3:37pm ET

A number of factors. Probably chief among these is the advent since the middle 1950s of extensive programs of prevention that have used things such as water flouridation, more regularly scheduled maintaince care, and increased appreciation on the part of the patient of their responsibilities to maintain an adequate home-care program. The use of flourides in food, and oral hygiene aides has helped control the development of tooth decay so that today, the decay rate in the U.S. is down in excess of 40 percent.

Aaron Billotte from [128.118.145.101], at 3:37pm ET
What is there to look forward to or worry about for dentistry as an occupation in the future?

at 3:40pm ET

I believe that dentistry has a very bright future, even though tradtional disease patterns in the American public are changing. New and exciting areas are being developed. The most exciting area will deal with the inter-relationship between oral disease and the patients systemic health. Current research would seem to indicate that many of the bacteria found in oral infections may, in some way, contribute to systemic contidions such as cardiovascular disease, pulmonary disease, low birth-weight infants and premature birth, osteoporsis, diabetes, and several other chronic degenerative diseases. If these linkages are defined, the scope of dental practice will change dramatically and the relationship between oral and systemic disease will require more professional care on the part of the dentist, rather than less.

Mary from [209.24.168.238], at 3:40pm ET
I'm 24 and recently found out that I severely grind my teeth during sleep. I have been using the nightguard for 7 months and already need a replacement at the cost of $375.00 each time. Are there any alternative, less costly treatments or new discoveries for bruxism?

at 3:42pm ET

Not really. Many of the conventional treatments that have been used in the past to include adjusting the patient's bite, fabricating night-splints, and other treatments are still the conventional and standard care that is used to treat bruxism.

Dale from [206.189.10.138], at 3:42pm ET
I purchased a sonic toothbrush a year ago and my dentist says it is doing a good job. Do you believe that this type of cleaning is better than the standard toothbrush?

at 3:43pm ET

I believe that any of the mechanical toothbrushes can be effective. They have a particular appeal for those patients who have physical disorders and cannot hold a hand-held toothbrush. They are also used by many people as their conventional oral hygiene aide, and they seem to work well.

Jim in Denver from uchsc.edu at 3:43pm ET
There is some work in immunology which is targeted at preventing tooth and gum decay. Is there any possibility that many dental/periodontal problems might be prevented with "immunization" against common oral pathogens?

at 3:45pm ET

The history of the development of a immunization process or vaccine has been going on for a number of years. To this point in time, it has not been efficatious, and we do not have a vaccine that can prevent periodontal disease. That process, as research continues to develop, offers some outstanding opportunites to hopefully create new products and techniques that will truly help control and/or prevent periodontal disease.

SKW in da fort from [149.164.187.176], at 3:45pm ET
Will tooth transplantation ever be available?

at 3:46pm ET

It is available now. In some cases teeth have been transplanted from one location in the mouth to a second location in the mouth. These processes have not been very effective and today a great deal of effort is going into the development of dental implant technology so that in fact the transplantation of teeth is waning.

Sunny Johnson from coastnet.com at 3:47pm ET
Will the use of mercury almalgams be banned? Is danger of mercury now evident?

at 3:49pm ET

To date, all of the scientific work that has been done, shows clearly that the mercury in amalgum resorations is safe. I believe that in fact other materials will be developed that will be more effecatious, more aesthetic that the matierials used today. Today, amalgum is considered to be a safe restorative material here in the United States. That decision has been made not only by the governement through the FDA, but also by the scientific testing agency of the ADA.

lily from qwest.net at 3:49pm ET
In the near future are they coming out with any kind of technology that when getting you teeth clean, it will not be painful? especially when scraping is involved.

at 3:51pm ET

There are a lot of new technolgies coming into the marketplace in the area of maintenance care. The long-term hope is that products and techniques will be developed so that root-planing and scaling as we know it today may not be the treatment of choice. There are a number of products that have been developed and recently introduced that appear to control the bacteria in the mouth, and thus inhibit the development of calcalus on the roots of the teeth.

Phill Watts from [208.230.244.1], at 3:52pm ET
Everyone is asking about dental work and techniques. What about the future of Dental billing practices. I have 2 teeth with small cavities but my dentist has made no effort to fix them. She keeps pushing me to get implants -