No drill future for dentistry

Professor Christopher Peck, dean of the Faculty of Dentistry at the University of Sydney: “Our ambition is to reverse the rate of dental decay in Australia and keep the incidence to minimal levels for future generations.”

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.

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

He adds that 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 per cent reduction in the incidence of decay, an almost 50 per cent decline in the need for first-time fillings, and more than 50 per cent 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. “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.”



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  1. A very noble endeavour and one that makes complete sense from the standpoint of scientific and medical philosophy in an ideal world.

    However, it completely under-estimates a little thing called “the human factor”. If, decades after the scientific community has proven the massive dangers of smoking, we are still at a stage where it is legal, popular and where governments welcome the revenues, in all honesty – what chance do we have of achieving widespread passionate toothbrushing?

    Cynical? Definitely. I won’t be throwing the drill away just yet – though I do like the quote “challenge the clinical practice as we were previously taught.” There is great wisdom in this.

  2. Intensive coaching on tooth-brushing tecniques and the hope to instil a life-long commitment to oral hygiene is doomed to fail when we continue to instruct rather than educate. The ability to create informed choice, with due respect for the intellects of our patients, will continue to be our only hope and cannot occur until we educate rather than dictating to our fellow humans. As few as eleven percent free of the effects of plaque is a sad indictment of the present system.

  3. Compliance is possible with patients if you never, ever, ever give up. IF (Big IF as this is the hardest part) you can manage to full compliance to six monthly visits, then the failure of patients to stop caries is our failure. As a hygienist, I am astonished at how much improvement our patients get with timely and meaningful education that starts where the patient is, bit by bit. I am equally astonished at how many new patients that I see who have never had a toothbrush put in their mouth by a dental professional or who have never been properly risk assessed or given health advice and knowledge that they can really use. We MUST believe in both minimal intervention and patient empowerment if we are to be a drill free profession.

  4. Interesting direction… However the human factor mentioned in several other comments is the reality of drill free dentists to become a reality.
    Education, no matter how aggressive although necessary will take decades to ‘sink-in’
    However this time could be reduced with a clever sin doctor and millions of dollars.


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