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By Meg Bryant
WASHINGTON, Mar 29 (Reuters Health) - Dentists are on their way to being able to find and treat cavities before they form, but poor research, insufficient funding and low reimbursement for dental care are slowing progress, according to an independent panel convened by the National Institutes of Health.
The panel cited a number of promising developments that could arm dentists with ways to know very early on that problems are occurring in a particular child, leading to earlier and cheaper treatment.
"Identification of early caries (tooth decay) lesions and treatment with nonsurgical methods involving remineralization represent the next era in dental care," a consensus statement prepared by the panel asserts. But more rigorous studies are needed to explore and test new techniques, the statement adds.
"That's not likely to happen in the absence of dramatic changes in the way the public perceives dental care, the way the profession perceives its responsibility to deliver that care, and, particularly, the way third-party payers understand the needs of society to maintain a healthy dentition," panel Chairman Michael Alfano of New York University told reporters Wednesday.
While the incidence of tooth decay in the US has declined by about two-thirds over the past 30 years, it remains a "significant" public health problem, according to the panel. Roughly 20% of children aged 2 to 4 have at least one cavity, and that figure increases to 80% by age 17. Two thirds of adults aged 35 to 44 have lost a permanent tooth as the result of decay, and a quarter of Americans 65 to 74 have no natural teeth.
Tooth decay actually begins years before any cavity appears, the panel reports. But current diagnostic techniques, such as x-rays, are unable to detect the disease in its early stages when proven, noninvasive therapies like fluorides, chlorhexedine, sealants, antimicrobials and salivary enhancers could halt or reverse decay, the panel said.
Despite improvements in dental care, panelists concurred, barriers to care exist for many Americans and need to be addressed with programs to educate the public about proper oral hygiene. According to the consensus statement, "health disparities...tend to be clustered in minority children, the economically underprivileged, older persons, the chronically ill, and institutionalized persons--the very populations with the lowest access to dental care."
Efforts should also be directed at identifying children who are high- and low-risk for developing cavities, so that resources can be used more cost-effectively, the panel said.
The panel criticized current clinical data on the management of tooth decay, arguing that too many studies are small and flawed. Among other recommendations, the panel called for well-controlled trials of established and new diagnostic and treatment methods, as well as population and risk-assessment studies and studies to identify potentially useful gene markers.
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