Here's the drill: There will be no drill.
August 8, 2016 2:22 PM   Subscribe

A Silver Bullet for Dental Cavities. "Nobody looks forward to having a cavity drilled and filled by a dentist. Now there’s an alternative: an antimicrobial liquid that can be brushed on cavities to stop tooth decay — painlessly. The liquid is called silver diamine fluoride, or S.D.F. It’s been used for decades in Japan, but it’s been available in the United States, under the brand name Advantage Arrest, for just about a year."

Here is the research.

"[the] promising results suggest that SDF is more effective than fluoride varnish, and may be a valuable caries-preventive intervention. As well, the availability of a safe, effective, efficient, and equitable caries-preventive agent appears to meet the criteria of both the WHO Millennium Goals and the US Institute of Medicine’s criteria for 21st century medical care."

The treatment protocol.

The only negative side-effect appears to be staining, which may be mitigated somewhat through application of potassium iodide (as described in the protocol).

A safe, non-invasive caries treatment that costs pennies has huge implications for dental health costs. This could be very good news indeed for low-income and marginalized populations who struggle with getting proper dental care.

An issue - the potential conflict of interest: dentists who used to charging hundreds of dollars for fillings and now....
posted by storybored (54 comments total) 38 users marked this as a favorite
 
Can I just say that I still cannot accept the word "caries" as an acceptable alternative to "cavities?" I don't know why, but my brain insists on processing it as a misspelling rather than a synonym, and it trips me up no matter how many times I see it.

I've also never been clear on whether "carie" is a Britishism, or a technical term, or what. I (East coast American with lots of fillings) have never heard it spoken aloud, and didn't even know the word existed until I ran across it on Wikipedia a few years back. What is the deal?
posted by Anticipation Of A New Lover's Arrival, The at 2:29 PM on August 8, 2016 [9 favorites]


Big Amalgam will stomp it out.
posted by GallonOfAlan at 2:37 PM on August 8, 2016 [9 favorites]


dentists who used to charging hundreds of dollars for fillings and now....
Depends on where you live I guess. I've had my fair share of fillings, but not even the more complex ones cost me nearly that much.
posted by farlukar at 2:40 PM on August 8, 2016 [1 favorite]


If I was the lawyer for Big Teeth, I'd have them patent a version of SDF with some "pixie dust" ingredient, and then present that product (and only that product) for approval by the FDA.

That's how I'd try to ensure that dentists and dental-product providers can continue to enjoy high prices and large margins.
posted by spacewrench at 2:42 PM on August 8, 2016 [1 favorite]


To add to the weirdness of the word, "caries" is singular, like species and congeries.

There was an idea for a caries vaccine a while back that sort of disappeared; I hope this treatment finds more success.
posted by gubo at 2:44 PM on August 8, 2016 [1 favorite]


I've also never been clear on whether "carie" is a Britishism, or a technical term, or what. I (East coast American with lots of fillings) have never heard it spoken aloud, and didn't even know the word existed until I ran across it on Wikipedia a few years back. What is the deal?


That is the term we use in french as well, I believe it is latin in origin, not english.
posted by Hazelsmrf at 2:45 PM on August 8, 2016


nooo don't pour silver diamine fluoride on caries, they'll kill everyone at the prom
posted by prize bull octorok at 2:46 PM on August 8, 2016 [72 favorites]


It's not the fillings that cost hundreds (and thousands), it's the eventual root canal or crown or other that seems to come along with fillings further down the road.

I've often wondered if there wasn't a better way to deal with cavities and infections in the mouth than destroying teeth. I see antibiotics mentioned on some of the more out there websites but part of me wonders if there isn't some truth there. I don't know, and you certainly don't want to fuck around with tooth infections but again, the physical assault on teeth because of various infections reminds me of the way we amputated limbs with abandon before antibiotics.

(Just some thoughts I've had over extensive dental work. Sigh.)
posted by [insert clever name here] at 2:48 PM on August 8, 2016 [11 favorites]


Why hasn't this been popularized/introduced to America before now?
posted by Monochrome at 2:51 PM on August 8, 2016 [1 favorite]


This is the best dental news I've heard since the most recent "Okay, we'll be able to grow new teeth from stem cells for you any day now, we mean it this time" article.
posted by Pope Guilty at 3:04 PM on August 8, 2016 [5 favorites]


Dear lord, this can be life-changing for someone as abjectly terrified of dentists, mouth pain and drilling as I am. Thank you for posting this!
posted by vers at 3:05 PM on August 8, 2016 [12 favorites]


Second to last paragraph:

Still, silver diamine fluoride is no silver bullet.

Checkmate.
posted by PsychoTherapist at 3:07 PM on August 8, 2016 [9 favorites]


Pictures on this site show the staining, which is extremely noticeable. (The article is blurred out unless you register or pay for site access or something, but the pictures on the right are not.)
posted by Jane the Brown at 3:10 PM on August 8, 2016 [2 favorites]


The only negative side-effect appears to be staining,

Given that staining is a possible side effect of colloidal silver, does this represent a potential new range for bluetooth?
posted by mwhybark at 3:13 PM on August 8, 2016 [8 favorites]


Pictures on this site show the staining, which is extremely noticeable.

what the actual fuck, this is garbage, bring on the drills
posted by poffin boffin at 3:26 PM on August 8, 2016 [16 favorites]


WHERE CAN I GET THIS IN MY MOUTH IMMEDIATELY?

Seriously, I've lost track of how many cavities I have (pretty sure it's more than I have teeth, I have genetically awful teeth in every way according to all dental professionals) and I don't care if my teeth turn brown since I don't smile with teeth anyway. Plus I already have to use tooth-staining prescription mouthwash anyway, so that's already happened.

But seriously: just paint my entire mouth in this stuff already. I'm so tired of being lectured about this stuff, that would have to cut down on it.
posted by jenfullmoon at 3:30 PM on August 8, 2016 [7 favorites]


Pictures on this site show the staining, which is extremely noticeable.

what the actual fuck, this is garbage, bring on the drills


The words in the article, the one linked above for pictures independent of text, points out that the staining happens where cavities have been forming. That's not going to happen to healthy teeth, which is why it's envisaged as a helpful preventive measure and not a full replacement for targeted treatment (even though it can be used that way for people who'd prefer a stain to a drill). Really, you guys, the words that go with the images in that article are a wee bit important to knowing what you're looking at.

Likewise, I have a lot of visible dental work--dark metal on the back of my teeth that's visible from the front of the teeth--that was put there by drills.
posted by late afternoon dreaming hotel at 3:39 PM on August 8, 2016 [3 favorites]


Bless you mattdidthat
posted by 1adam12 at 3:41 PM on August 8, 2016


So you're saying in the right circumstances, it would be cheaper for me to go to Japan for my dental work, if I cannot find a dentist near me to do this thing
posted by alex_skazat at 3:43 PM on August 8, 2016 [2 favorites]


(The article is blurred out unless you register or pay for site access or something, but the pictures on the right are not.)

You just need to edit two DIVs: delete the one with an id of "blurred-signup" and find the one with the "blurry" class and remove that class.
posted by MikeKD at 3:50 PM on August 8, 2016 [5 favorites]


"But where were you, Lord, when I went for my routine dental cleaning, and had four cavities?"
"It was then, my child, that I caried you." (swiped from twitter @neilaglet)
posted by fings at 3:51 PM on August 8, 2016 [23 favorites]


It's not the fillings that cost hundreds (and thousands), it's the eventual root canal or crown or other that seems to come along with fillings further down the road.


This. Every time they drill your teeth, there's structural damage. When the filling eventually falls out or if decay appears around the edge of the filling, they need to drill again... do that a couple of times and a root canal is inevitable. Still further down the line, the tooth itself is a goner, and now you're looking at implants or dentures.

Cost of SDF = .50 a drop.
Cost of drill-fill-root-crown-extraction-implant => large f*cking wallet.
posted by storybored at 3:56 PM on August 8, 2016 [9 favorites]


My daughter had a poorly formed tooth, one of her back molars. I believe this is what the dentist used to help protect it as an interim step. It stained her tooth black but it was in the back of her mouth so you really couldn't see it. Structurally, the tooth continued to deteriorate and so we just got a stainless steel crown as she'll have this baby tooth for some years yet. We have dental insurance but this cost us $200 out of pocket.
posted by amanda at 4:02 PM on August 8, 2016 [1 favorite]


Pictures on this site show the staining, which is extremely noticeable.

Today I got to be the person looking at weird dental horror pictures on BART.
posted by teponaztli at 4:05 PM on August 8, 2016 [8 favorites]


Safe? It causes chemtrails and communism (channeling John Birch).
posted by theora55 at 4:05 PM on August 8, 2016 [1 favorite]


So you're saying in the right circumstances, it would be cheaper for me to go to Japan for my dental work, if I cannot find a dentist near me to do this thing

Dental care is pretty cheap in Japan. My spouse has gotten small stuff done there because it was convenient even though we are 100% covered for it under my insurance here in Canada. They apparently aren't big fans of anaesthetic but if you can take the pain then dental tourism to Japan could be worthwhile.
posted by any portmanteau in a storm at 4:14 PM on August 8, 2016


I remember reading about this long time ago and asking my dentist about it. He said the problem was that the holes they clean out are not large enough to fill. Seemed a weak objection to my mind, but, you know, I'm no dentist.
posted by BWA at 4:30 PM on August 8, 2016


Interesting. My dentist recently gave me this treatment on my back teeth, and since I've been the recipient of multiple fillings and a root canal, I'm all for anything that prevents that, staining or no.
posted by Aleyn at 4:43 PM on August 8, 2016 [1 favorite]


I just assumed "caries" came from saying "cavities" with your mouth wide open.
posted by emelenjr at 4:43 PM on August 8, 2016 [35 favorites]


I wonder how it compares to laser dentistry. I had a filling done via laser a couple of years ago, and I still feel like that might have been magic, it was so quick and painless.
posted by peppermind at 4:52 PM on August 8, 2016


AOANLA,T: "Can I just say that I still cannot accept the word "caries" as an acceptable alternative to "cavities?" I don't know why, but my brain insists on processing it as a misspelling rather than a synonym, and it trips me up no matter how many times I see it."

My brain knows it's "caries", knows it means "cavities", and automatically conflates the two
posted by Pinback at 4:58 PM on August 8, 2016


If you've got cavies in your teeth, don't call the dentist. Call the vet.
posted by Anticipation Of A New Lover's Arrival, The at 5:01 PM on August 8, 2016 [7 favorites]


Why hasn't this been popularized/introduced to America before now?

Well, it's a painless medical intervention that lessens the risks of a youthful indulgence...
posted by condour75 at 5:07 PM on August 8, 2016 [5 favorites]


Not a single Macross joke in this entire thread? Jesus, Metafilter, get a grip.
posted by selfnoise at 5:11 PM on August 8, 2016 [2 favorites]


I performed a little natural experiment.

For the first three decades of my life, I performed haphazard dental hygiene, and got bleeding gums and had many cavities.

For the next three decades, I brushed carefully twice a day and flossed correctly once a day.

Since beginning conscientious dental hygiene, I haven't had a single cavity and my gums are in very good shape. Draw what conclusions you will from this.
posted by Modest House at 5:11 PM on August 8, 2016 [4 favorites]


Anesthesia is really catching on in Japan, to the point where it's the norm in all but the oldest dental clinics offer it. Never been offered this treatment in the article, though.

Incidentally, oh man, it's more than dental care that's fly-to-Japan-and-save-money cheaper. I got a hernia last fall and the doctor visit, X-ray, and MRI came to about ¥8,000. If I were uninsured in Japan, it'd have been about ¥30,000. An acquaintance of mine got an MRI in America and despite having insurance was out $3,000 for it.
posted by DoctorFedora at 5:18 PM on August 8, 2016 [2 favorites]


Why hasn't this been popularized/introduced to America before now?

Like so much else -- follow the money.
posted by CosmicRayCharles at 5:40 PM on August 8, 2016


I've thought this possible for a long time, glad it's finally here. But will it be allowed in the US? I'm guessing, not for years... but I'm fine with the notion of dental tourism to Japan.

And WTF is this term 'caries'? Never heard it before, and don' like it.
posted by Rash at 5:48 PM on August 8, 2016 [2 favorites]


I just happen to be recovering from a root canal right now. They had to do it in two stages because besides thinking it was a filling and maybe a crown, they opened it up and discovered it wasn't just a filling. Oh, and my terrible TMJ. Oh, and I'm almost impossible to get numb, and it wears off super quickly.

The first round was totally barbaric. It was one of the worst days of my life. Today wasn't quite as bad, but still not fun.

This treatment seems like a step in the right direction...for all the modern technology in the world, dental work has decades of catch up to do.
posted by guster4lovers at 6:01 PM on August 8, 2016


I thought "caries" was the name of the tooth decay disease itself, akin to "rabies".
posted by megafauna at 6:31 PM on August 8, 2016 [2 favorites]


Oh, I should also add that a standard drill-and-fill costs well under ¥3,000 including anesthesia (and usually much closer to ¥2,000 or even less). There's some strangeness about the national healthcare system's system of payments meaning that the healthcare only covers one tooth per visit, but honestly I'm okay with making a few half-hour visits in order to save like $100 each time compared to, to pick my home country at random, the United States.
posted by DoctorFedora at 6:33 PM on August 8, 2016


Oh, hey, I know a dentist! (Dude I went to high school with.) I just shot him this link and I'll report back if he has comments. His forte is more orthodontia and reconstructive dentistry, but he has a general practice so I'm sure he's heard of this thing, at least.
posted by EmpressCallipygos at 6:46 PM on August 8, 2016


I was taught that caries is the disease/infection. And that a cavity is the result. That's why you'll see phrases like "carious lesion" in dental texts. Cavity means hole. Caries is how you got that hole.

/went to dental school, but not a dentist
posted by readyfreddy at 6:55 PM on August 8, 2016 [9 favorites]


I was taught that caries is the disease/infection. And that a cavity is the result. That's why you'll see phrases like "carious lesion" in dental texts. Cavity means hole. Caries is how you got that hole.

/went to dental school, but not a dentist


I concur
/son of a professor in a dental school, but not a real doctor because I just have an MD and he had a PhD too.
posted by TedW at 8:38 PM on August 8, 2016 [2 favorites]


I thought "caries" was the name of the tooth decay disease itself, akin to "rabies".

Quite so. Getting "caries" confused with "cavities" is like getting "rabies" confused with "slavering psychotic rage".
posted by flabdablet at 9:21 PM on August 8, 2016 [2 favorites]


Last time I was at the dentist they used a laser for a cavity that had developed. Sounded even more terrifying then the drill, but they didn't have to freeze me, and I was able to eat lunch right after with zero pain.
posted by Canageek at 12:22 AM on August 9, 2016


You just need to edit two DIVs: delete the one with an id of "blurred-signup" and find the one with the "blurry" class and remove that class.

Is there some sort of alternative liquid I could spray on the webpage to make the article appear?
posted by Celsius1414 at 6:46 AM on August 9, 2016 [2 favorites]


Getting "caries" confused with "cavities" is like getting "rabies" confused with "slavering psychotic rage".

Now I wonder about capybaras...
posted by Namlit at 7:15 AM on August 9, 2016


Wow. I really recommend anyone thinking about this check out those pictures. 8 is before 9 is after.
posted by xammerboy at 7:22 AM on August 9, 2016 [2 favorites]


Used for decades in Japan?
Not by any dentist I have had the... opportunity to be treated by over the last decade.. Drillers to a man (and one woman) :(
posted by AxelT at 7:22 AM on August 9, 2016 [1 favorite]


Dentist Dude says he is unimpressed because of the staining and because it needs repeated treatments, from what he understands. He also has grumbles about fluoride-phobic clients in general, and fears that this particular treatment would spook them.
posted by EmpressCallipygos at 9:39 AM on August 9, 2016 [1 favorite]




You know, I'm starting to wonder if this is another standard-issue case of "internet declares something A Thing in Japan; Japan largely confused by declaration"
posted by DoctorFedora at 3:09 PM on August 9, 2016


Is there some sort of alternative liquid I could spray on the webpage to make the article appear?

Remove the signup div and change the "blurry" class to "article".
posted by aniola at 10:17 AM on August 20, 2016


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