An intraoral camera, similar to endoscopes
used in surgery, takes pictures inside
the mouth that are magnified 400 times and
projected on a video screen.

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This argon laser activates chemical bonds in the newly placed filling, enabling the patient to chew with it right away. The dark glasses are a safety measure for the patient when a dentist uses a laser.

Anesthesia, however, will still be available, and you’ll have your choice of delivery methods. Some offices already use high bursts of air pressure to deliver painkillers, or electrical conduction to mask nerve endings. The advantage of electrical conduction, said Dr. Jack Clinton, associate dean for clinical affairs at OHSU School of Dentistry, is that it doesn’t make you numb. However, some pain sensation may still get through.

For some procedures, a small patch could deliver a new breed of anesthetics through the skin. Another technique, called “the wand,” uses a tiny needle, but a computerized gauge ensures that the anesthesia is delivered with low and constant pressure. The pain of an anesthesia shot, said Dr. Sharon Turner, dean of the OHSU School of Dentistry, isn’t just the needle piercing the gum. A too-rapid injection of material pushes apart the tissue, which feels uncomfortable. With less pressure, she said, “many patients will say they didn’t even feel it.”

Those old mercury-silver fillings are passe. Ceramic tooth-colored fillings are aesthetically pleasing but present problems by being ultra-hard, fracture-prone and vulnerable to temperature changes.

New materials — some available, some in development — go far to solve the problem of the microscopic expansion or contraction of fillings with every hot or cold item eaten. Fillings react to temperature change differently from teeth, creating fissures and allowing decay to fester.

If you can stick a little tiny explorer tip in there in the dentist’s office, that’s a 10-lane freeway for bacteria,” Turner said.The tooth-colored materials becoming available can be set with an argon curing laser, which activates chemical bonds and allows you to chew with a filling right away.

New materials are hot right now, said Dr. John Sorensen, director of OHSU’s Dental Clinical Research Center, especially high-strength ceramics that can be designed and shaped right in the office by sophisticated computers called CAD CAMs — reducing the number of appointments for fillings and eliminating the need to make impressions of the teeth. Researchers are working with zirconia, a relative of the material used in faux diamond jewelry, which can be processed by computer and can approach 90 percent of the strength of metal.
       
BANISHING CAVITIES

While advances in these ceramics will benefit you, future generations will learn about fillings only in textbooks. Fluoride already has shifted the focus of dental research away from disease of the hard tissue — caries, or tooth decay — to diseases of the gums, or periodontal disease.

Keith Wycoff, research director at California-based Planet Biotechnology Inc., is among those working to banish cavities to history. His company produces CaroRx, a passive vaccine derived from genetically altered plants, which is in clinical trials at the University of California at San Francisco. When painted on cleaned teeth, the plant antibodies prevent harmful streptococcus mutans bacteria from adhering to tooth surfaces. Within five or six years, Wycoff said, the treatment should be in the hands of dentists and available to the public.

With all these advances, dental visits of the future may be precipitated less by immediate medical need than by social desire.

"The equipment is similar to a Breathalyzer,” Currey said of a halitosis evaluation machine in her office. It measures volatile sulfur compounds produced by bacteria, allowing a quantitative index of bad breath. Products containing the disinfectant chlorine dioxide can reduce the bacteria, Currey said.

Supermarket alcohol-based rinses actually contribute to the problem, because the odiferous organisms use alcohol as a food source. As soon as their potent tastes wear off, the rinses don’t offer much protection.
       
BATTLING GUM DISEASE

Probably the largest focus of study is periodontal disease.Researchers increasingly find reasons for it to hold their attention.

There’s a number of diseases that predispose a person to getting periodontal disease,” said Dr. Roy Page, associate dean and director of the Regional Clinical Dental Research Center at the University of Washington, “and a number of diseases that if you have periodontitis you’re more likely to get. That connection we really didn’t appreciate until a year or two ago.”

For instance, he said, the probability of having cardiovascular disease or a heart attack or stroke is about double if you have periodontal disease. Women with periodontal disease are more likely to give birth to low-weight babies. The exact reasons for these connections aren’t yet fully understood. Periodontal bacteria turn up in the arteriosclerotic plaques of people who have arteriosclerosis, indicating that oral bacteria spread throughout the body via the bloodstream.

Some pills, like Periostat, are available that inhibit the enzymes that destroy connective tissue. Anti-inflammatory drugs in oral rinses and toothpastes also may help. An injectible vaccine has proved effective — but so far only in monkeys. Page, who has been working for 12 years on bridging the simian gap, calls the development of human vaccines “a long, slow, expensive process.”

Until that time, regenerative periodontics can attempt to restore bone and gum. Using grafts and filters placed between the gum and the tooth and bone, specialists can stimulate new tissue in many cases. Lasers increasingly replace scalpels in these kind of soft tissue procedures.

“The high energy seals off the blood vessels, so you get minimal or even no bleeding, and the healing is wonderful,” said Clinton of OHSU. Rapid healing means less pain.

Ruth Bennett is a staff writer with The Oregonian of Portland, Ore.