UF Researcher Launches Dental Reform Group

December 12, 1996

GAINESVILLE, Fla.—The number of teeth filled in the United States could drop by as much as 75 million annually if dental payment practices are reformed, a University of Florida researcher suggests.

“In dental schools today, we teach ways to avoid filling teeth through prevention or by causing shallow areas of decay to heal themselves with fluoride. Unfortunately, students graduate and go into a payment system that primarily rewards them for filling decay rather than reversing dental disease,” said Dr. Douglas K. Benn, associate professor and director of oral diagnostic systems at UF’s College of Dentistry.

To combat the problem, Benn has formed a national nonprofit educational organization of insurance companies, dental researchers and practicing dentists whose goal is matching payment incentives with the latest dental knowledge. The UF-based Alliance for Best Clinical Practices in Dentistry plans to hold conferences to generate guidelines based upon scientific evidence for preventing and treating oral diseases.

Since Benn launched the alliance in February, more than a dozen health-related corporations have joined. Members of the group include Prudential Insurance, the Kaiser Permanente Dental Care Program, Eastman Kodak, Cigna Dental, Delta Dental, Pacific Union Dental and Tufts Associated Health Plan.

Each year, dentists in the United States fill almost 150 million teeth and perform 14 million root canals. About 70 percent of tooth fillings are done to replace old fillings, showing that filling teeth is not a very successful way of controlling decay, Benn said.

“Until now, we’ve been drilling out lumps of teeth and filling them, but it hasn’t been reducing the infection that caused the decay,” Benn said. “Very often, it simply ushers in a repair- destruction cycle. The original filling frequently gets replaced by a bigger filling and then you end up with root canals and crowns.”

Instead of fillings, research suggests early tooth decay should be treated with fluoride to induce self-repair and antibacterial rinses, such as chlorhexadine, to fight the infection that caused it, Benn said. Dentists should advise patients to reduce their frequency of eating sugar, give pointers on brushing techniques and monitor bacterial levels until the infection is under control.

“You would only need to fill teeth when the decay is so close to the nerve of the tooth that you would be worried if it progressed deeper,” Benn said. “Probably 50 percent of the teeth that are currently filled would not be filled.”

That’s good news for patients but raises an important question for dentists: How would they make a living? Under the system envisioned by Benn, dentists would be paid for assessing decay risks and controlling infection.

Patients would notice differences also, Benn said: They would visit dentists and have X-rays taken according to their risk for decay. Low-risk patients might make fewer trips to dentists. High-risk patients might go more often, but only rarely face the dreaded drill.

The Alliance for Best Clinical Practices in Dentistry is designed to bring differing viewpoints in the industry to the table, Benn said. Dental insurance companies want payment reform to control costs. Academics want reform to make sure research advances are applied in the field. And dentists want to take care of their patients in the best manner — without going broke.

“It was set up so that it would not be controlled by any one group involved in oral health care,” said Benn, who is president of the nonprofit organization.

The group has organized a symposium on cavity management for March in Orlando in conjunction with the International Association for Dental Research’s annual conference. The group’s own conference is planned for next fall in San Francisco.