"If the highpitched whir of a dentists drill as it bores into your molar terrifies you good news There could be fewer fillings in your future. A painless way to prevent cavities in adults is gaining traction. OK Alice we are going to put the fluoride varnish on your teeth says Marion Manski https director of the dental hygiene program at the University of Maryland School of Dentistry. Fluoride varnish is standard practice for childrens teeth but Manskis patient Alice Clash is  years old. Like many older patients Clash is taking medications that cause dry mouth httpnidcr.nih.govoralhealthtopicsdrymouthdrymouth.htm which puts her at high risk for cavities. So Manski takes a skinny brush and a little pot of yellowish liquid and paints the varnish on Clashs teeth. We know that saliva helps us wash away bacteria and food in the mouth Manski says. The fluoride varnish will help that. One way fluoride helps is by seeping into the enamel and drawing the calcium and phosphate thats naturally present in the saliva. The minerals boost the teeths natural healing process and make them more resistant to future decay. But there are other theories about how fluoride works. It strengthens the enamel before the tooth erupts which is why its so important for children. And it attacks the acidproducing bacteria in the mouth. One study httppubs.acs.orgstokenpresspacpresspacabs.la shows fluoride makes it more difficult for these bacteria to stick to the teeth. Article continues after this message from our sponsor It takes about a minute and the fluoride treatment is done. Some patients are also given a prescription for a concentrated fluoride gel that can be used at night. These preventative approaches work on adults just as well as they do on children says Norman Tinanoff https a professor of pediatric dentistry at the University of Maryland. He says part of whats making fluoride treatments popular for adults is a move to make dental care personal with an individual treatment plan for each patient. To do that you have to weigh a patients risk of getting cavities. One of the biggest proponents of this approach is John Featherstone httpprofiles.ucsf.edujohn.featherstone dean of the University of California San Francisco School of Dentistry. Featherstone came up with a comprehensive way of measuring http a persons risk for caries http or tooth decay. It includes testing the level of bacteria in the mouth and looking at dietary habits medical conditions medications saliva flow and history of tooth decay. When Featherstone put his patients on personal treatment plans he found the strategy http worked. It really proved that drilling and filling did not fix the disease Featherstone says. Putting in a filling fixes that hole in the tooth but it doesnt deal with the bacteria in the rest of the mouth. Most bacteria are friendly but a couple of bad actors can cause cavities. These guys feed on sugars and expel acid that eats away at the enamel. Traditionally dentists were taught that the only way to deal with decay was to drill it out. Thats still important in some cases Featherstone says but without fixing the underlying problem of bad bacteria patients just keep coming back for more fillings. Featherstone saw another way. Its a little bit like your car is starting to rust he says. If you can stop the rust before the rust goes right through the body of the car then youre in good shape. Like rust tooth decay is a slow process. A fullon cavity is a hole that needs to be fixed. But if you catch decay early Featherstone says it can be reversed  http fluoride treatments like varnish and concentrated toothpaste and gels. In the past we believed tooth decay was a rapidly progressive disease. But research shows its slowly progressive says Wendell Evans http_evans associate professor of dentistry at the University of Sydney in Australia. He recently published a study httponlinelibrary.wiley.comdoi.cdoe.epdf that found using these techniques reduced the need for fillings in adults by  to  percent. Striking as these results seem the concept isnt new. This shift to a preventive model of dentistry is decades in the making. Some of the stuff in our study has been known for  years Evans says referring to the use of fluoride treatments. Prevention has always been a part of the world of dentistry says Richard Valachovic http_adeawho_we_areBiosRichard_W__Valachovic_D_M_D__M_P_H_.html president of the American Dental Education Association. What were seeing is a generational shift Valachovic says. As dentists have come to better understand the microbiology of the mouth more effective preventive techniques have followed. But cost has been an issue. Insurance companies routinely pay for fluoride treatments for children but not so much for adults. The National Association of Dental Plans http couldnt give a definitive answer about coverage but calls to some individual carriers and dental offices suggest it depends entirely on the type of plan you have. Some higherend plans cover two fluoride treatments per year while cheaper plans tend not to cover any. If you pay out of pocket a varnish treatment costs from  to  compared with a filling which ranges from  to  according to the American Dental Association http Cost could also be a factor for dentists. Featherstone and Wendell say some dentists may be reluctant to embrace the preventive methods because they worry theyll lose money if they they do fewer costly procedures. At this point Featherstone says twothirds of dental schools in the U.S. teach some kind of disease management model based on a thorough risk assessment. And he expects that at some point all dentists will follow a preventive protocol. It will happen Featherstone says. Its just a matter of time."