Volume 8 • 2021 • Issue 1

Chemical Therapeutics and Non-Restorative Dentistry: Essential Tools During the Pandemic Dr. Brian Nový Chief dental officer of the Alliance Dental Center of the Massachusetts Public Employee Fund Dr. Brian Nový’s patient had decay around every restoration in her mouth. She had severe xerostomia caused by a long list of prescription medications [ Photo A ]. Dr. Nový restored two of her teeth and made appointments for her to come back regularly, so that he could “restore every single tooth in her mouth,” says Dr. Nový. When the pandemic hit, it was this patient that he worried about first. T he patient couldn’t stop taking any of her medications because they were necessary to treat her serious health problems. But Dr. Nový could no longer work on the restorations. “It’s up to me as her dentist to figure out the best way to treat her, to ameliorate the effects of her medication-induced xerostomia, while also producing high quality dentistry with a good prognosis,” he says. In 2018, the American Dental Association released evidence-based clinical guidelines on non-restorative treatments for caries. 1 It was the result of a two-year review of the scientific literature that determined the effectiveness of chemical therapeutics. “It brought together experts to discuss the evidence for treating tooth decay without a drill,” says Dr. Nový. “We’ve had chemical therapeutics for a while. With this review, we had the evidence, all in one place, that they work really well.” Dr. Nový believes that the pandemic is an opportunity to further embrace the use of non-restorative treatments for dental caries, especially because when aerosols present an increased risk, chemical therapeutics are a more attractive choice. Healthy biofilm A healthy mouth is nether too acidic nor too alkaline. Too much acid causes caries. Too much alkalinity causes calculus. “But right in the middle, that patient could exist in a state of homeostasis where they are healthy and they don’t develop disease,” says Dr. Nový. “So how do we do that?” The future of dentistry, Nový believes, will likely involve more dental care that doesn’t require a dentist to be in the same space as patients, but helping patients maintain healthy homeostasis. “I would love for all of us to be able to nurture the growth of good bacteria in our patient’s mouth, so they can 28 | 2021 | Issue 1