There is a large international meeting of dentists and equipment innovators in Cologne, every year where they gather to discuss the future of dentistry, learn about up and coming technologies and to sell and exchange information and ideas. Some of the products and ideas will take many years and even decades to come to fruition, but they are there every year – innovating.

There are robotic filling and crown printers, wireless mouth scanners, virtual reality style surgeon glasses and 3-dimensional x-ray units, among many other weird and wonderful sights. Each item advances and improves dental treatment. The future of dentistry is on show at this International Dental Show in Cologne, and at this moment in time in the Twenty First Century, the development of dentistry has reached a juncture where the pinnacle of dental technology and the pinnacle of dental treatment philosophy ideas are here, now.

Right now though, even in some remote suburban family dental clinics, there is a machine that mills a customized filling out of a material more than 4 times stronger than tooth structure. It is then glued onto the prepared surface of the damaged tooth with an adhesive that bonds the filling not only to the hard calcium based tooth structure, but also to the flexible tough collagen fibres in the tooth.

The computer scans the patient’s teeth and the machine makes the filling to an incredibly precise accuracy. Improved accuracy dramatically improves longevity and applicability of the filling and the tooth. This is one part of the future of dentistry. It is estimated that in just 10 years, more than half of all dentists will be using this form of futuristic computer generated filling technique.

Dentists have been restoring teeth akin to builders restoring houses, since the dental profession’s inception. The computerized milling machine just makes the restoration or rebuilding of the tooth more accurate and tooth-like by mechanically enhancing the defect rather than just mechanically repairing the defect. This is a big leap forward in the future of dentistry. The other aspect of the future of dentistry is biological enhancement.

Twentieth Century dentistry involved the drilling and filling of weakened teeth as the first and last line of treatment in order to save broken teeth. Twenty First Century techniques involve the biological repair of teeth as the first line of treatment. Activated calcium which repairs the initially weakened tooth structure through remineralisation and also bone augmentation to replace lost jaw bone after gum disease or tooth extraction, are two techniques where dentists are now able to encourage the body to re-grow weakened areas, or at least minimize the damage in the tooth or jaw.

From the early Twentieth Century, it was the norm of treatment for a dentist to excavate and fill a weakened or cavitated area of a tooth or to extract an unsaveable tooth. Modern dentists would describe these techniques as mechanical repairs and body part amputations respectively, due to the brutal nature of the treatment, especially of the latter. No other body part would have been amputated with such lack of regard for the consequences. In comparison, the biological foundation of modern Twenty First Century dentistry promotes healing and rejuvenation as the primary treatment of choice, with treatments such as remineralisation.
It is very obvious that different generations have different treatment requirements for their teeth. In the early Twentieth Century, in some cultures it was common to see the new bride have all her teeth removed so as not to burden her husband with the care of her teeth, such was the patriarchal and financial considerations of the era. In a dental practice, nowadays, these women appear with full sets of false teeth and atrophied shrunken jaw bones. They never have full chewing or speaking function again compared to a person with a full set of healthy teeth.
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The comparison would be of a fully able bodied race runner compared to an amputee running. The amputee may well be able to operate relatively well, but never as completely as a fully able bodied person.

The difference in the Twenty First Century is, of course, bionics. The innovation with the development of bionics or biocompatible functional artificial body parts has been very rapid in recent years. A great medical example is the artificial replacements which have allowed Paralympians to compete in sports. Both functionally and aesthetically, there is still much development needed before these equal the normal human body part and even moreso for them to exceed the function and aesthetics of the original body part.

The development stage of artificial mechanical teeth is well underway. Dentists and their patients will be seeing the benefits of this in the next decade where repaired or replaced teeth will look and function well, almost to the level of a healthy set of teeth. The next step beyond this will require a biological base for the repair and replacement of teeth. Growing a new tooth has always been the holy grail of restorative dental research. When this is achieved, repaired and replaced teeth will be equal in appearance and ability to natural teeth. But how do we get teeth that are stronger than natural teeth? Current technology already has materials that are able to be used as fillings that are stronger than natural teeth. The old silver amalgams had some physical properties that were stronger than natural teeth. However, as was learnt from the problems of the silver amalgams, with the questions over their toxicity, lack of biocompatibility and expansion fractures of the adjacent tooth structure, strength is just one of the properties that dentists have to consider. Strength is important, but not the most important factor in the artificial restoration of teeth. Also important are the shape of the tooth, especially the biting surface for the interlocking and functioning with the opposing tooth during chewing, and the sides of the tooth which must be a certain shape to minimize weakness inducing plaque buildups. The computerized filling machine has the accuracy and ability to improve the strength and shape of the tooth. In its current development phase, it is still very reliant on the skill of the operator, the dentist.

Even with ‘learning’ artificially intelligent computers in the future, where the computer learns from each success and failure of tooth design and improves at each stage, the input of the dentist is still the deciding factor as to whether the tooth succeeds or fails. Regardless, together with ubiquitous magnification equipment from surgical loupes to microscopes, the ability to create more precise and accurate treatment for the patient correlates directly to longer lasting and more ideal treatment.
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With the resulting ability to shape and strengthen teeth with the current and future technology, the question will likely be whether there can be too much strength in the filling material.

A likely balance would be a material that is equal to or slightly higher in strength than normal healthy tooth structure, whilst knowing that there is the possibility of generating a filling with much higher strength if required, and also of minimizing unwanted side effects.
One of the side effects already mentioned by researchers of extreme high strength filling materials is that the opposing natural tooth may suffer excessive wear against the relatively much higher strength material it is opposing.

The corollary of all this impressive high technology equipment is the knowledge that we now have of the causative factors for the patient’s dental conditions. Research has increased knowledge in all facets of medicine and dentistry exponentially in the Twentieth Century and if it continues in the Twenty First Century, we can expect to be able to find solutions for many more dental conditions within the next century.

Dental caries or decay which along with gum disease, is the most prevalent dental disease in the population. Dental decay is caused by three main factors sugar and acid; duration of contact on the tooth structure, and the caries causing bacteria. By reducing or eliminating, any of these three factors, dental caries cannot proliferate. Scientists have finally developed and are currently trialling a vaccine for the caries causing bacteria. The caveat relating to all dentistry is and always will be- the patient. Most dental conditions are preventable. The irony is that as mechanical tooth repair technology improves exponentially, the dentist treatment of choice remains as it was in the late Twentieth Century that is: the focus on prevention.

However, the advertising budget of sugar and acid laden drinks and foods which cause tooth problems, the stress that modern human society brings and its affect on the excessive wear on teeth and human nature and its foibles will always lead to the dental problems that firstly can be prevented and secondly treated.

There has been a reaffirming of the importance of dental health in the overall health of the body. A link was recently confirmed between heart disease and dental plaque and gum disease bacteria. The bacteria causing each has a familial similarity. The soft tissues of the mouth including the gums, palate and tongue have always been indicators of bodily health. For example, a dentist would be able to see signs of a weakened immune system or aspects of anaemia from looking at the condition of the tongue and gums.

Ancient Ayurvedic and Traditional Chinese Medicine never separated dental health from the body health. Holistic medical philosophies such as these would always look at the interaction between different body systems, treating the body as a whole. In modern medicine, particularly when based on Twentieth Century scientific validation techniques, there was a separation away from Holistic medical philosophies as they seldom met the scientific criteria of the era.
In the Twenty First Century however, as more knowledge about the dentistry and medicine is discovered, it is likely that there will be a reintegration of Holistic philosophies into mainstream Western medicine and dentistry.

The Holistic ideas will still need to be proven scientifically, but with a modified scientific criteria, showing their usefulness in preventive and regenerative medicine. It is likely that modern medicine will remain the primary choice for the treatment of acute medical conditions.
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The mouth is the first entry point from the external surroundings into the internal body, and as such, firstly, is a very important defence point which needs to be kept in optimum health, and secondly is unique as an indicator of internal/external body health. With patients usually seen every six months for a regular dental checkup appointment, it is also a useful consistent marker for changes in the health of the body over time.

Healthy teeth function well, wear normally and look good. They also must be supported by healthy gums, jawbone, jaw joint articulation and be easy to clean and maintain. With healthy teeth, comes a sense of confidence. A smile is the default facial position in a social contact situation. When meeting people for the first time or the last time, a confident smile is the natural opening facial posture.

The importance of teeth in a social context is can be confirmed by the fact that a smile is the default facial posture. It is intrinsically linked to the psychology of self confidence. Varying across cultures around the world, healthy teeth express a healthy body and healthy mind. In modern Western cultures, a smile must show white, straight teeth to show a person’s prosperity. In this same culture, prosperity and social status are linked to the wellbeing of a person’s psychology, based on Maslow’s studies.

So far in the Twenty First Century, visual communication is becoming a universal form of expression as there have been the proliferation of picture sharing apps and websites such as Instagram, Snapchat and Facebook, and the increasing use of emoticons instead of written words. A smile whether showing white straight teeth or a tilted crooked smile, or the ubiquitous duckface posture of several years ago, will always be the default facial posture in these visual picture sharing apps.

In the early part of the Twenty First Century, we are approaching the pinnacle of dental treatment , where there is the knowledge and the technology to restore teeth to incredible accuracy and durability. The dental profession are steadfast in their philosophies of preventive and conservative treatments in saving teeth and maintaining good oral health, so there is also the Twenty First Century technology treatment primarily by healing technologies and then secondly by use of the restorative dental technology.

Teeth as a part of the whole body, and as an important part of the psychological wellbeing of a person is being validated in much of the recent thinking. We are coming into in a golden age of dental health and dental treatments. We now have a choice in choosing which path of dental health to take. Do we look after ourselves to avoid dental problems? Or do we wait for dental problems knowing that they can now be solved better than ever before in the Twenty First Century. Unsurprisingly, dentists will still instruct you to choose the former.