You know what your new smile will look like before the dentist does any work, courtesy of a state-of-the-art comprehensive imaging system. Your teeth are numbed by a computer-assisted anesthesia delivery system while lasers remove decay. And if you need ceramic restorations, a computer-aided design and manufacturing techniques will construct them.

Space-age technologies already in use at many dental offices are giving patients more natural-looking results with reduced discomfort. But that's not the half of it. Dentistry is on the threshold of even more discoveries and cutting-edge developments that have the potential to dramatically advance oral health and other aspects of our well-being as we continue to improve our understanding of the relationship between oral health and total health.

Oral disease, including periodontal diseases—bacterial infections in the gums that can result in bone and tooth loss—may involve the rest of the body, too. Researchers are exploring how bacteria in the mouth might be associated with many health conditions, including diabetes, cardiovascular disease, pre-term births and strokes.

However, to establish clearly whether and to what extent those associations exist—and how to use that knowledge to improve people's health and lives—calls for more research.

"Smart" Fillings. On another front, imagine "smart fillings" that prevent further tooth decay; toothpastes that restore tooth minerals and strengthen teeth; and chewing gums and mouthwashes that reverse and "heal" early decay. Researchers are working on these and other developments to improve oral health and the delivery of dental care at the American Dental Association Health Foundation's Paffenbarger Research Center (PRC), in Gaithersburg, Md.

The ultimate "smart filling," for example, would release a substance on demand to reduce acid and decrease tooth-mineral loss. Recent studies have shown that calcium-phosphate cements (CPC) may be good candidates for drug-delivery systems that include "smart filling" material. This, according to scientists, would prevent decay from recurring around dental fillings and in adjacent teeth. Current uses of CPC include repairing cranial defects, fractures and periodontal bone loss.

PRC scientists are working to develop other calcium phosphate-based technologies that can remineralize hard tooth tissues or, at a minimum, retard decay-producing demineralization.

Studies show that an experimental chewing gum can raise the level of enamel-forming minerals in plaque fluid, lowering the potential for demineralization. Studies also have demonstrated remineralization using a mouth rinse.

Grow Your Own. In other breakthrough developments, gene therapy will be in the vanguard of 21st-century dentistry. Scientists are investigating gene transfer and tissue engineering that could be used for the repair of damaged or diseased tissues and even replace missing teeth. This new gene-transfer technology and strategies for artificial organ development, for example, are being used on damaged salivary gland tissue, a condition that is currently untreatable. If salivary glands can't make saliva (their primary function), resulting problems may include difficulty chewing, swallowing and digesting food, as well as rampant tooth decay, pain and discomfort.

Scientists also are investigating tooth-regeneration technology, which may one day offer an alternative to dentures and dental implants. Already, researchers have genetically engineered mouse and human cell lines to reproduce and form parts of the tooth—including dentin, enamel and cementum—in laboratory culture. And they have grown "teeth in a lab dish" for mice. Researchers now predict that, over the next 20 to 25 years, patients might have teeth genetically regenerated in their own mouths.

Other applications of this technology may include regenerating or repairing such structures as the periodontal ligament. This holds the teeth to the bone surface and may be destroyed by gum disease. Still other applications include growing soft pulp to replace damaged pulp in a tooth's root to help avoid dental infections.

Prevention, however, is still the best key to maintaining a healthy smile. By practicing good oral hygiene and visiting the dentist regularly, you can enhance the future of your own smile.

For more information about the American Dental Association's position on other oral health issues, visit the ADA Web site: www.ada.org.

Dr. Mascola is president of the American Dental Association, and in addition to his private practice in New York, he is an attending prosthodontist at the College of Dentistry, Brookdale Center of New York University.