Minimal Intervention Dentistry: Managing Dental Caries

In the new thousand years, there is a consistently expanding scope of items accessible to help us with the administration of oral illnesses. We have all had those testing patients in whom the utilization of fluoride alone has not controlled their dental caries.

Dental Imaging Device

For these patients, the new gathering of nebulous calcium phosphate items are useful, particularly when joined with fluorides, spit substitutes, stimulants, and antimicrobials utilizing the reasoning of insignificant mediation dentistry.

Consolidating Recaldent undefined calcium phosphate items can help battle caries in high-hazard patients.

What is MID (Minimal Intervention Dentistry)?

  1.  MID utilizations a restorative model for oral ailment control and contains:
  2. Oral illness chance evaluation with early recognition and counteractive action, External and inside remineralisation treatment,
  3. Utilization of a scope of rebuilding efforts, dental materials, and gear
  4. Surgical intercession simply after infection is controlled.

Fundamentally, MID is an instrument to enable us to comprehend and oversee oral infection with the goal that we increment the life span of our rebuilding efforts. For the administration of dental caries in MID, the appraisal and administration of a various gathering of patient-altering elements and essential variables is coordinated with an assessment of the plaque/biofilm interface and the resultant dynamic oral illness process.

This publication describes the history of Minimal Intervention Dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000.

The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the ‘surgical’ care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component.

Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI’s policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.

Rationale of the MID philosophy

Without doubt, the many studies assessing the effect of water fluoridation on the progression of carious lesions have contributed greatly to the development of the MID philosophy. The one study that stands out in terms of importance is the Tiel-Culemborg study from the Netherlands. This study, like many others, showed that the fluoridation of water reduced the prevalence of cavitated dentine lesions by approximately 50%. It also showed that the main long-term action of fluoride is retarding the progression of a carious lesion, rather than prevention of its development. This outcome became evident as ample time was spent assessing not only cavitated dentine lesions, but also enamel carious lesions. The secondary study outcome was confirmed in later studies that researched the effectiveness of fluoride in varnishes, gels and mouth rinses. These data led to a change in the cariology paradigm: fluoride appears not to act pre-eruptively, as was thought, but mostly post-eruptively by changing the mineral saturation characteristics at the tooth surface.

Another topic that was researched extensively in the 1960–80 period was dental plaque. The outcomes resulted in the wide acceptance of the fact that dental plaque or dental biofilm, as it is sometimes more correctly termed, should at least be disturbed or at best be removed from the tooth surfaces daily, if carious lesion development is to be minimised. In combination with fluoride toothpaste, plaque removal with a toothbrush has become a major cornerstone in managing carious lesion development for communities worldwide5.

An important concept, that governed the development of MID, is the ‘Repeat Restoration Cycle’. Elderton and co-workers clearly demonstrated, on the basis of studying the survival of amalgam restorations, that ‘eliminating’ carious lesions in order to improve oral health, through restorative procedures based on the G.V. Black concept, does not keep teeth functional for life for all individuals. The concept reitterated that preventive or non-operative actions should go hand-in-hand with restorative care, and that assessment of carious lesion development and progression plays a vital part in the provision of adequate oral health care. The development of various adhesive materials and adhesive systems has contributed greatly to attaining the primary aim of MID. The ability to reduce the need for cutting away healthy tooth tissues when using adhesive materials, relative to the traditional restorative concepts, has led to smaller and less destructive cavity preparations and therefore, smaller restorations. Retaining sound tooth structure, and thus increasing the chance for maintaining its vitality and function, was further increased as a result of the work done by colleagues like Massler and Fusayama. They showed that only the ‘infected’ (‘outer carious’ or ‘decomposed’) dentine needed to be removed as part of the cavity preparation process, and that the ‘affected’ (‘inner carious’ or ‘demineralised’) dentine could remain. This demineralised dentine would remineralise under a well placed, well sealed and well maintained restoration.

By early 1990, research had shown that managing dental carious lesions should depart from a traditional surgical approach and move to a ‘biological’ or ‘medical’ approach. The research pointed to a completely new approach to the management of the carious lesion. As far as we know, it was Mount who first cited the need for ‘Minimal Treatment’ of dental caries. Further elaboration of this new approach was published by Davis and Makinson, who first termed ‘Minimal Intervention Dentistry’ in the literature. The first International Association for Dental Research (IADR) symposium on minimal intervention techniques for dental caries was held in 1995 and was almost entirely devoted to the developments of one of the MID approaches, namely Atraumatic Restorative Treatment (ART)16.

As mentioned earlier, the aim of MID is to keep teeth healthy and functional for life. A most important element is achieved through implementing the important strategies for keeping teeth free from carious lesions. These strategies are considered to be:

a) early caries detection and risk assessment

b) remineralisation of demineralised enamel and dentine

c) optimal caries preventive measures

d) minimally invasive operative interventions and

e) repair rather than replacement of restorations. It is self-evident that MID does not equate to cutting smaller cavities than before, as many dentists thought.

The first three MID aspects (early caries detection and caries risk assessment; remineralisation of demineralised enamel and dentine; optimal caries-preventive measures) should be employed throughout a person’s life and only when oral health maintenance has failed and a cavity has developed should a minimally invasive operative intervention be undertaken. The authors are aware that the implementation of the MID philosophy will vary in different countries for a number of reasons, which include: professional dental training, access to the internet and printed dental literature, availability and type of dental equipment and dental materials and oral health remuneration systems.

The remainder of this paper will discuss in detail the five strategies that make up the MID philosophy using, as much as possible, evidence-based information available in the peer-reviewed literature.

Some Important Point:

  • Early caries detection and caries risk assessment Detection devices
  • Visual-tactile methods
  • Caries risk assessment
  • ‘Whole-population’ approach and ‘risk-based’ strategy
  • Remineralisation of enamel and dentine carious lesions
  • Mechanisms of action of fluoride in enamel
  • Role of calcium and phosphate
  • Casein phosphopeptide-amorphous calcium phosphate complexes
  • Optimal caries preventive measures
  • Effectiveness of caries-preventive measures
  • Pits and fissure sealants
  • Minimally invasive operative approaches for managing cavitated dentine carious lesions
  • Appropriate excavation methods
  • Disinfecting excavated cavities
  • Restorative materials
  • Restorative therapy
  • When is repair or replacement required?
  • How successful are repaired restorations?
  • Integration of MID in the dental curriculum
  • Survey results on MID application in undergraduate curricula

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