Preventive (Evidence-Based) Approach to Quality General Dental Care

Abstract

Restorative and scaling treatments have not generally provided an effective method for managing dental caries and periodontal diseases. Rather, restorative treatment has often covered up the disease processes in the short term and created a new problem: that of maintenance and re-restoration of restored teeth. Thus, standard invasive dental treatments that are commonly provided fail to address the fundamental bacterial nature of the diseases. Indeed, these treatments rather readily generate and perpetuate a totally unacceptable chain of events. This chain embraces many shortcomings, which themselves nurture what may be described as the repeat restorative cycle. The time has come to correct this iniquity. Dental caries and periodontal diseases are dynamic conditions which need ‘managing’ with a focused cocktail of preventive and refined restoration care. Much more emphasis should be placed upon the assessment of each and every caries or periodontal lesion, with a view to implementing specific preventive measures and allowing the natural arrest of disease processes to occur. The universal adoption of a preventive (evidence-based) approach to making dental treatment decisions could be by far the most powerful factor in reducing the restorative burden of dental services. It is clear that dental education and practice need to rise proactively to the challenge, or changes will be forced upon them while they are in a defensive position. There is a need to move wholeheartedly and contentedly into the preventive era.

Spatial distribuition of tooth loss in a population of adults

“…This is because tooth losses have a cohort effect, since they accumulate over the lifetime of individuals, without any natural association with aging, but due to the aggravation of oral diseases 5 . Not associating the access The fact of access to public or private dental services not being associated with tooth loss could be explained by both the easy access to the services, and by individuals' exclusion from them: because this could culminate in overtreatment and repetitive restorative cycles 23 , or delayed request for and access to dental care, with progression of the disease, respectively, resulting in tooth extraction as the only treatment option 24 .…”

Minimal intervention dentistry: part 1. From 'compulsive' restorative dentistry to rational therapeutic strategies

“…This 'rational' model of care is known as minimal intervention dentistry and is applicable not only to cariology but to periodontology and all other areas of dentistry. [1][2][3] Studies conducted in France in the early 2000s indicated that dental practitioners had not yet integrated this concept of cariology into practise [4][5][6][7] even though, since the 1990s, Elderton had already denounced traditional approaches to conservative dentistry when considered in isolation. [8][9][10] Indeed, traditional oral care, which comprises largely conservative/ operative dentistry, including scaling and polishing, has very little impact on the oral health of patients both in children and adults because the patient finds himself/ herself caught in a repeat restoration spiral of care, where successive replacement…”

“…2,8,11,12 Figure 1 illustrates a patient, aged 33 at the time of the photograph, who has, judging by the number of endodontic treatments present, been obliged to visit the dentist on numerous occasions in the past. The problem of oral hygiene has not been resolved and, the caries process, which is very aggressive, has not been halted.…”

The Role of Remineralizing and Anticaries Agents in Caries Management

“…Technology without purpose does not improve human health and well-being. As researchers, academicians, and clinicians, we need to continue to change the way in which dentistry is delivered, with more emphasis on prevention and intervention as the forerunner to necessary restorative work (Featherstone, 1999;Elderton, 2003;Fontana and Wolff, 2011). We need to target improved remineralization technology and anticaries agents to those who most need it.…”