Dental Tribune Indian Edition

10 Dental Tribune Indian Edition - April 2013World News “A common language for all stakeholders to communicate about caries” An interview with IDEM presenter Dr Nigel Pitts, UK At last year’s IDEM, Dr Nigel Pitts from the UK presented a lecture fo cusing on dental caries as a publiche alth issue, as well as the epidemiology and importance of understanding the science behind primary and se condary caries prevention. Dental Tribune Asia Pacific spoke with him about evidencebased approaches to planning care that can be utilised in dental practice. Dental Tribune Asia Pacific: Cari- es is increasingly considered a serious public-health issue. Has the percep- tion of the disease changed during the last few years and if so, what are the indications of this development? Dr Nigel Pitts: Yes, the perception has changed, but in what way, very much depends on which country one is con sidering. There is a growing aware ness in many “developed” countries, where caries has been declining dra matically for decades, but there are still vulnerable groups, particularly young children, with a very high bur den of preventable disease. In other countries, caries in young children is thought to be increasing. In yet other traditionally lowcaries “developing” countries, there are real concerns that changes in diet and li festyle may be accompanied by an increasing caries problem for society and for individuals. You are one of the developers of a caries classification and manage- ment system endorsed by dental or- ganisations like the FDI World Den- tal Federation. What is the concept behind it and what is its potential for decreasing the burden of tooth decay in the world today? ICDAS (International Caries De tection and Assessment System) is a simple, logical, evidencebased, de tection and assessment system that classifies the stages of the caries pro cess. It is designed for use in dental education, clinical practice, research and public health. It provides a com mon language for all stakeholders to communicate about caries, and faci litates valid, consistent comparisons of lesions at single and multiple time points. ICDAS has evolved to comprise a number of approved, compatible for mats for different needs and appli cations, including simplified forms for those wanting to work with fewer stages of caries. The potential for de creasing the burden of caries ranges from helping the transition to a more preventive approach to caries, hel ping in assessing health needs more realistically for populations and indi viduals, helping evaluate preventive programmes and helping to deliver more preventive caries control and better future products through rese arch. Apart from classification, what other advantages does such a system offer? ICDAS leads to better quality in formation, derived from the asses sment of caries severity and activity, to support decisions about diagnosis, prognosis and clinical management at both the individual and publichealth levels. As we know more about the complexities of the caries process, informing sound clinical decisions is increasingly important for providing appropriate and highquality caries care. How can these concepts be ap- plied to dental practice? ICDAS has created the In ternational Caries Classification and Management System (ICCMS), an open system developed specifically to meet the needs of those seeking a preventively orientated framework to support and enable comprehen sive clinical caries management in the dental practice situation. This framework will help the dental team secure improved longterm outcomes for their patients. There are improved means of de- tecting and assessing risks for early carious lesions. Has technology changed how we look at them? The clinical visual detection and assessment of early lesions (using ICDASstyle approaches) is the foundation for planning care, but the re is a continuing need for detection aids to help identify lesions that are difficult to detect visually and for ef fective risk assessment tools. Examples of some of the newer ap proaches on the market for detection are enhanced electrical, optical and radiographic detection aids. These should be considered prudently as aids to preventive caries care, not just finding more cavities to fill. There are also developments in risk assessment systems, such as CAM BRA, to accompany older established systems, such as cariogram. All of the information derived from these useful detection and risk assessment tools needs to be integrated into a holistic and personalised preventive treatment plan for each patient. Concerning the management of early carious lesions, you promoted a study in 2010 on the best way to ma nage decay in children’s teeth called FICTION (Filling Children’s Teeth, Indicated or Not?). The study to be finished in 2018 is examining the different approaches (conventional re storation, preventive method and the Hall technique) to children of ages three to seven. Is there a tendency to wards any of these approaches so far? As you indicated, this exciting study will not be completed for some years. The feasibility stage is finished and the muchneeded backtoback com parison is getting underway—it is too soon to see results yet. The mounting evidence we do have (from multiyear randomised controlled trials in gene ral practice) is that the approach of biological, preventive management with reduced surgical intervention (such as with the Hall technique) is showing results that are better than those achieved by the more conven tional methods. What approaches to primary and secondary caries prevention are the most promising and what evidence do we have with regard to their clini- cal effectiveness? The strongest evidence on caries prevention comes from highquality systematic reviews of fluoride, whe ther in water, salt, toothpaste, var nish or other forms. In addition, there is strong evidence of the efficacy of sealants. There are also some promising new developments with remineralisation, but it will inevitably take time to ac crue further evidence of clinical ef fectiveness. There is evidence that a purely restorative approach is not efficient but preventive caries control has been adopted rather slowly in many countries. Do you see a move from an operative towards a more preven- tive approach? I do see this move from a purely operative towards a more preventive based approach gathering pace. It has been a very slow change in some countries, despite the profession talking about it for decades. Howe ver, there are a number of countries that have been controlling caries in this way for years and an increasing number of countries that are in tran sition. Reform of payment systems and changes in patient expectations are important components of this change. Thank you very much for this interview.DT “I do see this move from a purely operative towards a more preventive-based approach.” DrNigelPittsatIDEM2012.(DTI/PhotoClaudiaDuschek,DTI)