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ePaper created 2014-09-12, 17:13:35 | version 1.30.01
Science & Practice Saturday & Sunday, 13–14 September 2014 W inning a competition is usu- ally something to celebrate. The Global Burden of Dis- ease 2010 study ranked untreated caries in permanent teeth first on the prevalence list of 291 diseases and injuries, with severe periodontitis ranked sixth and untreated caries in primary teeth tenth.1 Not exactly a cause for celebration, I would say, but more a profound wake-up call for the dental profession worldwide to analysethestructuresthroughwhich itcurrentlymanagesdentaldiseases to determine realistic and feasible meansofimprovingthesituation. Before the Global Burden of Dis- ease2010studywasevenpublished, we already knew that too many cavi- ties all over the world went un- treated.Wealsoknewthatthepreva- lence of this condition differed sig- nificantly on a global scale, with many countries, such as those in Scandinavia or even my home coun- try, the Netherlands, just to name a few, having done extremely well in this regard.2 In addition to a restora- tive–rehabilitative care system, they have a well-functioning oral health infrastructure, including state and private health insurance systems, and, most importantly, a good com- munication system with the public, through which the adverse effects of sugar consumption and the benefi- cialeffectsofregularbrushingwitha fluoride toothpaste are discussed andmonitoredthroughawell-estab- lishedrecallsystem,andpubliccom- munication measures, such as tele- vision promotions. Afterall,dentalcariesisabiofilm- induced behavioural disease that, supported by preventative meas- ures, can be controlled through per- sonal behaviour, as recently re- ported.3 Children attending educa- tionalandpreventiveprogrammesat university clinics 2.8 times on aver- ageperyearsincetheirbirthshowed a9 %prevalenceofdentalcariesand a mean DMFT (decayed, missing or filled teeth) score of 0.25 at age 4, compared with similarly aged chil- dren whose mothers had elected against attending such a pro- gramme.Theircariesprevalencewas 81 % with a mean DMFT score of 4.1. Dental caries is a dynamic dis- ease and does not always progress from a lesion in the enamel to the dentine and further into a dentine cavity. A carious lesion can be halted bypreventivetreatmentsandbypos- itive changes in a person’s oral health behaviour. This indicates that,incontradictiontowhatisbeing taught, it is not always necessary to drillintoacariouslesionthathasjust reachedthedentinewithoutcausing a clear cavity. If performed too early, drilling would be an unethical treat- ment that contributes to the repeat restoration cycle, which is known to lead to the early death of a tooth.4 Nowadays, life expectancy has reached up to 100 years in a few countries and this number may in- crease further in the future. People are expected to live much longer than they were 50 years ago. This meansthatteethneedtofunctionfor a much longer period. It was in- evitable that the dental profession would begin changing its restora- tive-driven approach for managing dental caries into a preventative communicative and community- driven approach, backed by educa- tion,thatconsidersrestorativeinter- vention as a last resort instead of a primary measure, as advocated by organisations such as the FDI World Dental Federation5 andWorld Health Organization.6 It is not news that the develop- ment of carious lesions can be pre- vented. This has been known for 30–40 years, although there was not as much information available then as there is now. The philosophy of minimalinterventiondentistry(MID) is an attempt to serve the public in thecurrentcentury,andtokeeptheir teeth healthy and functioning into old age. Its goal is to preserve as much sound and remineralisable tooth tissue as possible, starting right from infancy. While MID makes use of evidence-based preventive and restorative measures, it is also open to alternative treatments. It consists of five principles: proper di- agnosis and caries risk assessment at regular intervals, optimal evi- dence-based measures for the pre- vention and arresting of carious le- sions, an individualised recall sys- tem for reinforcing behavioural ac- tions and for providing preventive care, minimally invasive operative interventions based on biofilm erad- ication and the use of adhesive den- tal materials, as well as the repair rather than replacement of faulty restorations.7 Since dental caries forms part of the common risk factors for general health, dental professionals will havetoco-operatemorecloselywith medical professionals. At health care centres with mother-and-child care facilities, nurses need to be trained to inspect the mouths of in- fants, give advice to the caregivers and, if necessary, refer them for treatment. Why should these nurses counselmothersaboutallotherpae- diatric diseases, but not about den- tal caries as the most common child disease? The same applies to paedi- atricians. Many Western countries can no longer balance their health care and oral health care budgets, and as a re- sult they have exploded. If we feel collectivelyresponsibleforthefirst-, sixth- and tenth-ranked items on the list of the most prevalent diseases and injuries, then urgent action is necessary. The MID approach is a good step forward. It is applicable not only to cariology and restorative care, but also to periodontology and rehabilitative care. Dental profes- sionals should not rely on high-tech devices and sophisticated equip- ment to the extent that they do when it comes to the treatment of carious lesions.Ifdentalcurriculaworldwide embraced this philosophy and den- tal professionals worked more closely with medical professionals and the public, then we might create a future scenario in which a different disease will be first on the list in the next systematic analysis on global diseases and injuries. Minimal intervention dentistry Awayforwardformanagingdentalcariesinthetwenty-firstcentury.ByDrJoFrencken,Netherlands. 10 www.fdiworldental.org AD Dr Jo Frencken is head of the Department of Global Oral Health at Radboud University in Nijmegen in the Netherlands. On Saturday morning, he will be presenting a paper on the history of minimal intervention dentistry as part of the FDI 2014 scientific programme. © spotmatik/Shutterstock.com I Owing to increased life expectancy, teeth need to function for a longer period of time.