Caries has been treated by restorative intervention as a primary treatment. Knowing now that caries is a mutifactorial infectious disease which can be reversed if anticipated in an early stage. Despite that fact that around two decades back, medical model has been recommended to treat this infectious disease, not only dentists continue treating it in old fashioned manner but the clinical teaching of caries remains on obsolete principles. When and how this mindset would change??
Hi!
In response to the title question: Yes, since the other option is to leave caries to progress, and such progress may lead to infection, fractures, and even tooth loss. Drilling and filling is the strategy which showed over the years to work on stopping such progress, maybe sometimes slowing such progress.
Regarding the comment.
Your exposition has several domains.
Education. On the one side, people should be taught about the importance of oral hygiene, be involved in conscious self-care, and rely on honest regular checks (not moved by the willingness to earn the most performing fancy treatments). On the other side, dentists (stomatologist) have to be committed to the process of educating the persons on the importance of self-care, the correct hygiene procedures according to each person.
Clinical teaching (dentistry). It is imperative to understand the basis of the modern clinical procedures. It may be seen like time-consuming, but it is the way to understand and improve new techniques, otherwise, you will be forming mere-technicians.
Response to the final question: Several conditions have to happen before to promote a change in the teaching procedures of dentistry. The population have to reduce the need for “traditional” (maybe old-fashioned) treatments; similarly, need to be wealthy enough to cover to cost of modern “fancy” non-traditional treatments.
My statement:
If the population experiences the best possible oral health, “old-fashion” treatments, as well as “fancy” treatments, will not be needed at all.
As long as we identify economic disparities combined with the experience of infectious diseases, the best cheap, fast, effective treatments will always be needed. Moreover, personnel trained to perform under several conditions (urban, rural, camp).
Before thinking about the treatment of dental caries, we must establish a correct diagnosis and assessment of the risk of caries, in order to be able to decide in which cases we can establish as treatment: first non-invasive strategies, second, strategies of minimal intervention and when require restorative dentistry techniques.
The above must be taught without privileging restorative dentistry, but rather establish the correct diagnosis and assessment of the risk of caries as the central axis of the dentist's activity.
Remineralisation is a surface phenomenon, body of the lesion cannot remineralise. Cavitation of the tooth is like bursting of an abscess. If the cavitation does not occur then the pulp can be exposed, requiring root canal treatment or extraction. Restorations if done properly can last a long time.
I agree with Jose Francisco's point of view. The treatment should be based on caries risk of an individual patient. Non-invasive strategies should be employed first. But evidence suggests that dentists drill and fill any black carious lesion, may it be cavitated or not.
Beside establishing a correct diagnosis and assessment of the risk of caries, to decide if non-invasive strategies or minimal intervention would fit to the patient, the real challenge is and will long remain what to do with those asymptomatic very deep decay lesions, where the patient walk into the office door just by chance or because a broken enamel ridge suddenly bothers him. ( see attached x-ray)
New concepts of caries removal focusing on vitality preservation are recently been proposed from the ICCC consensus report , where unselective to soft dentin procedure or stepwise deserve to be implemented.
Unfortunately the general practitioner's compliance for such MID procedures is very low ... one side because of fear to end with an emergency or a bad reputation in case of pulpitis pain... on the other side because contemporary materials lack of anti-bacterial properties and are uneffectives to stimulate the self healing potential of the pulp-dentinal organ which is based on restoring homeostasis and on stimulating the phisiological remineralisation of the affected dentin.
As long as adhesion rules dental practices there is little hope to move forward....and RCT is a better way to make more benefits $ !!
Best regards
Nicola
Attached pdf. file : follow up of the case 6 years later ... and a pedo case for exemple of restorative MID
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