The art and science of dentistry has little to do with the patient’s life span but a lot to do with their lifestyle. Physical comfort, enjoyment of food and drink, overall bodily health, aesthetics and personal pride are all affected by the state of patients’ teeth. Currently the understanding of the dental disease process is advancing considerably. Techniques for early identification, prevention and healing are improving while the terminology is also changing. Significantly, patient expectations are rising.
Within this context the greatest change in dental treatment is recognition of the concept of ‘minimal intervention dentistry’. This approach involves providing dentistry in the most conservative manner and limiting undesirable outcomes.
Today, there is sufficient evidence for the dental profession to justify modification of its approach to the treatment of dental decay which, for a long time, was based on a surgical cure for a bacterial disease. The profession should concentrate on the dental disease process and overcome that, before considering what is necessary to repair an affected area. Many early abnormal changes, commonly called lesions, can actually heal through elimination of the impacting disease resulting in no further treatment.
The life span of a filling is 10 to 15 years. The average life span of patients is increasing and is around eighty years. The filling materials currently available continue to improve but remain a poor substitute for natural tooth structure. With our current knowledge it is now possible to minimise the problems that occur from decayed teeth and ensure patients’ teeth will last well in to the later years of life.
Water fluoridation has lead to a dramatic reduction in tooth decay. However fluoride is not the only important factor in the mouth. Calcium and phosphate are also significant. These are components of saliva as well as major components of teeth.
The critical role of saliva is finally being recognised in the maintenance of dental health. Apart from calcium, phosphate and fluoride ions, saliva contains bicarbonate buffers to assist in breaking down acids generated from food, drink and bacterial activity. The effectiveness of saliva can vary considerably in an otherwise healthy patient and is subject to rapid change as a direct result of health variations. These can be controlled or modified.
Tooth structure can be compromised in two ways. Decay caused by bacteria and non-decay tooth loss resulting from long term acid in the mouth. Non-decay tooth loss is an insidious process that unfortunately is becoming more common because of diet and lifestyle changes. The early stages of this are difficult to identify, however the damage done can be as serious as decay, so early recognition is imperative.
The only constant in any profession should be change. The dental profession is no exception. If all dentists were to concentrate on early recognition of decay, its elimination and then adoption of minimal intervention principles for the treatment of lesions, patients would be both appreciative and much better off.
The profession would raise itself to new heights as ‘Dental Physicians’ rather than ‘Dental Surgeons’. Our practice is actively pursuing this goal.