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November 3, 2008 | Web Exclusive

More MID commentary  

Drs. Joe Whitehouse, Stewart Rosenberg and Mark Wolff had more interesting things to say about minimally invasive dentistry than we could fit in the November 2008 print edition of DPR. Here are a few more of their comments.

Dr. Joe Whitehouse			Dr. Mark Wolff			Dr. Stewart Rosenberg

Dr. Joe Whitehouse

“When I consider the benefit of MID for my patients, I only have to think of my own knee surgery. It was a no-blade scope and for a repaired meniscus. My patients, when informed how I can use MID to best serve their needs are thankful I have embraced the philosophy. From my lasers to implants, ortho, Lumineers, and CAMBRA, I find each use of MID feels good to me, and the outcomes are equal to or better than old, more invasive procedures.”

Dr. Mark Wolff

“Dentistry is not about a preparation design or material, it’s about preventing the need for surgical intervention in the future. MID is an understanding that conventional surgical procedures may be overly destructive of healthy tooth structure.

“For example, a porcelain laminate veneer though more conservative than a full crown, destroys far more tooth structure than the a simple bonded restorative to close a diastema. Minimal Intervention Dentistry is a philosophy of preserving tooth structure, preventing and reversing the effects of dental caries.”

DPR: How did you get started?:

Dr. Wolff: “My first introduction into minimally invasive dentistry came in 1980 when I questioned a faculty about why we extend Class II preparations facially and lingually beyond the contact. After completing a literature review, it became obvious that there was no “evidence” to support this practice and I wrote an article for Dental Student (60:32-36, 1982) titled “Conservative techniques result in better restorations.”

“I began practicing conservative preparation and restorative techniques since I started in practice in 1982, both in amalgam and composite restorative materials. When unsure whether a tooth required an occlusal restoration or not, I sealed it. This is what we were taught in the late 70’s and have practiced since my start. When viewing early demineralizations and caries invading the enamel only, I have always used remineralizing techniques. First prescribed fluoride products and now prescribed fluoride and calcium remineralization products.

“My patients are educated that restoring a carious lesion does not cure the disease, rather fixes the damage. The disease involves a complex interaction of the effects of carbohydrates, bacteria/plaque and saliva. They learn about the disease and how we recommend controlling it. Patients come to my practice, in part, because of this!”

Dr. Stewart Rosenberg:

“Every dentist has some percentage of patients in his practice, that no matter how good they seem to be doing with the dentist in terms of oral hygiene on a daily basis and regular checkups, no matter how exquisitely we feel we’ve done our restorative dentistry, we all have patients that almost every time they come back for a recare visit they have recurrent decay or they have new lesions. In dental school we were taught to wait until somebody had a hole in the tooth and then fill it.

“But those that embrace minimally invasive dentistry recognize that caries is a bacterial/biofilm disease and that unless we determine and then treat the cause of the disease our work is destined to fail.”

Dr. Rosenberg also considers screening for things such as oral cancer as a critical component of the overall MID care provided to patients.

“I think it begins again with diagnosis and early detection,” he said. “A case in point. Something as simple and potentially horrific as an oral cancer examination. Twice as many die from oral cancer than cervical cancer every year and it’s growing. Yet many dentists don’t really do adequate oral cancer examinations. So I’m a huge believer in such technology as the VELscope and Vizilite being a part of everybody’s routine hygiene examination once a year on every patient because you may save somebody’s life by doing so. This again is not a terribly expensive thing to do or to implement into your practice. In fact it’s inexpensive.”


For the full article, "Providing More with Less " click here.