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October 2008 | Modern Hygienist Mad about MID With more ways to prevent and detect caries, minimally invasive dentistry is becoming the new standard of care for dental hygienists.
In the not too distant past, fluoride treatments and fluoridated water were the most common caries prevention strategies. Removing and replacing decayed teeth and fixing other dental problems after they occurred were standard operating procedures. Patients often feared the pain and discomfort of visiting the dentist and jokes portraying dentists as sadists were common. However, the last few decades have seen major advances in understanding the causes of caries, and hygienists are a leading force in the growth of early caries detection, non-invasive treatments and prevention strategies. Obstacles remain, but someday soon the dental paradigm might be completely shifted from the reactive surgical status quo to a proactive medical model. “It’s still a reparative model versus a prevention model, but slowly but surely preventive care is moving into the dental arena,” says Carri Cady, RDH, sales director for Oral BioTech, maker of CariFree products.
This new model is based around treating the bacteria that cause caries and detecting the caries-caused tooth decay that does occur as early as possible. Prevention and early detection allow optimal treatment and less discomfort for the patient. Laser caries detection technologies can spot the onset of the disease in its earliest stages and use of this equipment is becoming more commonplace. Jeff Thibadeau, vice president of clinical affairs at KaVo America, says about 20% of U.S. dental offices use his company’s DIAGNOdent laser detection systems. “The hygienists have really championed integrating these preventive concepts into practice and the next step is better treatment of the source of the infection,” he says. Early detection technologies allow caries to be spotted before they cause enough decay to require the drilling and filling that were once the hallmark of dentistry. Instead, a number of low-impact remineralization treatments are now available to address early caries impact and repair damaged teeth. As these technologies and treatments continue to improve, stopping carries from occurring in the first place might someday be the norm.
Studies have shown the make up of saliva is a key component to the development of the bacteria behind caries infections. These bacteria thrive in acidic environments, and some prevention efforts are now focusing on the benefits of balancing the pH in patients’ mouths. Cady believes this is a promising area of care that could eventually lead to non-invasive treatments that curtail most caries infections before they impact a single tooth. “The most current research on cariology and biofilms shows that if we can control the pH of the biofilms in the mouth, we can control caries prevention,” she says. These developments can lead to improvements in general oral health, and patients certainly will support anything that means less pain and discomfort during a visit to the dentist. Unfortunately, for now these advancements are still outpacing the financial infrastructure of the dental industry.
Current industry standards pay dentists much more for treating tooth decay than preventing it in the first place. MID advocates know this has to change because as Thibadeau says, “there needs to be better ways to compensate a dentist for doing what’s in the patient’s best interest.” Proving the effectiveness of these minimally invasive strategies, techniques and technologies, and educating patients about these advancements are the keys to shifting the focus of dental care toward prevention. Cady and Thibadeau agree that hygienists, who already take the lead in patient education, can have an impact in advancing MID. “Hygienists play an important role in helping people understand how oral health relates to their overall health. I think the hygienist is best equipped to communicate to the patient how the dental community is approaching their health,” Thibadeau says. As patients gain an understanding that prevention- and detection-focused dental care can be more comfortable, less painful and more affordable, they’re sure to increase the demand for MID. With the science and technology already pointed in that direction, Cady is confident the fee structure will find a way to catch up and dentists will be fairly compensated for their preventive efforts. “The cost of wellness and preventive care will help drive a move to this area because prevention is more affordable than treatment,” she says.
Noah Levine is an associate editor for Modern Hygienist.
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