Traditional methods of addressing dental caries have evolved significantly in recent years, reflecting a shift in how we understand the disease. Initially viewed as an infectious, communicable condition, dental caries is now recognized as a chronic, non-communicable disease primarily influenced by lifestyle and behavior. This shift in perspective has sparked a change in the way dental caries is prevented and managed.
Historically, dental care focused on the late-stage symptoms of caries, emphasizing restorative therapy after the disease had already caused substantial damage to the teeth. However, this approach fails to address the root causes or risk factors contributing to caries, making it less effective in preventing further tooth decay. While restorative treatments are crucial, their success is limited by the finite lifespan of dental restorations. Advances in material science have improved the durability of restorative treatments, but restorations inevitably wear out, leading to the need for repeat procedures. These re-restorations often contribute to further damage to dental hard tissues, ultimately increasing the risk of tooth loss.
This limitation has prompted a shift in dental practice, moving away from traditional surgical approaches toward a more proactive method of caries management. The modern approach emphasizes the control of etiological and risk factors associated with dental caries, rather than merely addressing its symptoms. Since 2002, the World Dental Federation (FDI) has advocated for the adoption of Minimal Intervention Dentistry (MID) as a means to manage caries. MID focuses on preserving dental structure and maintaining pulpal vitality, ultimately extending the life of teeth. This approach encourages non-restorative treatments to prevent the loss of minerals in teeth at all stages of caries development, including early detection, risk assessment, remineralization of enamel and dentin, and the repair of restorations instead of full replacement.
Recent studies support the use of novel, minimally invasive agents in MID strategies. For example, a study on the use of AgNCls (silver nitrate-clusters) synthesized in polymethacrylic acid (PMAA) demonstrated promising results. The compound showed chemical stability, low cytotoxicity, and effective antibacterial properties against strains commonly associated with caries, even at low concentrations. This discovery highlights the potential for such topical treatments to serve as part of a broader MID strategy, contributing to effective caries prevention.
Furthermore, when dental caries progresses to a point where cavities form, the MID philosophy still plays a crucial role in treatment. Rather than performing traditional invasive drilling, which can result in further damage to the tooth, MID promotes minimally invasive restorative procedures that focus on preserving healthy dental structures. These treatments prioritize the remineralization of carious tissue after it has been carefully removed.
In a clinical trial conducted by Kitsahawong et al., a comparison was made between chemo-mechanical caries removal (CMCR) and traditional drilling in terms of treatment effectiveness and long-term restoration success. Over a two-year period, CMCR proved to be as effective as conventional drilling for caries removal, with the added benefits of less discomfort during treatment and fewer complications. While CMCR requires a longer treatment time, it aligns with the MID philosophy, offering a viable and effective alternative to traditional restorative procedures.
As the dental field continues to adopt the MID model, it becomes clear that preserving natural dental structures and preventing further decay through targeted, minimally invasive treatments are essential for long-term oral health.
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