Caries: New Approaches to Treatment
Are you surprised to see "caries" listed here? In the era of fluoride, we think of caries as a solved problem, but in some groups (children, elderly persons, and those at risk for infection), the prevalence of caries remains high. Unfortunately, these are often the very people with the least ability to pay for dental care.
I believe that new approaches to the treatment of caries constitute a game changer. For one thing, several tools -- questionnaires and biological assessments -- have been shown to have the high sensitivity required of a screening test to identify, and selectively treat, the patients at highest risk.
Patients who are found to be at low risk for caries (or rampant caries) can be treated using so-called minimally invasive dentistry. Most dentists treat all caries according to the century-old "extension for prevention" protocol, under which a healthy tooth is sacrificed to ensure elimination of the infection and retention of the restoration. In the minimally invasive approach, only the carious tissue is removed, and the tooth is sealed (and sometimes, although not always, filled) to prevent the recurrence of caries. This treatment philosophy has been widely followed in Europe for many years, but adoption in the United States has been slow.
The combination of screening tests and minimally invasive procedures in low-risk patients could be a real game changer for dentistry. So far, formal application of these strategies in the United States has been limited to academic and institutional settings rather than the small private dental offices where most dental care is delivered today. Acceptance is on the rise, however, as both practitioners and patients become aware of the advantages of this approach.