by Dr. V Kim Kutsch
As practitioners I believe we must start discussing and treating dental caries as a disease of the person, rather than a tooth surface issue.
“Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease… The article concludes with the notion that accurate caries risk assessment at the population level and “precision dentistry” at the person level are both desirable and achievable but must be based on high-quality longitudinal data and rigorous methodology.”1
So what does it mean exactly to treat dental caries as a ‘person level’ disease with ‘precision dentistry’?
Precision medicine is defined as: A medical model that proposes the customization of healthcare, with medical decisions, practices, and/or products being tailored to the individual patient.
If we look at these two patients as an example, they are both high risk, averaging 2 new lesions per year. However they obviously have VERY different risk factors. With precision medicine we take into account who they are, their behaviors and their individual risk factors in order to precisely target their issues and create a customized strategy for treatment. We cannot treat these two patients with the same strategy and expect the same result.
If we were to revert to intuitive medicine, or gut reaction, to fix the tooth surface problem, we would drill and fill with both patients. However, as we know, drilling and filling does not treat the underlying cause of the damage and is thus not a good strategy.
Taking it one step further, using empirical medicine we may look to more of a medical model and treat them both with Chlorhexidine and fluoride, a one size fits all approach. However, using an antimicrobial on the top patient will not help as they do not have a bacterial load issue. A one size fits all treatment plan does not work.
Finally, if we instead take a precision medicine approach, we target our therapies to the patient’s individual risk factors and can then be effective in helping them overcome their risk and effectively manage the disease process.
CAMBRA allows us to determine exactly what each individual person’s risk factors are and we can therefore respond precisely. Relying on any other method will not help our patient’s fully manage their disease.
- Divaris K1. Predicting Dental Caries Outcomes in Children: A “Risky” Concept. J Dent Res.