Can Dentists Manage a “Behavioral Issue” with Restorations?

In a recent webinar, Dr. Kutsch discussed whether or not dental caries is a disease of choice. Choice by the patient to continue to “neglect” their dentist’s advice and a choice by the dental profession to manage caries with only restorative care. As a profession are dental professionals really being honest about their beliefs? Is dental caries a disease or simply holes in the teeth? Here are a few interesting samples of patients being treated with a restorative-model approach.

 

Example 1: Glass Ionomer Treatment

Image of teeth Image of Teeth“A healthy but anxious 28-year-old single mother of four…Review of the patient’s medical history and lifestyle revealed no systemic or behavioral causes for her advanced cervical caries other than consumption of sweetened ice tea and infrequent professional care. Her plaque control was acceptable, except in the areas around the demineralized and cavitated lesions that were “too sensitive to brush”. The patient had followed the recommendation of a friend who suggested she substitute xylitol for granulated sugar in her sweetened tea.”

The treatment was to fill the holes with glass ionomer: “Traditional glass ionomers and RMGIs have been important materials for caries management, atraumatic restorative treatments, and interim therapeutic restorations.” (Ewoldsen N. Management of advanced dental caries. (control anxiety, conserve resources, repair and preserve teeth). Inside Dentistry April 2015. 10(4):90-93.)

 

Is restorative dentistry really a solution? Will filling lesions with glass ionomer ‘cure’ the patient? What do you think this patient will look like in 2 years? Glass ionomer is not the issue. The issue is that this patient’s problem is not curable simply by filling her lesions with the material. This patent needs to change their behavior; and we cannot manage a behavioral issue with glass ionomer.

 

Example 2: Digital Dentistry Treatment

“All mandatory caries were excavated, root canal therapy was completed, restorative dentistry was accomplished in four visits. Practicing digital dentistry, I’ve become a provider that provides both the surgical and restorative needs of my patients while improving their quality of life with 21st-century diagnosis and personalized treatment planning.” (Ramirez A. Galileos, Cerec and success in modern dental practice. CERECdoctors.com Q2 2015:14-22.)

 

Example 2D Example 2C Example 2B Example 2AAgain, the product or method of restoring the teeth is not the issue, CEREC is amazing. It is the fact that this patient will be back in the office in 2 years with the same problems.

Restorative dentistry already failed this patient in terms of treating her dental caries.

 

This is a disease, not just holes in the teeth. We can no longer be okay with categorizing this disease as a tooth level disease.

“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.” (Divaris K. Predicting Dental Caries Outcomes in Children: A “Risky” Concept. J Dent Res. 2015 Dec 8.)

 

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