Rethinking Our Approach to Caries Disease
Cavities are a disease. The caries disease is one that dentists have been tasked with treating for as long as there have been dentists. Both patients, and sometimes dentists, have been approaching this disease in a narrow way. By broadening their vision and looking at caries disease in a more appropriate way, it’s possible to revamp the way cavities are treated. Because caries disease is not merely a disease of the tooth surface, it’s a whole person disease. If you shift your treatment paradigm from treating the surface of the tooth to treating the patient who has a disease, you can treat the causes of the disease and meaningfully improve patient health and long-term patient outcomes.
An Outdated Model
Science is constantly developing. Consequently, those people in medical professions need to consider how that science should inform treatment decisions.
The previous treatment model for cavities was fairly straightforward, if frustrating for patients. When a cavity developed, the dentist would drill out all the decay and fill it with an appropriate repair material. Prevention was limited to fluoride containing toothpaste and flossing daily, which was not particularly effective in a number of cases. Those people were told that they weren’t brushing well enough or some version of them losing the luck of the draw where their tooth health was concerned.
This line of thinking about caries disease is largely reactive. When a cavity develops, it gets drilled and filled. Prevention is not really practical in this model. It’s too limited in scope to help patients remain cavity free, so it focuses on treating symptoms as they emerge.
A Broader View
The evidence is there, and it is growing every day. Caries is a whole person disease. It is preventable when you consider the whole disease process. CAMBRA, Caries Management by Risk Assessment, is a systematic way to take this research evidence and implement it in your practice for the benefit of your patients.
Starting with a comprehensive history, including diet and medications, the dentist looks at the lifestyle factors and develops a picture of the behaviors that can be modified and the risk factors that can be controlled to keep patients caries free. Instead of looking in the patient’s mouth to guess what has changed since the last visit, the patient history and clinical experience added together can indicate that medication-caused dry mouth is leaving the patient with unprotected teeth. This can open a conversation about saliva restoring products to keep the tooth enamel bathed in protective, hypermineralized saliva. Patients can be counselled about their frequent snacking and how to restore a healthy pH without brushing away enamel while acidic conditions have dissolved minerals out of the enamel. When patients talk about feeling plaque on their teeth between twice daily brushing, it can spark a conversation about bacteria control, particularly when that feeling is corroborated by a high CariScreen score.
Perhaps more importantly, a broader view of caries disease can help spark a conversation with patients about the evidence pointing to oral health and cardiac health commonalities. Talking about how long-term medical conditions and oral health are linked can help in the management of chronic conditions. Looking at the oral environment as part of the whole body health instead of considering oral health a stand-alone system may also help patients understand that delaying dental care is not a great way to keep healthy. Teaching parents to manage oral health can help pass better health onto the next generation. Looking at caries not as a tooth condition, but as a systemic condition can help actually treat the underlying disease, not just treat symptoms of the disease.