Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions

Minimal (or minimum) intervention dentistry is the complete holistic team-care approach to patient-centred prevention of disease and management of oral health in the long term. It is centred on managing the ‘dental caries’ process, first ‘controlling and curing’ the disease, and employing minimally invasive techniques when operative intervention is unavoidable. This concept is not a new one, given that the man frequently referred to as the father of operative dentistry, GV Black, stated that ‘The day is surely coming…when we will be engaged in preventive rather than reparative dentistry’ and there are textbooks on the subject listed as recommended reading for undergraduate students and qualified dentists alike.1^,2^,3 The breakthrough discovery of the acid-etch procedure by Buonocore in the mid 1950s laid the groundwork for the ability for clinical dentistry to adapt to a more conservative, minimally invasive approach to restorative dentistry.4 Despite the presence of MID in the dental literature, the application of this concept seems slow in its integration into general dental practice. There is no doubt that a more restrained approach to placing the first restoration in a tooth surface has a long-term beneficial effect for the longevity of the tooth.5 Unfortunately, many dentists in NHS practice feel inadequately reimbursed for preventive care to adults and this may be affecting the transition from dental surgeon to dental physician.6