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Overtreatment in caries management? a literature review perspective and recommendations for clinicians Indrajeet Ghosh Prakriti Dayal Samiran Das Dental Update 2024 43:5, 707-709.
Authors
IndrajeetGhosh
MMedSci, BDS
Associate Specialist, Department of Dentistry, (drighosh@tatasteel.com)
Professor, Department of Prosthodontics, Guru Nanak Institute of Dental Science and Research, Nilgunj Road, Panihati, Kolkata, West Bengal-700110, India
Dentistry, like various branches in the healthcare profession, is susceptible to overtreatment, especially in the management of dental caries, due to the adoption of an aggressive restorative approach. This philosophy provides no actual benefits to the patient in terms of arresting the disease process, which initially led to the carious lesions. Yet practitioners routinely continue to initiate restorative treatment procedures without attempting to understand and alter the biologic factors contributing to the caries process. This paper examines the available scientific literature in this regard and makes recommendations to the clinicians of today based on the available evidence.
CPD/Clinical Relevance: The paper provides clinicians an approach to avoiding overtreatment by adhering to established clinical guidelines and accepted operative strategies.
Article
More than two decades have elapsed since academic stalwarts and caries researchers realized the need to apply a different treatment approach towards caries and cavitated lesions.1,2,3,4,5 Historically, tooth conservation by repeated restoration was favoured over extraction owing to the functional ability of the restored tooth.4 Dental schools favoured disciplines which mastered the art of improving upon existing restorative treatments, thus spawning what is termed as the ‘energetic restorative tiger’.4
Government-funded research in Western countries towards the latter part of the 20th century provided the insight into and the impetus for a better comprehension of the caries process. Recognizing that the cavitation of teeth via demineralization was only a symptom of the disease process and not the disease itself, researchers started focusing on the actual disease process and the steps that should be taken to arrest or reverse it.4,5 Beneficial to this new focus was the emergence of long-term clinical studies which suggested that the ‘repeat restoration cycle’ that dentists subjected their patients to actually shortened the life span of teeth.3,6,7,8,9,10 The research consensus was that the demineralization process in initial and incipient lesions can be arrested and possibly reversed without any restorative intervention by the patient's maintenance of excellent oral hygiene and change in lifestyle.9 Where it is necessary to restore frank cavitated lesions, a minimally invasive approach is suggested after a thorough caries risk assessment.7 Additionally, a stepwise excavation and sealing-in of caries is advocated.5,11,12,13
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