Minimal Intervention Dental Care: What’s it About? {Part 2}
In part I of this series, I discussed the basic philosophies around minimal intervention dental care – saving sound tooth structure (i.e. not cutting away teeth), repairability and restorative life cycles. In part II of this series, I’d like to touch on how minimal intervention dental care is essentially focused on fundamentals -and why fundamentals are the focus of long-term value in any system.
I frequently see patients who are seeking an opinion around their dental care needs. This need for a second opinion has often arisen from the recommendations (regarding dental care) provided by another dental practice. Very often – the recommendations are focused on the placement of crowns, bridges and implants. In my opinion, these recommendations of “more involved” treatment modalities are premature. By looking in the patient’s mouth, I often notice broken teeth, inadequate/leaking fillings, scope for improvement of the patient’s bite, that, if delivered correctly, will provide stability, improvements in chewing efficiency and the cosmetic benefits that go hand-in-hand with these functional improvements. I call these fundamentals. Traditionally, fundamentals are considered boring, so let me elaborate.
Let’s take the humble filling. Almost invariably, many of the composite resin (white) fillings I see come into my practice lack at least one of the following:
Comprehensive removal of decay (using a dye that demonstrates the presence of decay as a method of quality control);
Engineering of the shape of the tooth to accept the filling, disciplined use of formwork to shape up the filling;
Disciplined application of adhesives including prevention of contamination of the adhesive layers;
Choice of filling materials based on stresses the tooth is to experience and;
Shaping of the filling to create the appearance of a tooth.
Yes – these concepts are technical – and boring. But…The application of these multiple, critical concepts are what form the essence of an excellent filling. Furthermore, the dental material manufacturers spend millions upon millions of dollars on developing these dental filling materials. The correct and disciplined use results in a restoration that looks just like a tooth and works like a tooth.
By identifying the critical teeth in a patients’ mouth and applying these fundamentals to restore those teeth, it is almost inevitable that dental stability will arise.
Almost inevitable because I haven’t mentioned education. Education provides patients with the ability to understand their requirements in terms of diet, stress, home care, personal strengths and weaknesses. It is not possible to develop fundamentals without education – education is the key to patients’ developing their own stability – an achievement that very often can’t be taken away from the patient once correctly implemented – it has the potential to be permanent.
The establishment and maintenance of these fundamentals is at the core of dental health – i.e. dental stability. Once established and understood, it is usually very durable. It is only once stability is established that the dentist sees ‘eye-to-eye’ with the patient around what is lacking in the system.
It is essential that the patient’s teeth and dental health is developed to the best it can be, before moving to more advanced treatments. By restoring people’s mouths with direct composite resin fillings, refinements can be made if necessary by simple remodelling of the fillings with either more or less filling material to make changes in functionality, cosmetics, or repair in instances of breakage.
Once patients experience this kind of stability, they can see ‘eye-to-eye’ with the dentist. Any choices around more advanced treatments (if necessary) become more elective and simpler since the tone of the outcome has already been set in the fundamentals.
DR ALEX HUSZTI BelleDental
Alex has had a career focused on low-biologic cost reconstructive cosmetic dental care – common sense teeth for life.
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