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Minimally Invasive Selective Caries Removal put into Practice

From Volume 47, Issue 10, November 2020 | Pages 841-847

Authors

Bhupinder Dawett

BDS MDPH

Doctoral Research Fellow, School of Clinical Dentistry, University of Sheffield

Articles by Bhupinder Dawett

Sarah Young

BSc (Hons), BDS, MJDF RCS (Eng), GDP

Hafren House Dental Practice, Alfreton Derbyshire

Articles by Sarah Young

Email Sarah Young

Chris Deery

BDS, MSc, FDS RCS Ed, PhD, FDS (Paed Dent), RCS Ed, FDS RCS Eng, FHEA

Professor/Honorary Consultant in Paediatric Dentistry, School of Clinical Dentistry, University of Sheffield

Articles by Chris Deery

Avijit Banerjee

BDS, MSc, PhD (Lond), LDS, FDS (Rest Dent), FDSRCS (Eng), FCGDent, FHEA, FICD

Professor of Cariology & Operative Dentistry, Hon Consultant in Restorative Dentistry, King's College London Dental Institute at Guy's Hospital, KCL, King's Health Partners, London, UK

Articles by Avijit Banerjee

Abstract

Dental caries remains a significant health problem globally, causing morbidity in those affected and consuming health resources. The management of caries consumes considerable finances both for individuals and the public purse. The scientific understanding of the dental caries process has evolved considerably over the last four decades with a move towards a minimum intervention oral care (MIOC) approach to managing patients. The minimally invasive operative intervention that retains demineralised, caries-affected dentine under a well-sealed restoration in order to avoid instrumentation close to the pulp, has shown clinical efficacy in treating individual teeth, as part of the MIOC framework. However, implementation of the selective caries removal approach in deep lesions is still not thought to be practised routinely by clinicians both globally, and in the UK. This article discusses some of the issues that may account for this and describes a case study using this operative strategy.

CPD/Clinical Relevance: Restoring deep carious lesions can be a challenge, but using selective caries removal approaches will help minimise the adverse effects of pulp trauma.

Article

Although epidemiological surveys over the last four decades have shown an improvement of the rates of dental caries in the UK, caries is still a common problem with the 2009 Adult Dental Health Survey indicating that 84% of UK adults have at least one restoration.1 The Child Dental Health Survey 20132 reported that nearly half (46%) of 15 year olds in the UK have obvious caries experience and a similar number (45%) of 15 year olds reported that their daily life had been affected by problems with their teeth and mouth in the preceding 3 months.2 Over a third (35%) of parents of 15-year-old children reported that their child's oral health had impacted negatively on family life and, over the same period, nearly a quarter of parents had needed to take time off work because of their child's oral health.3 Children indicating engagement with positive oral health behaviours were less likely to have severe or extensive caries. Furthermore, the burden of severe or extensive caries was borne unequally across society, with those most deprived being more affected.

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