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In focus: Minimally Invasive Dentistry
One of the more progressive movements in dentistry during the past few decades has been the philosophy of Minimally Invasive Dentistry (MID). With the 1999 formation of the World Congress of Minimally Invasive Dentistry (www.wcmid.com) —and similar organizations in Europe and South Africa— the movement received formal recognition and continues to gain adherents worldwide. Dental Practice Report Digital Edition recently spoke with Dr. Joseph Whitehouse, past president of WCMID, about MID’s basic tenets and associated business, clinical and technological implications. Dental Practice: What is Minimally Invasive Dentistry and how has it evolved since its inception? Dr. Whitehouse: Minimally Invasive Dentistry (MID), also know as Minimal Intervention, has been developing over time in dentistry just as in medicine. MID is the philosophy of preserving teeth for a lifetime with minimal intervention. It is the systematic respect for the original tissue by preventing disease from occurring and, when it does occur, by intercepting its progress by removing and replacing disease with the least loss of that tissue, hard or soft. Technology in recent years has enhanced the ability to practice MID in terms of prevention, diagnostics and treatment. Some of these technological developments include digital x-rays, Diagnodent, Difoti, air abrasion, lasers, magnification, bonding and material changes, veneers, Invisalign, ligajet, interosseous injections, sealants, bleaching, and more. The latest effort to prevent caries is called CAMBRA, which stands for caries management by risk assessment
Dr. Whitehouse: CAMBRA originated in 2002 with Dr. John Featherstone, University of California, San Francisco, dental school, and Dr. Doug Young, University of Pacific dental school. They and a group of researchers came up with a consensus statement that provides both a summary of the components of caries risk assessment, and the basis for minimally invasive caries management based on that assessment. This was published in the February and March 2003 issues of the California Dental Association Journal. Dental caries is a continual balance, or imbalance, between pathological and protective factors. This is the basis for CAMBRA. This approach involves understanding patients’ caries risks, and devising appropriate strategies for prevention, early detection and minimally invasive intervention. Fluoride applications have impacted caries by making teeth stronger; nevertheless, the biofilm holding the acid-producing bacteria have not been adequately managed. CAMBRA helps in this management by identifying the habits and diets of a patient with the disease so that the negative behaviors (such as sipping soda all day) can be identified and eliminated. The biofilm’s acid production can now be tested, interrupted and treated by using the correct medications. MID cannot be practiced without the CAMBRA principles.
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