With his introduction to Minimally Invasive Dentistry (MID) in 1991, Dr. Kim Kutsch joined a small, but growing, group of dentists intent on redefining optimal dental care.

For the next nine years, the Albany, Ore., general practitioner added and refined MID techniques—all aimed at preventing disease and, when it occurred, salvaging as much of his patients’ healthy tissue as possible for as long as possible. If, for instance, he encountered a carious tooth, he’d likely spurn the drill in favor of loupes and a small bur to ensure he removed no more than the diseased tissue. For Dr. Kutsch and his like-minded peers, any notion of extension-for-prevention existed only in dental history books.

Then in 2000, Dr. Kutsch’s practice took another progressive turn. Not content to merely coral and minimize the effects of oral disease, Dr. Kutsch began to hone in on the bacterial basis of infections. His aim was to eliminate the very threat of caries. “I had a huge paradigm shift in my thinking,” he says. “I started looking at risk assessment-based diagnosis … and trying to treat the root cause of the disease rather than just the signs and symptoms.”

The move had practice-wide implications. Patient education protocols would need to be overhauled; and because Dr. Kutsch’s success in eliminating their bacterial risk could involve lifestyle changes—such as diet modifications—their compliance would be key. Also, because his staff would share educational responsibilities, their buy-in was essential.

Getting started

For patients, Dr. Kutsch decided to begin with an interview. “The first thing I do is sit down and go through a risk-assessment form with them, identifying what risk factors they have that are causing the cavities,” says Dr. Kutsch. Discussion ranges from diet (particularly the intake of refined carbohydrates) to medications and home-care habits. Researchers, he adds, have identified 23 different bacteria believed to play a role in demineralization and caries formation. So his staff typically culture cells from patients’ mouths, looking for the suspect bacteria.

While Dr. Kutsch still treats existing cavities, his treatment plans today also include a medical component to target bacteria. In the case of a patient with obvious demineralization, for instance, his recommendations might include new home care strategies, and antimicrobial or fluoride treatments.

All this of course—from the initial risk assessment to bacterial culturing and counseling—entails taking more time for patients. “And we charge fees for that,” says Dr. Kutsch. He adds that the American Dental Association (ADA) recently included entries in its Code on Dental Procedures and Nomenclature (also known as CDT7) to cover some of these added procedures. “It has fee codes for counseling a primary caregiver for a child, age three and under who’s at risk for caries,” Dr. Kutsch says. “There’s also a new fee code for applying fluoride varnish to adult patients at risk.”


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