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Preventive Dentistry Restorative Dentistry

What are minimum intervention dentistry (MID) principles and objectives?

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This summary is based on the article published in the Australian Dental Journal: Minimum intervention dentistry principles and objectives (June 2013 Issue)

Authors: LJ Walsh and AM Brostek

Abstract

Purpose: This review paper discusses the key principles of MID as a philosophy of patient care, and the practical objectives which flow into individual patient care.

Minimum intervention dentistry (MID) is the modern medical approach to the management of caries, utilizing caries risk assessment, and focusing on the early prevention and interception of disease. Moving the focus away from the restoration of teeth allows the dentist to achieve maximum intervention, with minimal invasive treatments.

The four core principles of MID can be considered to be:

  • Recognition – early identification and assessment of potential caries risk factors through lifestyle analysis, saliva testing and using plaque diagnostic tests;
  • Reduction – to eliminate or minimize caries risk factors by altering diet and lifestyle habits and increasing the pH of the oral environment;
  • Regeneration – to arrest and reverse incipient lesions, using appropriate topical agents including fluorides and casein phosphopeptides-amorphous calcium phosphates casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); and
  • Repair – when cavitation is present and surgical intervention is required, conservative caries removal is carried out to maximize the repair potential of the tooth and retain tooth structure.

Bioactive materials are used to restore the tooth and promote internal healing of the dentine. Effective implementation of MID involves integrating each of these four elements into patient assessment and treatment planning. 

Conclusions

  • Despite dramatic advances in caries management methods over the past two decades, significant challenges and opportunities remain.
  • Considering the microbial environment, the use of inhibitory compounds from bacteria and those derived from natural sources has great potential, both in topical agents and in dental sealing, surface coating and restorative materials.
  • Effective discrimination between cavitated and non-cavitated lesions on approximal surfaces is a persisting challenge, and is important because of the inherently irreversible nature of a restorative intervention.
  • With ageing of the population, effective methods for arresting and/or reversing root surface caries are in great need.
  • The need to better ‘recognize and remineralize’ will drive the developments in methods and materials for caries prevention, diagnosis and treatment for decades to come.

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