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Dr. Stephen Abrams speaks about modern caries management

Stephen AbramsPodcast Icon SmallDr. John O’Keefe, Director of Knowledge Networks at the Canadian Dental Association, spoke with Dr. Stephen Abrams about modern caries management. 

Dr. Stephen Abrams is a general practitioner in the Toronto area and was closely involved with the development of the CANARY System for the detection of caries. 






Listen to the Audio Interview


Interview Highlights 

Science is evolving in two directions:

  • How do you detect and measure the progression of a lesion?
  • How do you treat the lesion?

Managing caries lesions is different than what it used to be 5 years ago. Consideration is given to:

  • Risk factors.
  • Home care and varying different products.
  • Measuring the progression of lesions.
  • Replacing the restorations placed to treat the damage resulting from the disease.

Engaging with patients is also different what it used to be 5 years ago:

  • Patients are more knowledgeable and they want to know ‘Why things do or don’t work.’
  • Information is readily available to patients on the internet.
  • The practitioner’s duty is to educate patients about caries lesions.

Key factors in managing caries:

  • Patient engagement through an understanding of the disease is and by providing them with a measure to show the progression of the caries lesions.
  • The measuring tool should be linked to the disease process and should have quantifiable numbers that the patient could understand and identify with in learning about the progression of caries lesions.
  • There needs to be a new partnership between the dentist and the patient to treat caries similar to the one happening when treating periodontal disease.

What CDA can do

  • Provide the profession with knowledge on how to critically evaluate the literature
  • Educate the public about what dentists do in treating oral health diseases.
  • Set up a fee system that supports services that allow treating the disease early in its process.
  • Message the importance of treating caries in the “dental home;” an environment in which the dentist becomes the supervisor and is actively engaged in the management of caries across its progression spectrum.


Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

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  1. Ron Kellen August 5, 2014

    There is a great need for info re OBSERVE incipients, educate re diet, OH, etc PREVENTIVELY. NOT to promptly DRILL, FILL, BILL. A real growing concern is the (corporate?)(“for profit”) dental office, often staffed with Associates, making maximum use of Dental Benefit Plans. i.e. Fill EVERY teeny incipient (NO regard for: has it been there for years, arrested? OR recent?) EVERY cervical (“sensitive”)abrasion, every incisal (“sensitive”)slight wear hollow,etc. These associates have huge university debts, and this is a great income stream for them.

    AND, when these “re-trained” Associates leave that office, raise a family, need a home, car, buy a practice ,etc.– they are most likely to CONTINUE this income stream concept.

    UNfortunately, as a dental consultant at a union benefit plan, I SEE these dental claims.

    I am DEEPLY CONCERNED about this still small but growing segment of aggressive opportunistic dental care. Is it ethical? Is it professional? Is it changing our profession towards being a retailer of product?

    I know I do not “get paid” for educating, promoting excellent OH & diet, etc. BUT I CHOOSE TO DO IT – as a professional. And then, I find that it is even more appreciated by my patients. That actually makes me more of a professional. MY raison-d’etre as a dentist is to make my patient HEALTHIER & happier (cosmetic, ortho). UNfortunately, that coincides with seeing each healthy patient for less (more health-oriented) dental care. Hopefully, this is compensated for by more patients who want that level of care. It certainly is a nicer work week with happier, more fulfilled staff & dentist.

    I STRONGLY believe that IF IT IS PROPERLY USED, the Canary could help this CURRENT UNprofessional situation from escalating. I do not know if “regulation” can improve this situation. It is a PERSONAL & PROFESSIONAL CHOICE.

  2. Oasis Drafts August 9, 2014

    Dear Ron; Thanks for the support. It is imperative that our profession move towards the management of caries. Restorations do not manage or treat caries but only treat the destruction caused by caries. We need to move the profession to show the value in treatment across the entire spectrum of the disease process. Waiting for cavitation and then placing a restoration, in my opinion, is not the optimal way to treat caries.

  3. Borislav August 9, 2014

    Experts King’s College London have developed a new painless treatment method, which allows self-restoring teeth without drilling and injection. Cavities are usually removed by the dental drill, after which the cavity fills with materials such as amalgam or composite resin. The new method, called Electric accelerated and enhanced remineralization (Electrically Accelerated and Enhanced Remineralisation (EAER), accelerates the natural movement of calcium and phosphate minerals to soon reach the damaged tooth. Process, which consists of two phases, the preparation of the damaged area of ​​tooth enamel and then uses an electrical current low power to streamline minerals to the places. Scientists expect the technique to be ready for use within three years. – Not only is our device for the patient and better for your teeth, but it is expected that, In the worst case, be equally cost-effective as the current treatment methods. Besides suppressing caries, our device can be used for whitening teeth – explains Professor Nigel Pites with the Institute of Dentistry at the ‘Kings’ College.To commercialize research established the company’Remini’, headquartered in Perth (Scotland), which currently searching for private investors to finance the development EAER.


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