Happy December! We wanted to take some time to share our practice philosophy and how we make treatment decisions here at Potrero Hill Dental. It’s important for us that our patients understand our practice philosophy and how preventative and minimally invasive dentistry (and even medicine) is changing the landscape of healthcare and treatment recommendations today.
Dentistry as a profession has adopted a more preventative, minimally invasive approach in the past decade, especially here in the United States. As technology advances (just to name a few things: stronger dental materials, better diagnostic equipment, magnification and light aids for the dentist), we have significant improvements in our ability to diagnose and treat dental disease. Our goal with a minimally invasive approach is to conserve as much natural, healthy tooth as possible for the entire life of the tooth by focusing on education, prevention and restorative procedures that are based on “caries risk”.
Caries risk is a measure of a patient’s susceptibility to dental disease, namely developing cavities. This assessment is made after a thorough evaluation of each individual’s diet, hygiene and history of cavities, both active decay lesions and the number of previous fillings. Based on this caries risk, we decide which cavities, if any, need to be treated. Not all small cavities need to be filled right away. The long term goal is to help our patients preserve as much healthy tooth structure as possible by implementing preventative or smaller procedures when needed. This can improve the patient’s dental health over time. It is also a significantly smaller financial burden than more invasive procedures down the road, such as root canals and crowns, which are needed when decay is more extensive.
To get a little more technical – Dentistry as a profession used to be much more reactive and only treat problems once there was a larger problem. This made sense at the time since older silver fillings needed a minimum requirement of a certain depth and size to withstand chewing forces, sometimes necessitating removal of healthy tooth structure to achieve an ideal form. So, dentists often would wait until the decay was deeper to meet and justify the requirements of the filling materials. Nowadays, new bonding techniques and tooth-colored composite resin fillings allow for much smaller and conservative restorations, which ultimately result in the removal of less tooth structure. Since dental cavities are an infectious disease process caused by bacteria, we believe it makes the most sense to reduce the risk to healthy tooth structure by removing the infected portions of the tooth when the cavity has reached the dentin (or second layer of the tooth. We can go on (and on and on) about the technicalities here, but we’ll save you the dental anatomy lesson for now! Although we’re always happy to continue the discussion, just let us know.)
We understand it can be confusing and frustrating when different dentists come up with different treatment recommendations. Some diagnoses are subjective and there is a range of when to intervene and treat a tooth; thus, not every dentist may agree with our treatment recommendations. However, as technology advances and materials continue to improve, it is hard for us to justify leaving decay that will only progress deeper into the tooth and create the need for larger fillings, which can compromise the tooth’s structural integrity. We want to be clear – our goal is not to fill every small superficial cavity. We take a patient-centered, risk-based approach in developing treatment plans for our patients. For example, in a patient with excellent hygiene and low risk factors for cavities, we feel comfortable watching smaller, superficial cavities and look for ways to help remineralize or arrest the progression of decay. We have patients with teeth that we have been watching for years. On the other side of the spectrum, in a higher risk patient, we need to remove the bacteria and infected areas more proactively in order to achieve a healthy oral environment. When we say we take a patient-centered, individualized approach to our care, this is what we mean.
Generally, we find that the science and clinical evidence supporting minimally invasive dentistry is sound, and we apply this philosophy to our practice. Our primary dedication is to our patients and improving their oral health to the best of our ability. We would never recommend more treatment than we genuinely think is necessary or complete treatment that is more harmful to a patient’s oral health - it’s just not who we are.
Thank you for reading and we welcome the opportunity to discuss this topic in more depth with those who are interested!
