Minimal intervention dentistry
Minimal intervention dentistry is a modern dental practice designed around the principal aim of preservation of as much of the natural tooth structure as possible. It uses a disease-centric philosophy that directs attention to first control and management (health)|management] of the disease that causes tooth decay—dental caries—and then to relief of the residual symptoms it has left behind—the decayed teeth. The approach uses similar principles for prevention of future caries, and is intended to be a complete management solution for tooth decay.
History
Classical restorative dentistry has traditionally followed the century-old approach of G. V. Black in classification and treatment of tooth decay. This was based on very limited knowledge at the time about the pathology of the underlying dental caries disease, and the need to specially prepare a cavity to repair a lesion with the limited available materials. Therefore, the only approach was to treat the symptoms—to remove the decay and restore the tooth surgically. Modern science has since allowed for better understanding of the pathology, thus opening the door for new methodologies and approaches to treatment. The practice of minimal intervention dentistry was designed to utilise these new possibilities by implementing a disease-centric philosophy to management of tooth decay. While advances in dental science are of course used in mainstream dental practice, MI dentistry has redesigned the treatment guidelines beginning with a new classification of caries lesions. This classification was intended to reflect the possibility of curing the disease and remineralising early lesions before irreversible damage has been done. It was first published by Mount and Hume in 1997 and has subsequently been revised.Some see minimally invasive dentistry as merely a philosophical change, but since the practice has been in mainstream discussion in the late 1990s, it has acquired some respectable international academic backing.
Approach to restorative dentistry
The approach of minimal intervention dentistry is centred on management of the dental caries disease responsible for tooth decay, first controlling and curing the disease, then restoring the tooth, filling only where necessary, and finally prevention of future caries.Treatment: controlling and curing
Classical dietary and oral hygiene techniques of reducing sugar content and eating frequency, and removing plaque by effective brushing, are still very important practices for treatment as well as prevention. Also, biochemical techniques can be used to treat the bacterial infection directly. Agents such as chlorhexidine can help fight gum disease and thus reduce the amount of bacteria in the mouth that are responsible for tooth decay. After a wave of empirical studies on the efficacy of xylitol, a consensus report in the British Dental Journal considered it to give a reduction in the risk of caries. There is also increasing use of newer technologies such as photo-activated disinfection and treating with ozone.There is also an aspect of minimising the effect of the caries to control the symptoms of decay. Constant remineralisation with continuous application of fluoride toothpaste is highly common practice that reduces the impact of the caries on decay. Changing the biochemical properties of saliva, potentially through the use of appropriate drugs, can help the buffering capacity of the saliva to resist changes in pH caused by plaque acid, resisting the acid attack caused by the active caries.