Management of Dental Caries Throughout Life – Part 2

The management strategies we select for the management of dental caries have largely been framed by the lens through which we look at the disease.  Dentists have long viewed dental caries management utilizing the surgical tenants clearly described by dentistry’s “Grandfather”, Greene Vardiman Black. The tenants of extensive restorations, the irreversibility of caries, the need for total excavation and more were set in place nearly 100 years earlier. 

These tenants have been taught world-wide and often followed, often without regard for the science.  This is not unprecedented…for centuries, we believed that the sun circled the earth, that the earth was flat and that gravity was a function of the weight of the object! In fact, great minds of the day all believed that these tenants were true until they were disproven. 

Management of dental caries may be the same circumstance where management strategies have been restricted by history rather than science.  After 65 years of fluoride use and 55 years of sealant use, caries remains a significant health problem throughout the life-span of the majority of people.  New life-span prevention and treatment strategies involving both the patient and the caregiver must be developed that insure maintenance of teeth throughout the lifetime. 

The persistence of caries as a health issue, particularly in the rapidly growing underserved community of patients with disabilities (intellectual and physical whether developmental or acquired) throughout the lifespan, requires implementation of new management strategies.  These management strategies involve the recognition of varied levels of dependence, the need for increased education for all (especially caregivers), the need aggressive management of sugar exposure in the individual and varied management strategies for the caries lesion that reduce surgical interventions and destruction of tooth structure.

New strategies are emerging and require scientific validation through research and aggressive implementation throughout the life cycle… if we are to promote healthy aging with our teeth.