Minimum intervention dentistry and the management of tooth wear in general practice

Abstract

The incidence of tooth wear, or non-carious tooth surface loss (NCTSL), is increasing and oral rehabilitation of patients with non-carious tooth loss requires strategies that address all the factors relevant to the aetiology and pathogenesis of the condition. The multifactorial nature of tooth wear and the variability in its clinical presentation provides treatment challenges for the clinician and successful management must be more than just restoration. Management must include an appropriate mix of preventive and restorative strategies and an understanding that long-term restorative success is affected by the patient's oral environment, and how diet, lifestyle and medical status can modify this environment. Ultimately, the success of any restorative intervention is very dependent on the stability of the oral environment and the condition of the remaining tooth structure. Minimum intervention dentistry (MID) philosophies are ideally suited to tooth wear cases and an overall MID strategy involving diagnosis, recognition and control of predisposing factors, stabilization of the oral environment, remineralization and restoration of the tooth structure, and ongoing maintenance can be implemented. When restorative treatment is required, contemporary materials and techniques are available that can provide cost-effective and conservative restorative alternatives for patients unable to undergo the complex indirect restorative techniques that are both costly and time consuming to implement. These minimally invasive approaches are not only an economically viable solution, but can provide aesthetic and functional rehabilitation and maintain tooth structure as a precursor to more complex restorative options when required.

Nanoscratch testing for the assessment of enamel demineralization under conditions simulating wine erosion

“…Thus, dental erosion has been recognized as an occupational hazard in professional wine tasters, emphasizing the need for early detection and management in accordance with the minimal intervention philosophy . Consequently, a key priority area in dental erosion research is the assessment of the fundamental mechanisms involved in early stages of erosion that may lead to the development of more effective preventive strategies …”

Three-dimensional profilometric assessment of early enamel erosion simulating gastric regurgitation

“…3 In order to prevent a lifetime of compromised dental health that may require complex and extensive rehabilitation, it is now generally recommended that, in accordance with the principles of minimal intervention dentistry, emphasis should be placed on early diagnosis and prevention before restorative management is considered. [4][5][6][7] Reported recent increases in the prevalence of erosion in children and young adults have been attributed to extrinsic erosion from increased consumption of acidic beverages, 8 with the relative effect of erosion due to intrinsic factors generally being considered minor.…”

Changes in Occlusal Caries Lesion Management in France from 2002 to 2012: A Persistent Gap between Evidence and Clinical Practice

“…Furthermore, the results showed that the variability observed in 2002 toward caries management decisions was persisting in 2012. © 2015 S. Karger AG, Basel In modern cariology, minimum intervention (MI), based on prevention and on intervention limited to the absolute minimum, is considered to be the most logical choice -both from a medical and an ethical standpoint [Bowley, 2002;Darby and Ngo, 2013;Elderton, 2003;Farah et al, 2013;Featherstone and Doméjean, 2012;Meyers, 2013;Pitts and Ekstrand, 2013;Sheiham, 2002].…”