The Monitor Practice Program: implications for dentistry and dental education

Abstract

The restorative model of care, known colloquially as drilling and filling, has been challenged on the basis of its inappropriateness. The Caries Management System protocol was developed as an evidence-based strategy for non-surgical treatment of caries lesions and the Monitor Practice Program was designed to test the hypothesis that use of the protocol would reduce risk of dental caries experience. After 7 years, patients attending intervention practices, compared with those attending control practices, needed: 30%-50% fewer restorative interventions; 55% fewer first time restorative interventions; 32% fewer repeat restorative interventions; and were only 23% as likely to be classified as high risk. The outcome was cost-effective and patients attending intervention practices highly valued non-invasive care, and intervention dentists derived professional satisfaction from non-surgical caries management. The implications of the program are that the general public will likely embrace the benefits of non-invasive caries management, as will many current and future dental practitioners. This calls for dental practice reform including: the establishment of a clinical discipline in cariology; cariology curriculum development; revised accreditation regulations for cariology programs in dental schools; advanced training in clinical cariology leading to a specialty; support from the dental profession; and public health advocacy.

Knowledge and Attitude of Preschool Children Parents Towards Professional Topical Fluoride Therapy

“…Preventive methods applied in different ways, such as oral hygiene and dietary instructions, topical and systemic fluoride, and fissure sealants can significantly reduce dental caries [3,4]. Water fluoridation is one of the most effective ways of caries prevention, but water fluoridation does not use in IRAN, and the groundwater amount of fluoride in different areas of this country is changeable [5,6].…”

Conceptualization of dental caries by dental students is related to their preventive oral care routine

“…Thus, its prevention and management are based on individual risk 37 and dominated by nonsurgical methods 38 . Non‐invasive caries management has shown to reduce the need for restorative care, and the benefits are for both patients and dentists 39 . Since the most rational and widely accepted preventive oral care routine is tooth brushing with a fluoridated toothpaste, 22,40‐42 our survey contained several questions related to these daily routines 31,32 .…”

Experiencia en la implementación de sistemas de gestión de calidad para la atención odontológica en un centro docente asistencial universitario.

“…El beneficio del establecimiento de protocolos clínicos y de la constante preocupación por su actualización conduce a mejoras en la calidad de la atención, como recientemente lo demuestra la revisión periódica de la evidencia y protocolos para el manejo clínico de la enfermedad caries, que acoge el actual cambio de paradigma científico, ha alcanzando importantes modificaciones sanitarias al observar cambios en el modelo de educación odontológica, donde la revisión del currículo motivado por la acreditación, condujo en Australia, a la migración de un modelo restaurador a un modelo no quirúrgico para el manejo de la caries dental en etapas precoces, demostrando la reducción del 30 al 50% de las intervenciones restauradoras después de 7 años (9) . Otro ejemplo de detección de problemas en la atención odontológica de calidad, lo muestra el análisis sobre certificación y desarrollo de los implantes dentales para los próximos 10 años, concluyendo que la ingeniería dental, las enfermedades peri-implantarias y el flujo de trabajo digital en odontología actualmente tienen herramientas limitadas que no garantizan resultados clínicamente predecibles (10) .…”