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Amongst health professions all in all there has been acknowledgment that exploration proof is not as a matter of course deciphered into practice. There are sound scientific reasons to pursue preventive non-operative routines for controlling dental caries yet the use of these systems all in all dental practice remains a perplexing issue.

The need to replace restorations efforts is because of a scope of variables including inadequate tooth preparation, marginal failure, and secondary caries. The preventive non-operative approaches to improve remineralisation and control dental caries require professional dental care and patient self-care efforts. The professional input includes: oral hygiene instruction for effective dental plaque control via tooth brushing; use of fluoride in a variety of forms (toothpaste, mouthwash, rinse, professionally applied varnish); saliva stimulation or substitution and more recently calcium phosphate-based remineralisation systems.

The relation inability of the dental team should be concentrated on other caries risk factors which can be successfully changed, such as

  • Fluoride exposure
  • Dental plaque control
  • Regular monitoring of oral health.
  • Dietary advice could be added to this list,
  • Patients start to use home care fluoride products regularly
  • And if the dental team maintain an interest in advising individuals about maintaining their routine recall visits.

The efficiency of preventive non-operative approaches to manage dental caries have been validated for more than 35 years. These approaches include a grouping of intensive topical fluoride applications, oral hygiene instruction, and monitoring the success of tooth brushing by recording the levels of dental plaque on the teeth.

Since the 1980s, non-operative approaches and regular monitoring have been recommended as ways of arresting enamel and dentine carious lesions. This indication suggests that general dental practitioners should therefore only restore teeth with cavity lesions.

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One possible barrier to the widespread implementation of this evidence is the values and routines of practicing dentists. If preventive therapies are to be used extensively, it will be particularly important that dental practitioners prioritise these over restorative intervention. That is, dental practitioners will need to accept that whilst restorative care eradicates carious or diseased tissue in a specific tooth and replaces it with a filling material, it does not restore or maintain general oral health. Non-operative approaches, in contrast, do help patients to maintain and protect their own oral health.

Despite the amount and consistency of the research findings on the value of preventive care, there has been limited acceptance of the non-operative approach in dental practice where restorative care remains the dominant philosophy.

References:

Sbaraini A, Carter SM, Evans RW, Blinkhorn A. How to do a grounded theory study: a worked example of a study of dental practices. BMC Medical Research Methodology.

Sbaraini A, Carter SM, Evans RW. How do dentists understand evidence and adopt it in practice? Health Education Journal .

Sbaraini A, Carter SM, Evans RW, Blinkhorn A. How do dentists and their teams incorporate evidence about preventive care? An empirical study. (Under review on Community Dentistry and Oral Epidemiology Journal)

Sbaraini A, Carter SM, Evans RW, Blinkhorn A. Experiences of dental care: what do patients value? BMC Health Services Research.

Sbaraini A. What factors influence the provision of preventive care by general dental practitioners? British Dental Journal.