DENTAL CARIES (CARIOLOGY) TREATMENT IN THE NEW MILLENNIUM 

A Paradigm Shift in the Treatment of Dental Caries

      Treating Dental Caries as an Infectious Disease      

 

   Moving From a Mechanical Approach to a Preventive Model.

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  Steven C. Steinberg DDS, BA
Clinical Consultant, Skokie, IL 

Arnold D. Steinberg DDS, MS
 Department of  Periodontics
University of Illinois College of Dentistry

The following online course material is presented as a service to the Dental Professionals  and students through the auspices of the University of Illinois at Chicago School of Dentistry, Department of Periodontics.   It represents a review and interpretation of the dental literature that has evolved over the last 2 decades concerning an increasingly important concept, Treating Dental caries as an Infectious Disease.

Surgeon General David Satcher's recent report* focused on oral health identifying “a silent epidemic of dental and oral diseases that burdens some population groups and calls for a national effort to improve oral health among all Americans.  During the last 50 years, there have been dramatic improvements in oral health, and most middle-aged and younger Americans expect to retain their natural teeth over their lifetimes.  However, this report illustrates profound disparities that affect those without the knowledge or resources to achieve good oral care.  Those who suffer the worst oral health include poor Americans, especially children and the elderly. Members of racial and ethnic groups also experience a disproportionate level of oral health problems.  And, those with disabilities and complex health conditions are at greater risk for oral diseases that, in turn, further complicate their health." 

There are many reasons for the disparity in oral health cited above.  However, universal application of available procedures to detect and treat caries non-invasively and to monitor the disease well before cavitation occurs is essential.  Dental Professionals  need to re-evaluate, rethink and change the direction of preventive intervention presently in vogue.

Currently the treatment of dental caries is focused mainly on a surgical model of removing the carious tooth structure followed by replacement  with  a restorative material.  There is a slow, but steady, movement into the concept recognizing that dental caries is a transmissible, infectious disease (medical model) in which interventions can be applied to prevent and control this infection.  This model recognizes that dental caries is a chronic process having episodes of activity and inactivity and that with early recognition of the disease process (before cavitation) intervention will stop and even reverse the disease process (remineralization of the non-cavitated lesion).

The material presented represents an entire treatment philosophy beginning with a review of basic scientific concepts, patient caries risk assessment, establishment of a treatment methodology  along with a customized monitoring over a period of time appropriate to assure that progression and/or recurrence are prevented.  This program is preventive dentistry oriented and is a gentle and conservative approach to the treatment of dental caries for all ages.  It is based on the concept that dental caries is an infection mainly caused by a marked elevation of mutans streptococcus bacteria and that a decrease in the levels of these bacteria must be achieved.  The information is made available to all as a reference source and is regularly updated.  Appropriate references will be found within the body of the presentation.

Dr Arnold Steinberg is Professor of Periodontics and Biochemistry and teaches Information Technology at the UIC College of Dentistry.  He has been teaching the Cariology Course at the College for over 25 years and is currently a guest lecturer.

Dr Steven Steinberg is in private practice in Skokie, IL and has been applying the concepts presented here, daily, in a General Dental Practice.  He has practiced the philosophy of treating dental caries as an infectious disease in his private practice for a number of years and allows us the ability to observe the practical applications.

Goals

To understand the biological basis for dental caries: to obtain a biological working knowledge of the etiology, initiation, progression and prevention of dental caries.
To understand the biological basis for treating dental caries:
to understand the biological concept of treating dental caries as an infectious disease.
To understand two defining points regarding dental caries:

        1-    
Caries is a bacterial infection caused by specific bacteria.
        2-    
Caries is a reversible multifactorial process of tooth demineralization and remineralization.
To classify patients according to caries risk potential:
to determine a patient's caries risk potential by analyzing current clinical information, bacterial tests and other pertinent information.
To understand carious lesion activity:
to differentiate between active and inactive carious lesions.
To understand and determine the specific treatment modalities for dental caries by combining risk and activity status:
From the patient's caries risk and activity status, to outline a  course of treatment which would not only control dental caries and initiate a remineralization protocol for white spot lesions, but would also move the patient into a low caries risk profile.

This site is prepared for use mainly by professionals, but it is also freely available for use by the general public. 

*Oral Health in America: A Report of the Surgeon General, May 2002.
 

 For more information or comments  e-mail: sssov@aol.com

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© Copyright -Dr. A. D. Steinberg 2005