Medical Approach to Dental Caries: Fight the Disease, Not the Lesion

Meghan Sullivan Walsh August 1, 2010

St. Joseph Pediatric Dental Medical Approach to Dental Caries

Medical Approach to Dental Caries: Fight the Disease, Not the Lesion

Resident Name: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Medical Approach to Dental Caries: Fight the Disease, Not the Lesion

Authors: Phoebe Tsang, DMD, PhD, FRCD; Fengxia Qi, PhD; Wenyuan Shi, PhD

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s: 28:2, 2006 Pages 188-191

Major Topic: Creating a medical approach to dental caries.

Overview of method of research: Opinion paper using scientific, biologic and technologic discoveries in the field of dental medicine.

Findings: The authors of this article discuss the manner in which dentistry is moving away from a surgical approach to a biological approach towards fighting carious lesions. Their beliefs are that future dentistry should and will become a clinical situation in which we, as dentists, will no longer be treating the lesions, but rather the disease process. Throughout this article the authors discuss the many advances in science which will have clinical applications for the dentist. The authors feel there is a three phase comprehensive approach to diagnosing caries and the carious patient. Detection of cariogenic bacteria, survey of plaque acidogenicity and recognition of tooth demineralization are the three phases discussed.

The first, detection of cariogenic bacteria, remains an assessment of visual, tactile and radiographic methods. The author concludes that these methods produce moderate specificity and low sensitivity. The advances in methods such as laser florescence, or the DIAGNOdent, are just the beginning to enhancing specificity. While the authors recognize that this diagnostic tool has moderate results, they believe this tool should be used in conjunction with the previous methods discussed.

Oral microbiology has allowed scientists to detect cultivable and uncultivable bacteria by examining bacterial RNA and DNA. Because of these studies our knowledge of microbial flora in the oral cavity has increased. The authors of this article feel that current studies at the National Institute of Dental and Craniofacial Research will lead us to know not only the number of microbes in the oral cavity, but also their metabolic genes and virulence factors. In addition, the authors also mention studies monitoring plaque acidogenicity. Currently there are pH-sensitive fluorescent dyes that can produce different absorption spectra under different pH levels. These dyes can be used to monitor pH levels in dental biofilm. With this new technology, the authors feel that we may be able to answer questions providing insight to the mechanisms of cariogenesis.

The third method they discussed, demineralization/remineralization has been studied using new imaging tools. Currently there are two being studied, Atomic Force Microscopy (AFM) and laser interference microscopy (LIM). The authors realize these methods are still being perfected, but anticipate good clinical cariogenic potential.

Key Points, Summary:

The authors discuss how these new scientific methods and studies will change the way we, as dentists, treat caries and caries development. Their hopes are that we will no longer look at caries management as a surgical approach, but a holistic, biologic approach. We will use oral pH and plaque acidity to monitor tooth demineralization. Use diagnostic tools such as florescence, antibodies, nucleic acids and biomolecules to promote therapeutic treatment plans based on quantitative measures. They also believe there is a chance that a vaccine will be invented to target and treat dental caries. Of note for those in the Pediatric Dental profession is that we, as specialists, will monitor the bacterial burden of caregivers preventing the colonization of bacteria in their children.

Assessment of Article:

I appreciate the enthusiasm of the authors and the studies being performed to approach dental caries as a medical disease. There is much in this article that I agree with. I do feel that our profession is changing and that we will have to adopt many of these scientific models to treat our patients. However, I am skeptical that dental caries will be eliminated. While we may have all the tools available for us and our patients in the future to treat dental disease, I feel there is also a social, mental and societal aspect that will prevent our our patients from heeding our advice and curing the disease.