(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
EXTRACTIVE and restorative dental care should be a last resort, the world’s largest grouping of dental associations says.
Prevention is the key to good oral health, declares the Fédération Dentaire Internationale (FDI, or the World Dental Federation).
The FDI represents over a million dentists worldwide, including members of the Philippine Dental Association.
Extractive and restorative approaches to the care of tooth decay or caries “are outmoded, costly, and fail to ensure the best health outcomes for patients,” the FDI states.
And yet a preventive approach to caries remains to be adopted in many countries, it says in a just released white paper.
“A strong body of evidence exists on the effectiveness of fluorides, sealants, and other methods of sugar control and preventive care, and translation of this evidence into guidelines has armed the profession with the knowledge required to prioritize prevention and reserve restoration as a last resort.”
The white paper addresses 13 key issues for advancing a patient-centered, evidence-based approach to caries care.
The white paper provides dentists, other oral health workers, and national dental associations with the knowledge and tools needed to deliver caries prevention and management in the best interest of the patient.
“Dental caries is a complex multifactorial disease, involving interactions among the tooth structure, oral microbial biofilm, dietary carbohydrate, and salivary and genetic influences,” it says.
These interactions determine whether the teeth are in a healthy or diseased state.
Primary prevention seeks to maintain health and prevent disease in patients who do not already have a disease, the white paper states.
Toothbrushing with fluoride toothpaste are the main means of controlling plaque formation.
“Antimicrobial agents such as mouth rinses, gels and varnishes have not been shown to reduce caries effectively, with the exception of chlorhexidine/thymol varnish every three months to reduce root caries incidence in adults,” the white paper observes.
Recently there has been a paradigm shift in dentistry from biofilm removal to promoting a healthy biofilm through dietary changes.
There is limited evidence that one-on-one dietary interventions to reduce sugar intake in the dental setting are effective.
Sugar consumption should still be assessed however, and patients advised to limit sugar consumption when necessary.
Chewing sugar-free gum for 10-20 minutes after meals has been recommended to stimulate saliva and reduce coronal caries.
Community water fluoridation is the most cost-effective population level means of preventing caries, the white paper says.
Fluoride toothpaste is a proven effective measure, with its preventive effect increasing significantly with higher concentration.
Fluoride mouth rinses are additionally recommended for adults and children with high caries risk.
There is also “strong evidence” that supports the use of dental sealants for preventing the initiation and progression of caries in both clinical and school settings, the white paper says.
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Dr. Joseph D. Lim is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; and Honorary Life Member of the Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com/PN
