Paradigm Shift in Dental Research

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Dentistry is currently undergoing a revolutionary shift in the way dental caries are examined and treated. W.D.Miller first identified the bacterial basis of the cavity process over 100 years ago. Contemporary understanding shows that the development of cavities is a disease process with many facets. In some cases expert understanding of dental cavities, especially in areas such as remineralizing enamel lesions, has galloped ahead of the knowledge of clinicians in the field.

The historical method of dealing with cavities has been the surgical option with teeth removed in their entirety, this evolved to removing just the demineralised area and restoring them with inert material. This mechanical approach still predominates even though is had been shown not to remove the infection behind the cavities.

The development of antibiotics significantly changed how dentists approached gum disease and infected teeth. Bacteria was attacked as it was seen as the cause of infections and cavities. However recent research has indicated that it is not the bacteria themselves that causes most dental problems, but rather the inflammatory response of the body to the infection. The discovery that inflammation, not bacteria. is the cause of most periodontal damage has left dentistry facing new challenges in its response to these problems.

Traditional techniques such as restoring cavities, eliminating pockets and straightening teeth are all targeted at reducing bacteria. However the true issue is the response of the host.

The pace of research in cariology is truly astonishing however practitioners are still stuck in the past, trying to deal with the symptoms of cavities, not the root cause.

The focus should be on dealing with the disease as well as the lesion, there is a new focus on non-invasive/minimal approaches to these issues. Particularly preventitive techniques that aim to deal with causal issues such as host, diet, microbial and salivary factors.

Another exciting new field is the development of probiotics, bacteria that provide a health benefit to the host. The idea is that these probiotics can be introduced to the teeth where they may have an effect on plaque and may provide a cariostatic effect, slowing the effects of damage to teeth.

Although early indications of the utility of probiotics in dealing with tooth decay are promising, more clinical testing needs to be carried out. This is particularly important in the light of the global problem of microbes becoming increasingly resistant to anti-biotics.

Therefore it seems that new research points the way ahead for dentistry, it seems that dentists may need to shift their focus from attacking the symptoms of a disease to dealing with the disease in itself.

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