|Year : 2021 | Volume
| Issue : 5 | Page : 199-202
Cognizance and use of minimally invasive dentistry approach by general dentists: An overlooked companion
Santosh Kumar1, Nutan Mala2, Kuldeep Singh Rana3, Nasim Namazi4, Rathi Rela5, Kunal Kumar6
1 Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
2 Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna, India
3 Department of Conservative Dentistry and Endodontics Government College of Dentistry, Indore, Madhya Pradesh, India
4 Department of Oral Pathology and Microbiology, Rangoonwala Dental College and Research Centre, Pune, Maharashtra, India
5 Department of Oral Medicine and Radiology, Nalanda Medical College and Hospital, Patna, Bihar, India
6 Dentist, Muzaffarpur, Bihar, India
|Date of Submission||15-Oct-2020|
|Date of Acceptance||17-Oct-2020|
|Date of Web Publication||05-Jun-2021|
Department of Dentistry, Nalanda Medical College and Hospital, Patna, Bihar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Dental caries begins with the decalcification of the first nonorganic part, followed by the decay of the organic tooth matrix. Minimally invasive dentistry (MID) focuses on using the adhesive technique for restoration as these techniques allow minimum removal of healthy tooth structure. Objective: This study aimed to assess the attitude, knowledge, and behavior of the general dentists toward the use of MID and to evaluate if MID is considered as standard care measure among general dentists. Materials and Methods: This was a cross-section observational survey and included 285 practicing dentists. The survey questions were divided into two parts. The question related to the use of sharp explorer utilized response categories (1–5), with options of always, most of the time, often, sometimes, and never or rarely. The independent variables collected were age, gender, years of practice, clinical hours, type of practice, postgraduate education, and clinic environment. The data collected were tabulated and were statistically analyzed. Results: The results of the present study showed that MID meets the standard of care for the treatment of both primary teeth 85.96% (n = 245) as well as permanent teeth 78.24% (n = 223). ART, sandwich technique, in-office, and at-home topical fluoride application were considered active for treating dental caries. The use of sharp explorers, nonsharp explorers, radiographs, and magnification were considered common for caries detection. Conclusion: The more dentists who listened to about MID in the past responded that the MID concept is the standard of care for the treatment of primary and permanent teeth than dentists who have heard little or nothing about MID.
Keywords: Dental caries, explorer, glass-ionomer cement, minimally invasive dentistry, xylitol
|How to cite this article:|
Kumar S, Mala N, Rana KS, Namazi N, Rela R, Kumar K. Cognizance and use of minimally invasive dentistry approach by general dentists: An overlooked companion. J Pharm Bioall Sci 2021;13, Suppl S1:199-202
|How to cite this URL:|
Kumar S, Mala N, Rana KS, Namazi N, Rela R, Kumar K. Cognizance and use of minimally invasive dentistry approach by general dentists: An overlooked companion. J Pharm Bioall Sci [serial online] 2021 [cited 2022 May 22];13, Suppl S1:199-202. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/199/317614
| Introduction|| |
Dental caries is one of the most common, most prevalent, persistent, and costly oral infectious diseases affecting the population worldwide. Dental caries is caused by bacterial colonization. Caries begins with the decalcification of first the nonorganic part, followed by the decay of the tooth organic matrix. The exo-polysaccharide-rich biofilm matrix formation and persistent low pH (due to acidification) at the tooth-biofilm interface are major virulence factors that modulate and control the dental caries pathogenesis. Dental caries prevalence of total and untreated cases in permanent/primary teeth among the age group of 2–19 years was found to be 45.8 and 13.0%, respectively, according to the National Health and Nutrition Examination Survey 2015–2016. Dental caries contributes one of the main reasons for replacement and placement of restorations. The demineralization seen in dental caries is attributed to the consumption of starchy and sugary food and beverages along with inadequate salivary flow, poor oral hygiene, and less fluoride exposure.,
With the advancement in surgical instruments and techniques, use of adhesive restorative materials and advanced techniques for caries restoration and prevention were advocated and famous. To minimize the size of the prepared cavity, the use of the adhesive restorative materials was advocated in the minimal intervention paradigm., Majority of dentists continue to use the conventional treatment strategies for the treatment of dental caries rather than the modern adhesive restorative protocols focusing on preserving the healthy tooth structure.,
Minimally invasive dentistry (MID) includes different techniques which including chemomechanical systems, hand instrumentation, laser cavity preparation, and air abrasion., Atraumatic restorative technique (ART) is one of the MID techniques including hand instrumentation.,
Laser cavity preparation utilizing the hydrokinetic systems is another MID technique, which cuts hard tissues and fissure sealing as well as removes soft caries. Glass-ionomer cement (GIC) has adhesive properties and fluoride release along with other ions like calcium into saliva and teeth are favorable properties of GIC. It also uptake fluoride released from dentifrices.
With the advancements in new technologies, newer studies were aimed to increase the saliva flow and calcium and phosphate concentration in the dental plaque. Xylitol and chlorhexidine are also being used for caries treatment which is safe, although diarrhea is reported with large doses.
Public health/community dentistry is focused on diagnosis, prevention, and control of various dental problems and also aims at promoting oral health via education, promotion, research-based strategies, and dental health-care programs. Very scarce data in the literature are available regarding MID and its use by the general dentists.
The present survey study aimed at assessing the attitude, knowledge, and behavior of the general dentists toward the use of MID. Furthermore, the study evaluated whether MID is considered as standard care measure among general dentists and to identify factors that associate with the dentist's belief of using MID as a standard care tool. Factors influencing the use of sharp explorers for caries detection were also focused on the study.
| Materials and Methods|| |
The study included the 285 dentists who agreed to participate in the survey and who were practicing at the time of the survey.
The survey questions were divided into two sections. One section was based on the general knowledge and familiarity of the practicing general dentists with the MID approach. The responses of the participants were recorded in the form of numbering 1–5 for questions related to the use of various MID techniques. Many responses were in terms of if they ever agreed or have used the mentioned specific techniques.
The question related to the use of sharp explorer utilized response categories (1–5), with options of: always (100%), most of the time (75%–99%), often (50%–74%), sometimes (10%–49%), and never or rarely (0%–9%). If responders answered always, most of the time, and often, these responses were counted as a yes, whereas sometimes and never or rarely were considered a no answer.
The independent variables collected in the present cross-sectional observational study were age, gender, years of practice, clinical hours, type of practice (government or private), postgraduate education, and clinic environment. The data collected were tabulated and were statistically analyzed.
| Results|| |
A total of 372 general dentists were approached to respond to the survey. The demographic characteristics of the study subjects are presented in [Table 1].
Responses of the study participants were also recorded in terms of the MID training. Various questions that were asked included if the responders were aware of the MID or ever heard about it, to which 95.08% (n = 271) were aware of MID [Table 2].
|Table 2: Awareness about minimally invasive dentistry in the study responders|
Click here to view
[Table 3] shows that the responses of the general dentists on questions regarding the effectiveness of different MID assessed in the survey were Atraumatic Restorative treatment, sandwich technique (utilizing GIC + composite), in-office application of the fluoride varnish, and topical high-concentration fluoride application at home. Responses by the general dentists concerning the effectiveness of different MID techniques for caries treatment in primary teeth were recorded [Table 3].
|Table 3: Responses for minimally invasive dentistry techniques by general dentists|
Click here to view
| Discussion|| |
A total of 372 general dentists practicing at the time of the survey in either private or public sectors were contacted to respond to the survey. However, 75.2% (n = 285) among the approached 372 gave consent and responded. The rest (87) did not agree to participate; the reason given by all was lack of time. Overall, 53.33% of the study respondents were male and 46.66% were female. Dentists with postgraduate training were 48.07% of respondents, which was consistent to study by Gaskin et al. who reported that 58.1% of respondents completed postgraduate training.,
Concerning the results of the present study, 75.08% of responders use this approach sometime or other. Traumatic defects on hard tissue leading to future caries lesions do not improve caries diagnosis accuracy, and consistency.
The effectiveness of these techniques in permanent teeth was reported to be 10.87% for ART, 9.12% for the sandwich technique, and 21.05% and 15.08% for in-office and at-home fluoride application, respectively. This can be explained by the fact that ART, fluoride varnish, and sandwich techniques are more commonly employed in primary teeth than adults. Previous studies in the literature have reported that MID concepts and techniques including the use of fluoride varnish, chlorhexidine, pit-and-fissure sealants, and resin base composite restoration have been used in the recent past.,
| Conclusion|| |
MID meets the standard care of treatment for primary and permanent teeth in the belief of the practicing general dentists. The factors that relate to MID as the standard of care were dentist agreement for knowledge about MID and consideration that fluoride varnish is efficacious. To conclude, the present observation survey suggests that there is a paradigm shift from conventional treatment toward the MID concept.
Hence, further studies in future with more study subjects from different geographical areas and logger monitoring periods are required to gain further insight into the MID use.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dean JA, Avery DR, Mc Donald RE. Dentistry for the Child and Adolescent. 9th
ed.. London: Mosby Co.; 2011. p. 177.
Jeon JG, Rosalen PL, Falsetta ML, Koo H. Natural products in caries research: Current (limited) knowledge, challenges and future perspective. Caries Res 2011;45:243-63.
Pakshir HR. Oral health in Iran. Int Dent J 2004;54:367-72.
Goldstep F. Proactive intervention dentistry: A model for oral care through life. Compend Contin Educ Dent 2012;33:394-6, 398-402.
Bernardes WA, Lucarini R, Tozatti MG, Souza MG, Silva ML, Filho AA, et al
. Antimicrobial activity of Rosmarinus officinalis
against oral pathogens: Relevance of carnosic acid and carnosol. Chem Biodivers 2010;7:1835-40.
Ohara A, Saito F, Matsuhisa T. Screening of antibacterial activities of edible plants against Streptococcus mutans
. Food Sci Technol Res 2008;14:190-3.
Henningfield JE, Higgins ST. The influence of behavior analysis on the surgeon general's report, the health consequences of smoking: Nicotine addiction. Behav Anal 1989;12:99-101.
Huang R, Li M, Gregory RL. Nicotine promotes Streptococcus mutans
extracellular polysaccharide synthesis, cell aggregation and overall lactate dehydrogenase activity. Arch Oral Biol 2015;60:1083-90.
Li M, Huang R, Zhou X, Qiu W, Xu X, Gregory RL. Effect of nicotine on cariogenic virulence of Streptococcus mutans
. Folia Microbiol (Praha) 2016;61:505-12.
Liu S, Wu T, Zhou X, Zhang B, Huo S, Yang Y, et al
. Nicotine is a risk factor for dental caries: An in vivo
study. J Dent Sci 2018;13:30-6.
Subramaniam P, Nandan N. Effect of xylitol, sodium fluoride and triclosan containing mouth rinse on Streptococcus mutans
. Contemp Clin Dent 2011;2:287-90.
] [Full text]
Zero DT. Dentifrices, mouthwashes, and remineralization/caries arrestment strategies. BMC Oral Health 2006;6 Suppl 1:S9.
Wijesekera RO. Historical overview of the cinnamon industry. CRC Crit Rev Food Sci Nutr 1978;10:1-30.
Keskin D, Toroglu S. Studies on antimicrobial activities of solvent extracts of different spices. J Environ Biol 2011;32:251-6.
Gupta A, Duhan J, Tewari S, Sangwan P, Yadav A, Singh G, et al
. Comparative evaluation of antimicrobial efficacy of Syzygium aromaticum, Ocimum sanctum
and Cinnamomum zeylanicum plant extracts against Enterococcus faecalis
: A preliminary study. Int Endod J 2013;46:775-83.
Miller AB, Cates RG, Lawrence M, Soria JA, Espinoza LV, Martinez JV, et al
. The antibacterial and antifungal activity of essential oils extracted from Guatemalan medicinal plants. Pharm Biol 2015;53:548-54.
Gaskin EB, Levy S, Guzman-Armstrong S, Dawson D, Chalmers J. Knowledge, attitudes, and behaviors of federal service and civilian dentists concerning minimal intervention dentistry. Mil Med 2010;175:115-21.
Caufield PW, Schön CN, Saraithong P, Li Y, Argimón S. Oral lactobacilli and dental caries: A model for niche adaptation in humans. J Dent Res 2015;94:110S-8S.
Huang R, Li M, Gregory RL. Effect of nicotine on growth and metabolism of Streptococcus mutans
. Eur J Oral Sci 2012;120:319-25.
Muchuweti M, Kativu E, Mupure C, Chidewe C, Ndhlala A, Benhura M. Phenolic composition and antioxidant properties of some spices. Am J Food Technol 2007;2:414-20.
Wong Y, Ahmad-Mudzaqqir M, Wan-Nurdiyana W. Extraction of essential oil from cinnamon (Cinnamomum zeylanicum
). Orient J Chem 2014;30:37-47.
Filoche SK, Soma K, Sissons CH. Antimicrobial effects of essential oils in combination with chlorhexidine digluconate. Oral Microbiol Immunol 2005;20:221-5.
Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries - a review: Report of a FDI task group. Int Dent J. 2012;62:223-43.
[Table 1], [Table 2], [Table 3]