Brushing up on tooth conservation is key to good dental practice

Australian dental education and practice has moved away from the drill-and-fill approach to managing tooth decay, prioritising patient education and conservative dental treatments to help patients keep their oral health on track.

What is tooth conservation and why is it so important?

With the primary aim of preserving original tooth structure and remineralising wherever possible, tooth conservation is the foundation of general practice dentistry.

Patients are living longer and retaining more teeth, however as a result of gingival recession, poor diet and inadequate oral hygiene, dental decay is becoming an increasing problem.

Despite the many advances in dental materials research, inevitably all restorations (fillings) will need to be replaced, which contributes to the ongoing loss of patient's natural tooth structure.

To prevent the restoration placement/replacement cycle from starting, the first approach to tooth conservation involves techniques to remineralise early decay, as well as educating patients about diet, oral hygiene practices and lifestyle habits that contribute to dental decay.

In the second instance where restoration is required to achieve comfort, function and aesthetics, selecting the most appropriate treatment or the restorative material that will provide the greatest longevity for the tooth and the patient is also crucial to tooth conservation.

The conservative approach is important in dentistry as it allows patients to keep their teeth and avoid restorative materials that will have a limited life expectancy.

What knowledge or protocols fall under tooth conservation?

An understanding and application of the Caries Management System is essential for practicing dentists, where any changes affecting tooth structure are identified early and managed through oral hygiene, diet and fluoride applications to assist remineralisation.

An ability to provide minimum intervention dentistry so that restorations are placed in the most conservative manner possible is also essential. Small, carefully designed cavities complement this technique as larger cavities and restorations are likely to fail at a faster rate than smaller ones.

Knowledge of dental materials and their clinical applications is also key. Despite new materials entering the market at an increasing rate, not all new products are superior to their predecessors and many manufacturers’ often release new products without an appropriate clinical trial period.

What role do patients play in maintaining good oral health?

Professional guidance and treatment is necessary for patients to keep their teeth for life. Patients play a big role in ensuring that restorative dentistry can either be avoided, or once placed maintained, by taking responsibility for their oral hygiene and diet, making regular visits to the dentist and receiving early treatment when appropriate.

What are the key challenges preventing dentists from choosing minimally invasive procedures?

Inadequate remuneration from health funds to complete preventive procedures and limited access to public dental services often means patients only seek treatment when a problem arises, which encourages more instances of restorative treatment being provided than preventive care.

Another factor may be resistance to change where practitioners continue to undertake treatment patterns that don't prioritise minimal intervention dentistry, which is the established mode of care now taught in all dental schools across Australia.

What more can be done to increase preventative dental treatments in Australia?

Education is the most important component, whether it be during training within a dental program or as part of continuing education following graduation.

Investment by practitioners in conservative dentistry will only come about through the support of the insurance companies to appropriately recompense practitioners to undertake preventive procedures.

Involvement of stakeholders – ADA, dental schools, public providers, corporate dental providers, health insurers in having an open conversation about the state of dentistry and what constitutes appropriate patient care.

What are your goals in the position of Chair of Tooth Conservation?

To ensure that students educated within the Sydney Dental School respect natural tooth structure, remineralise before placing restorations and use conservative means to ensure a patient has the opportunity to retain their natural dentition for life.

That when restorations are required to be placed they will be as conservative as possible, using the most appropriate materials to provide the greatest longevity. Ideally, all treatment is patient-focused and conservative of tooth structure.

With a focus on lifespan oral health, research at Sydney Dental School aims to 'put the mouth back into health.' Find out more about how our research aims to go beyond the mouth to enhance studies in fundamental cell biology, microbiology, molecular biology and biomechanics, with our dental expertise.