COVID-19 has fundamentally changed the way dentistry operates now and in the future. Virginia Health Catalyst is highlighting topics in oral health that focus on ways to provide care in a post-COVID-19 world through its Front Line Innovations blog series.
The first blog in our series is from Dr. McAllister Castelaz, the dental director at Horizon Health Services Ivor Dental Center on the opportunities for minimally invasive dentistry.
When I first heard of minimally invasive dentistry it was in conversation with a fellow dental student who had returned from a mission trip to Guatemala. They had brought silver diamine fluoride (SDF) with them among the usual extraction cassettes. He mentioned SDF was going to be appearing in the United States dental care system soon and he was correct. Minimally invasive dentistry is a growing trend in dental care, and something the Ivor Dental Center was beginning to implement before COVID-19. With the changes we will need to make following COVID-19, minimally invasive dentistry will play a large role in how we treat patients safely.
Historically, much of what is considered traditional dentistry is derived from GV Black, the father of modern dentistry. His philosophy of cavity preparation is what is taught in many dental schools still. GV Black taught a principle called "extension for prevention", which meant dentists should incorporate more grooves and pits in the tooth than just those exhibiting decay. This would prevent the tooth from decaying again in the future. His principle was based on the idea that the tooth has a disease (i.e., dental caries) that must be removed, including the damaged and compromised tooth structure. The removed structure must then be replaced to restore form and function; typically accomplished through the use of amalgam or composite materials.
However, as dentistry has evolved there’s been a growing emphasis on "less is more" when it comes to dental care. This means taking a more minimally invasive approach to treatment, in other words, using the least invasive surgical technique possible while removing the least amount of tooth structure possible. Minimally invasive care includes SDF application, SMART, ART, and Hall crowns. All these treatment options have one thing in common, they have minimal aerosol production, utilizing a slow speed handpiece (one that does not spray water) and specific hand instruments. This principle is one of the reasons minimally invasive dentistry is recommended by the CDC for dental care during COVID-19.
What is most notable about minimally invasive approaches is unlike what GV Black taught, dentists are purposely leaving decay in the tooth. We can do this successfully only if we have a good pulpal diagnosis (i.e., is the tooth alive or dead), proper technique is followed, and a good seal is created with final restoration. Failure in any aspect of these steps will likely result in failure of the minimally invasive technique and re-treatment of the tooth will be required.
There is no one size fits all solution to providing care in a post-COVID-19 dental setting. Each dental clinic will need to adapt to meet the needs of its patients and staff. While minimally invasive dentistry won’t be the complete solution, it offers a safer way to provide care and improve a patient’s health.
For further information on minimally invasive dentistry and techniques please check out these resources:
- “Minimally invasive dentistry”. MURDOCH-KINCH, CAROL ANNE et al. The Journal of the American Dental Association, Volume 134, Issue 1, 87 - 95
- Elevating Care: The SMART Pediatric Dentist
- Elevating Care: Minimally Invasive Caries Treatments
- Elevating Care: Managing Dental Emergencies, Controlling Caries, and using Teledentistry and SDF
- VivaLearning: Be SMART: Improve Your Practice with Silver Diamine Fluoride and Glass Ionomer Cement