You've seated a new patient and have reviewed her medical and dental histories. Your next step is to discuss your office’s philosophy and what you plan to do. You want to convey how you will perform your clinical assessments and manage her care. Imagine this explanation: “Ms. Patient, as you may know our office is dedicated to providing the minimal care necessary to maintain your oral health. We don’t use methods you may be familiar with, like inserting a probe into your gums to measure periodontal pocket depths or sticking your teeth with an explorer to check for decay. Our office uses different, newer types of technology to measure your oral health. We also perform objective risk assessments on a regular basis to see if your profile for developing oral diseases changes over time. Using these tools allows us to focus on preventive strategies to keep you healthy and to then use the least invasive strategies to treat your problems during the early stages of disease.” Does this sound idealistic, crazy, or downright impossible?

My inspiration for this month’s Editor’s Note is the article, “Small Incisions = Big Benefits,” by Stephen K. Harrel, DDS, viewable here. In this second article in a series (the first was published in the October 2007 issue), Dr. Harrel explains the benefits of minimally invasive periodontal surgery (MIS), a technique he has used for 13 years. According to Dr. Harrel, his use of MIS has resulted in less post-operative pain, more rapid healing, and less sensitivity for his periodontal patients. The concept of minimally invasive procedures applies not only to the treatment of periodontal conditions but to dental caries as well. For caries, minimally invasive procedures might include aggressive preventive regimens, risk assessment, and remineralization techniques, while never removing more tooth structure than is required to treat a lesion.

There is actually an organization called the World Congress of Minimally Invasive Dentistry (www.wcmid.com) that will be hosting its ninth annual meeting in August. It’s definition of minimally invasive dentistry is simple: minimally invasive dentistry is respecting the health, function, and esthetics of oral tissue by preventing disease from occurring or intercepting its progress with minimal tissue loss.

Even though it sounds straightforward, minimally invasive dentistry is not a simple concept to grasp. We need to think preservation and prevention first, and treatment second. Risk needs to be assessed before providing any type of therapy. We need to educate patients about this new way of thinking and get the insurance companies on board. Our focus has been the disease model of care for so long that changing to a wellness model of care takes some adjustment.

Gone are the days of Dr. G. V. Black’s “extension for prevention” concept. (Yes, I know I’m showing my age since I learned this theory when I was in dental hygiene school!) We are now trying to preserve as much of the natural tooth structure as possible, and minimally invasive dentistry promotes that idea. As we focus more on prevention and risk assessment for all forms of oral diseases, minimally invasive dentistry is making a name for itself. It’s time for less so we can truly provide more—more care that is patient-centered and preventive in nature.

—Jill Rethman, RDH, BA
—Editorial Director
—jrethman@belmontpublications.com