Perspectives on Dental Caries Prevention and Tooth Restorations
The day is surely coming .... when we will be engaged in practicing preventive, rather than reparative, dentistry. When we will so understand the etiology and pathology of dental caries that we will be able to combat its destructive effects by systemic medication.
Dr. G. V. Black 1896
Much of Black's prediction has come true. Thus, there is now a rational basis for prevention and treatment that reflects the successes of dental research. Caries is an infectious disease caused by acid-producing bacteria in dental plaque. The old adage that "a clean tooth never decays" is still valid. Fluorides, both systemic through community water fluoridation or prescribed supplements, and topicals such as toothpaste, rinses, and professionally applied gels, dramatically reduce caries rates. Protective sealants applied to the chewing surfaces of children's permanent teeth reduce these rates further. Therefore, there is every reason to expect that with concerted effort, dental caries largely can be eliminated in future generations and can be well-controlled among Americans living today. This must be the fist priority for the U.S. Public Health Service (PHS), health care providers, and the Nation.
In future years, the restoration of cavities will cease to be the mainstay of general and pediatric dentists. Treatments emphasizing conservative and preventive approaches should be expected. New adhesives and more durable plastic restorative materials that are currently available allow for increasing use of minimally invasive procedures that are more preventive than restorative. Preventive rinses allow remineralization of early lesions on tooth crowns and roots and should be used increasingly. Caries in all its forms, however, will continue to be seen in adults, the elderly and populations at high risk of disease regardless of age. In addition, there remain generations of people with fillings that predate the preventive era. Large, oversized replacement restorations and durable, effective restorative materials will be required for this group for many years to come.
The PHS is committed to disease prevention and health promotion and is trying to assure proper access to necessary diagnostic, preventive, and clinical services for those segments of the populations most susceptible to disease. This goal is embodied in Healthy People 2000: National Health Promotion and Disease Prevention Objectives, and includes 16 oral health objectives. These objectives, to be achieved by the year 2000, target reductions in oral diseases such as caries, as well as increased use of proven preventive therapies or practices, the most important being community water fluoridation and dental sealants.
Although this report addresses the use of important dental restorative materials, first priority should be placed on the conservation of healthy teeth through the use of available preventive therapies. This would limit the use of any restorative material. The best restoration is the one that is never needed. When teeth can be kept sound, there are no concerns over longevity, toxicity, or the esthetics of restorative materials. The all-important achievement will be oral health for all and preservation of natural teeth for a lifetime.