Minimal Intervention Dentistry

Minimal Intervention DentistryChildren 0-6OHI1000ppmF toothpaste, can suggest 1350ppmf if concerned.2.2% NaF- varnish twice yearlyDietary adviceChildren 10+2.2% NaF- varnish twice yearly2800 ppmF toothpaste for active cariesSIGN 138 fissure sealant should be applied to the molars of ALL children as close to eruption as possible.

Children 16+2.2% NaF- varnish twice yearly2800 or 5000 ppmF toothpaste for active cariesSIGN 138 fissure sealant should be applied to the molars of ALL children as close to eruption as possible.Elderly, Dry Mouth, Other Needs2.2% NaF- varnish twice yearly2800 or 5000 ppmF toothpaste for active cariesF mouthrinse daily 0.05% NaF- at a different time to brushing.Toxic Doses5mg a kg F toxic dose.F varnish 22600ppmf is 50mg a ml. 20 kg child ingest 2mlsTube 10mls100 applications a tubeBlob about 0.1mlsToxic blobs 20kg child 20. Minimally Invasive DentistryCaries removalDuring cavity preparation the removal of carries infected dentine with the preservation of caries affected dentine is advocated; Caries infected dentine lacks the physical properties required for an adhesive seal (Vila Verde et al. 2009; Banerjee et al. 2010; Banerjee 2013b; Holmgren et al. 2013). SubjectiveTwo recent Cochrane systematic reviews (Ricketts et al. 2006; Ricketts et al. 2013) and a meta-analysis (Schwendicke et al. 2013) support the use of incomplete caries removal techniques These techniques reduce health risks to the dental pulp and post-operative complications. However, initial low-grade evidence argued by Schwendicke et al. (2013) suggests that in vivo the combined risk of mechanical and biological failure is comparable in completely and incompletely excavated teeth. A contrasting paradox is that there is no conclusive evidence to suggest that caries infected dentine that is soft and wet; in contrast to caries affected dentine that is firm and leathery requires removal (Kidd 2004). One randomised controlled clinical trial placed sealant restorations on moderate sized cavities with no caries removal. Lesion progression was arrested with no more failures than a control group with complete caries removal (Mertz-Fairhurst et al. 1998).

What Restorative Material?Adhesive materials such as composite restore teeth preserving tooth structure unlike amalgam. Amalgam requires mechanically retentive features at an expense of tooth tissue, as it does not adhere to tooth tissue. Interestingly the chemical bonding of amalgam offers no substantial benefits (Fedorowicz et al. 2009). One extensive cross-sectional study has reported that posterior composite restorations outperform the longevity of amalgam restorations (Opdam et al. 2007; Opdam et al. 2010). The observed annual failure rate appears to be in the region of 1-3% (Demarco et al. 2012).