Wednesday, August 14, 2013

Minimally Invasive Dentistry

What exactly is minimally invasive dentistry? There is much written on this subject.

The device shown above is a cavity detector. It's a nice piece of technology that allows dentists to assess cavities more accurately. The technology is far more precise than visual or tactile inspection.

Even though we have and use many different tools and techniques, minimally invasive dentistry is not a collection of procedures, techniques or treatments. Minimally invasive dentistry is a concept. Basically, it can be summarized as doing the most conservative possible treatment to maintain optimal oral health.

There are three main advantages to this approach:
  1. We avoid unnecessary tooth destruction
  2. We minimize expense
  3. Results are more predictable
Let's look at a diagram on the right to demonstrate an example. Here we see that in the early stages of a carious lesion (a cavity), it is confined to the outer layer (enamel) of the tooth. As it advances, it penetrates into the inner layer (dentin) of the tooth. Once this happens, the progression of the carious lesion is accelerated. In other words, it gets bigger faster. If allowed to progress into the pulp of the tooth, now a root canal is required to salvage the tooth. If enough tooth structure is destroyed, then the tooth may not be salvageable.

How do we minimize expense and unnecessary tooth destruction? Easy, just treat at the earliest time possible. I often tell my patients that it's much better to change your oil than to change your engine; or change your car;  or simply stop driving. I know, crazy analogy but it makes sense. With the progression it gets more 20 fold or more. 

Let's look at some costs of possible treatments:
  • Treat early--cost of a filling: $100-200
  • Treat later--cost of crown or onlay/inlay: $1,000-1400
  • Treat much later--cost of root canal, build up and crown: $2,200-2800
  • Treat much much later-- cost of extraction $100-200 + bone graft $300-600 + implant $3,800. Alternatively a bridge $3,000 or partial $1,800 can be made to replace the missing tooth.
If we opt to wait, what are we waiting for? For things to get worse?

Unfortunately, most people will wait. Approximately, 80% of the population does not see a dentist on a regular basis. Most in this group will only address their issues when it is blatantly obvious or when they are in significant pain. The entire experience can however be much more pleasant while at the same time being easier on the pocketbook and psyche if a proactive approach is taken.

Here some examples of potential scenarios:

Small lesion treated very conservatively
Much more extensive decay. The restorability is questionable because it is impossible to determine
the extent of the vertical fractures.

In summary, addressing issues in the earliest stages possible will enable the conservation of tooth structure, will reduce costs, will increase predictability and decrease physical and/or emotional distress.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit


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