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A monograph addresses a single subject and this book is about caries excavation – everyday dentistry for many. How should soft, infected dentine be managed? The authors have studied, discussed, and researched this question and distilled contemporary knowledge for you. Intriguingly, with one notable exception, it may not matter what you do. Brush, seal, or selectively remove, all have their place but with each you must understand what is being attempted and why.
So what is the exception? What must you not do? You must never pick up a sharp excavator or burr and remove soft tissue vigorously because this could damage the tooth and even prejudice its survival. Perversely, this might be precisely what you were taught to do in dental school! This just goes to show how research changes clinical practice and how important it is to keep up to date.
So read and enjoy the book!
Edwina Kidd, London
Em. Professor in Cariology
There is a reason why medical researchers do their work. They wish to contribute to improving people’s health and well-being through eradicating diseases, to improve existing treatments and change disease-causing behaviour, and much more, through the study of these areas.
An astronomically high number of medical publications appear in the literature monthly. The number of oral health-related publications is very high, too high for a dental practitioner to read them all. Some of these have a quality that leaves one wondering how the manuscript passed the review process. Others are of extremely good quality and provide new worthwhile information.
The scientific world is assisting medical professionals by producing systematic reviews and/ or meta-analyses on an ever-growing number of topics. A systematic review merely appraises the available evidence on a topic in the literature on the basis of research quality criteria and then draws conclusions. They are not designed to make recommendations on treatment. Therefore, these reviews and/or meta-analyses cannot be left on their own as the impacts of the individual results need to be merged to facilitate change, for example in improving (oral) health or aspects of it. It is like bricks that need cement to build a solid structure. A way of combining newly acquired knowledge into contemporary disease management concepts is to write a book, or in this par-ticular case a monograph. Another way is to develop guidelines.
The current monograph was written by dedicated researchers who are experts in the various subfields of cariology and restorative dentistry. The chapters are built on evidence-based results and take the reader through the development of dental caries, assess the devices for diagnosing it in clinical practice and in an epidemiological setting, and provide new insights in the way a dentine carious cavity can be managed both from a tissue removal and a restoration point of view. Examples of dental tissue-preserving methods are presented and the necessity for sealing a dentine carious cavity with a quality restorative material is highlighted with ample evidence. Also, an update on how to conduct a randomised clinical trial is presented, and a chapter is included on terminology to support better verbal communication and interactions between members of the oral health profession from all corners of the world. The monograph concludes with recommendations and suggestions of areas in dentine carious cavity treatment that are not fully understood yet.
In essence, dental caries is a preventable, behaviour/life-style disease. It implies that members of the public do not need to go through the ordeal of drilling and filling teeth regularly as the generation following the Second World War had to undergo. At that time, oral health research was in its infancy. Over the past decades, oral science has yielded information that benefits the public. It is the duty of the oral health profession to embrace philosophies of managing dental caries, such as the minimal intervention dentistry concept, which aims to keep healthy teeth healthy throughout life by preserving sound and remineralisable tooth tissue. The expectation in many parts of the world as people are getting older is that they wish to enjoy a well-functioning, painfree oral cavity. Therefore, tissue-saving procedures should be commonplace after caries prevention has failed, in order for the elderly to have a sufficient number of functioning teeth to assist them.
The idea for writing this monograph on the Evolution of Treating Cavitated Carious Lesions was born at the memorable congress of the European Organisation of Dental Research (ORCA) in Liverpool in 2014. It became operational first at the 2015 Leuven meeting, where the International Caries Consensus Cooperation (ICCC) was established. The ICCC published 4 papers in 2016 that form the basis of a number of chapters contained in the current monograph.
We wish the reader very many happy moments reading this work. We hope that this monograph finds its way to undergraduates in all dental schools and to postgraduate education courses around the world. The oral health profession has the knowledge and tools, as well as the duty to participate together with people/patients to “prevent restorations” and to “prevent root canal treatment and extraction on the basis of dental caries,” and to prolong a healthy dentition into older age. Let’s collectively do it.
Falk Schwendicke, Berlin
Jo Frencken, Nijmegen
Nicola Innes, Dundee
Schwendicke F, Frencken J, Innes N (eds): Caries Excavation: Evolution of Treating Cavitated Carious Lesions.
Monogr Oral Sci. Basel, Karger, 2018, vol 27, pp 1–10 (DOI: 10.1159/000487826)
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Pathophysiology of Dental Caries
aDivision of Oral Microbiology and Immunology, Department for Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University Hospital, Aachen, Germany; bAix Marseille University, CNRS, ISM, Institute of Movement Sciences, Marseille, France
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Abstract
Carious lesion dynamics are dependent predominantly on the availability of fermentable sugars, other environmental conditions, bacteria, and host factors. Our current understanding of the microorganisms involved in the initiation and progression of caries is still rather incomplete. The most relevant acidogenic-aciduric bacterial species known to date are Streptococcus mutans, bifidobacteria, and lactobacilli. Whereas mutans streptococci are initiators, bifidobacteria and lactobacilli are more enhancers for progression. Boosters for microbial activity are specific environmental conditions, such as the presence of fermentable dietary sugars and the absence of oxygen. Based on these conditions, the necrotic and/or contaminated zone fulfils all criteria for disease progression and has to be removed. For those deep lesions where the pulp vitality is not affected, a selective removal of the contaminated leathery dentine should take place as this approach lowers the risk of regrowth of the few embedded microbial cells here. In repelling
