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Operative Dentistry - Best Practices

Departmental Vision & Mission

(last modified October 14, 2014)

Vision: Global leaders in operative dentistry.

Mission: To support the academic goals of the institution through teaching, patient care and research. Our primary goal is to educate dental students, using best available evidence, to achieve and maintain optimal patient oral comfort, function and esthetics through risk-based diagnosis, prevention and minimally-invasive treatment of caries and other dental hard tissue disorders.

Primary scope of discipline:

  • Diagnosis, prevention and management of dental caries
  • Diagnosis, prevention and management of non-carious dental defects (attrition, abrasion, erosion, abfraction, developmental abnormalities, discoloration, and trauma)
  • Esthetic smile enhancement through minimally invasive adhesive dentistry.

Caries Management

Background and Guiding Principles

  • Dental caries is a disease that is not caused by a single factor but the interaction of several factors (Selwitz et al, Lancet 2007) and is one of the most prevalent diseases throughout history
  • Dental caries is a complex multifactorial disease that is not easily prevented, diagnosed or treated
  • Dental caries is the #1 disease among children in the U.S.
  • In the US alone, the total annual cost of treating dental caries and its sequelae is estimated to be around $60 billion out of ~ $100B total annual expense (Ismail et al, Comm Dent Oral Epi 2013)
  • 500 million direct restorations are placed globally per year making direct restorations one of the most prevalent medical interventions worldwide (2010 Ivoclar market data)

We are in general agreement with the ICDAS Foundation Coordinating Committee philosophy and recommendations, a guiding principle of which is that the quality of caries management is not solely assessed by the quality of restorations but rather by the preservation and promotion of oral health which may be measured by the prevention and arrestment of any caries activity in an individual over a period of time:

  • Manage dental caries as a disease process
  • The detection of a lesion is not a diagnosis nor a treatment plan
  • The detection of a caries lesion by itself must not automatically lead to a decision to restore it
  • Preserve dental tissues first and restore only when indicated
  • Achieve and maintain dental health, prevent progression of existing initial lesions and restore moderate or extensive lesions by use of risk-based clinical decision making
  • Follow the principles of minimally invasive surgical techniques
  • Restore to form and function with the highest quality esthetic outcome
  • Engage patients with activities focused on understanding the caries disease process and creating caries preventive and behavioral norms at home.