Conservative Dentistry

Minimally Invasive Dentistry - where are the practitioners?

Have you ever heard that old cooking adage, “you can always add more, but you can’t take it out?”  Chefs everywhere know that when making a recipe, less is more.  You can always add more salt, more sugar, more vanilla, but once you have added an ingredient to a recipe you cannot take it out.  This concept is true in dentistry as well.  Once natural tooth structure is removed it's gone forever.  It can only be replaced artificially.  

Minimally Invasive Dentistry (MID) (conservative dentistry) is a State-of-the-Art trend that is being ignored by many dental professionals - even today in 2012! MID is dedicated to restorative and gum dental treatments that allow for the patient to retain as much of their natural tooth structure and soft tissue in the mouth as possible.

An example of Minimally Invasive Dentistry is to treat cracked teeth with "ONLAYS" instead of "CROWNS".  Onlays result in less root canals (less trauma); they look better; and they last longer (less likely to re-decay).  They are being taught as BEST treatment option - and they should be offered by all dentists (this is the consensus opinion of "national experts" in the field of restorative dentistry and has been for quite a few years).

While MID is in the best interest of patient care, many dentist still do not practice MID.  As a dentist who has been practicing conservatively for many years, I am often asked why more dentists do not subscribe to the philosophy of MID.  In this blog, I am offering up my rationale which I believe helps to answer this question.

Porcelain Crown

Porcelain Inlays and Onlays

1.      Minimally Invasive Dentistry is more technically demanding … In short, MID is tougher to learn than traditional dentistry.  An example of this would be Onlay vs. Crown.  An Onlay, when indicated, is a far more conservative approach to restoring a fractured tooth than a crown.  Considerably less natural tooth has to be removed to restore a tooth with an Onlay. However, Onlays are technically more demanding than cutting down a tooth to cement a crown.  When Onlay treatments are performed by a less than competent dentist it can be frustrating for all involved.

2.      Expense… MID can be considerably more expensive for the dentist to perform, although LESS costly in the long-term for patients.  MID can run up the bill for a penny-wise dentist.  Let’s use the Onlay as an example.  Onlays carry a stiffer lab fee than traditional porcelain/metal crowns.  Moreover, purchasing the technology that allows the dentist to perform more conservative dentistry balloons overhead.  Furthermore, MID requires more continuing education classes, time and more financial resources to stay proficient than traditional dentistry. All of these can add up to a significant expense for a conservative dentist.

3.      Significance of newer concepts is not quickly grasped… As a new technique or technology emerges, few (hopefully insightful) pioneers begin a movement.  The importance of which, in subsequent years, eventually becomes apparent to the DDS/DMD masses – who then finally opt in. 

4.      Patient/Insurance dictated treatment…  Many times patients allow dental insurance to dictate treatment.  As we discussed earlier, MID is far superior in long-term benefits in oral health for the patient.  However, dental insurance companies, which are often concerned with their bottom dollar and not patients’ best interest, opt for coverage of cheaper treatment options albeit not the BEST option for the patient. Often times, patients allow their dental insurance to dictate treatment that is not in their best interest, but in the best interest of the dental insurance company's bottom line.  In 2012, fortunately, dental insurances ARE covering more and more MID procedures - which is a healthy change!

Dentists who are not practicing minimally invasive dentistry are, in politically correct terms, dental leftists.  And, Caveat Emptor: Liberal is desirable when cutting teeth is the issue. Conservative dentists on the other hand, take the time and effort to respect and save natural tooth structure, which they believe, is vastly superior to even the best artificial restoration.  In this context, count me a proud, yet lonely, ‘right winger.’