Make confident clinical decisions for better preventive dentistry – Justin Smith Director of Marketing CALCIVIS Ltd

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  Posted by: Dental Design      4th August 2019

Making effective clinical decisions is probably the most important and responsible tasks assigned to dental practitioners. These decisions can have far-reaching effects, as the judgements made have to describe a condition or problem that needs to be solved and ultimately, convert this information into actions.[1]They detail the diagnoses made, determine the prognosis, ascertainwhat prevention strategies are required and help patients to make choices about which treatment pathways should be followed.

In order to avoid any adverse events or errors, clinical decisions should be based on current evidence and best practice guidelines, but they also require a combination of skills and experience. To make sound, professional judgements dental professionals carry out a risk assessment involving a review of information such as the patient’s history, oral hygiene habits, diet and lifestyle to assess any modifying factors that could affect the development of oral disease. This is then integrated with a clinical examination to evaluate the impact of those factors. Most dental professionals use clinical decision support systems (CDSS) to analyse patient related data to help predict potential events and to prevent problems from arising. This software improves efficiency at the point of care as it provides prompts and gives alerts, flags up disease symptoms and reminds clinicians of factors such as medications or underlying health conditions that could potentially affect the treatment programme. Of course, any uncertainties and doubts must be identified and converted into relevant and useful information to arrive at an appropriate clinical decision that is in the best interests of the patient.

When evidence of disease or the risk of disease progression is identified, appropriate treatment can then be discussed and planned. However, as dental professionals know, modern dentistry is in no way similar to the historical “drill and fill” mentality of the past. It has shifted significantly to the minimally invasive, proactive prevention paradigm. In the case of dental caries, for example, recording cavitated lesions and focusing on operative treatment is extremely out-dated.[2]Rather, it is about detecting tooth decay at an early enough stage in order to intervene with preventive measures and take steps to reduce advancement and, if possible, to arrest the disease process.

The most common caries detection method is the combination of visual-tactile examination along with additional information gained from bitewing radiography. Nevertheless, radiographs are unable to differentiate between active and inactive lesions2 and studies suggest that by the timelesions on the occlusal surfaces are visible on a radiograph they may have already reached the advanced stages, rendering them beyond the scope of remineralisation therapy.[3]

To save more natural teeth from decay and to minimise the need for surgical intervention, practitioners need to capture any manifestations of the caries process prior to the cavitation stage, ideally when tooth enamel first begins to lose minerals. At this stage, the tooth enamel can be regenerated with remineralisation therapies and preventive strategies assigned to the patient’s individual risk levels, in order to stand the best chance of preserving the tooth structure.[4]

Until recently, it was extremely difficult to identify the caries process at the initial stages. However, a team of scientists, researchers, cariologists and technical specialists from Scotland have developed the CALCIVIS®imaging system. This is a unique, chair-side visualisation device that uses a bioluminescent photoprotein that detects microscopic free calcium ions as they are released from actively demineralising tooth enamel. The CALCIVIS imaging system is a first for dentistry and a breakthrough for caries management as it provides reliable, visual evidence of damaging demineralisation at an earlier stage than was previously possible. As well as this, it enables practitioners to differentiate between active and non-active lesions on tooth surfaces and allows them to monitor the tooth enamel accurately and effectively over time.

For obvious reasons, patients need to be willing to comply with preventive measures such as improving their oral health and making positive lifestyle changes in order to prevent oral diseases from progressing. However, when they are able to see and understand their oral health more effectively with images displayed at the chair side, they become more engaged and motivated to carry out the oral health measures and instructions that clinicians recommend to protect their teeth from decay.

Technology that captures signs of disease at the early stages and provides evidence to confirm and support clinical findings enables dental practitioners to make more confident clinical decisions. Uncertainties can be more easily overcome and converted into reliable information to benefit patients with better preventive dentistry.


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[1]Eddy D.M. Successes and challenges of medical decision making. Forum: What’s Right? Health Affairs. Summer 1986.

 [Accessed 15thApril 2019]

[2]Gomez J. Detection and diagnosis of the early caries lesion. BMC Oral Health. 2015; 15(Suppl 1): S3.

 [Accessed 15thApril 2019]

[3]Ricketts D.N et al. Clinical and radiographic diagnosis of occlusal caries: a study in vitro. J Oral Rehabil. 1995 Jan;22(1):15-20.[Accessed 15thApril 2019]

[4]Anusavice K. Clinical decision-making for coronal caries management in the permanent dentition. J Dent Educ. 2001 Oct; 65(10):1143-6.

 [Accessed 15thApril 2019]


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