My childhood recollections of a visit to the dentist still invoke images of the drill and its whining sound. Visions of Dustin Hoffman shrieking with fear and pain in Marathon Man were vivid in my mind before I even embarked on a career in dentistry. I remember when I first graduated that to treat decay without removing tooth tissue would have seemed a little far fetched. The amount of time that was spent with drill in hand is more than I care to remember.
However, move on 20 years and now the approach at our dental practice is entirely different. We are focused on minimal intervention (MI) and this ranges from diagnosis, prevention, right through to treatment and recall. Our practice team from receptionists, extended duties nurses, dental therapists, and dentists play important parts in our MI approach. Everyone gives preventive advice and perform caries risk assessment tests such as plaque testing, saliva testing, cariogenic bacterial counts and caries laser detection. Together with equipment such as magnification, air abrasion, and latest adhesive restorative materials we have firmly planted the ethos of MI in our dental care. The importance of each member of our team to continuity of service delivery cannot be underestimated, and we have very low staff turnover for a multi-surgery practice. The culture of MI is all pervading. It hasn’t just changed patients but also our practice and working environment for the better.
Minimal intervention has certainly transformed the way that patients receive care at our practice, which has resulted in regular attendance by those patients once thought of as toothache attenders. Moreover, it has improved their attitudes of us as professionals and a practice team.
We also have a constant stream of new patients coming to us and it is clear the philosophy of MI attracts them. They can connect with the MI vision and that we are trying to avoid drilling which they relate to discomfort and dare I say costs.
It is so important that we as professionals recognise the evidence base behind our clinical decisions. Research carried out in primary care practices although getting better is still lacking. It is here at the coalface of dental care provision that we need to conduct robust clinical studies that answer important questions on efficacy and feasibility. Our practice is very research active and, together with our patients and stakeholders is involved in several studies incorporating MI.
With the advent of new materials and techniques MI is an evolving science. In our busy working lives it is all too easy to fall into habits without questioning them, and the clinical and financial framework in which we practice can appear very dictatorial. It is important though to be inquisitive and question what we do to on a daily basis in our practices. There is now a master’s programme in Advanced Minimal Intervention Dentistry at Kings College London, which not only expands on the science of MI but also will provide insight into innovative ways of incorporating MI in general dental practice under varying remuneration systems (private and NHS).
For our team MI is not just a novel new age trend that separates our NHS practice from some others, it is actually the basis of routine dentistry. It is for our patients the most appropriate care at the most appropriate time.