Keep the Plain Things the Main Things

Becky O'GuinFeatured News

Dr. Carrie Mauterer

By Carrie Mauterer, D.D.S., CDA Editor
From the  Summer 2023 Journal of the Colorado Dental Association

Ferris Bueller once said, “Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.” I couldn’t agree more with this wise, fictional, sassy sage. The same is true when looking at the field of dentistry. Our profession has evolved and changed quickly throughout the years. There have been changes in dental materials, procedures, workforce, work models, regulations, practice management software/IT and administrative outsourcing options. Not to mention the AI elephant.

While I love reading about the advancements of dentistry in the cutting-edge areas, I am trying to get back to basics this year and use my journal research time to read more about cariology. I know what you are thinking because I thought the same thing at first. Cariology? That topic was dry even back when we were learning about it for the first time. Why on earth would I circle back to a topic as dry as the hump on the back of a camel in the middle of the Sahara Desert? Because part of my personal journey this year is focused on keeping the plain things the main things. In all aspects of my life, I am focusing on the smaller things in life – the areas I used to take for granted; the main and plain aspects that are central to my contentment and success. There isn’t any dental topic “more plain and main” to the work I do every single day than cariology. I have to be honest though. Surprisingly, I’m being drawn into the plain work of caries control. It’s a little bit fascinating. So much has changed.

While I attended dental school during the early aughts of 2000, (AKA right around the end of the last Ice Age) we were taught a very specific methodology for caries removal. We used the non-selective caries removal technique. This meant that we drilled and spoon excavated carious tissue until hard dentin was reached. We learned that the dentin makes a certain sound when caries removal is complete, and the feel of the hard dentin left behind should feel like glass with our explorers. We would fail a prep check if we left any soft or even firm (but not hard) dentin behind. This approach was based on the peer reviewed science available at that time.

As I read the latest article released in the July 2023 JADA by the ADA Council on Scientific Affairs and ADA Science and Research Institute, I was excited (yes, I’m being honest) to see advocacy for a more conservative approach to caries removal. There has been a mind shift in taking a different approach in caries removal to have the best long-term outcome for the tooth. Long story short there is evidence that selective caries removal (stopping at soft or firm dentin rather than going all the way to hard dentin) in deeper carious lesions may be a better alternative for the longevity of the tooth.  I have seen similar results from studies like this outside of our country, but this is the first time I have seen encouragement for a more conservative approach to caries removal within our national borders. The article is JADA vol. 154, issue 7, p551-566.E51, July 2023 if you are interested in walking down a back-to-basics journey with me. May I suggest lighting some candles and adding a little John Prine vinyl playing in the background to really set the mood for proper cariology research.

I don’t want to get too nerdy here (we may be too late) and I certainly don’t want to give away any spoilers from the article, so I’ll stop with the details and round this article out into the big takeaway. When there are challenges made to dental approaches as basic as caries removal, one has to acknowledge that there is a wide spectrum of clinically acceptable, science-based approaches to keeping our patients healthy. When you think of all the brilliant minds who put together the brilliant curriculum of our elite higher education dental schools you might want to assume we all learn the exact same thing no matter where or when we attend our courses. When you think of the golden standards that have been emphasized in our peer reviewed journals, you might want to assume they all say the exact same thing. When you think of the 202,536 dentists in the United States (thank you ADA Health Policy Institute for that data point) you might want to assume that every dentist has the same philosophies. But hey…we don’t.

There is a broader spectrum of clinically acceptable outcomes that come from different backgrounds and sources of scientific evidence. Dentistry isn’t a one-size-fits-all philosophy. So, if one dentist is performing non-selective caries removal while another finds that selective caries removal works best in her hands and both are considering what is in the best interest of their patients while leaning on peer-reviewed scientific research, who is to say one is wrong and one is right? In the bigger picture, we have very diverse perspectives on many choices we make for our patients ranging from the basics (how to remove caries or whether to save a tooth) all the way to the cutting edge (whether to use lasers with every SRP or if AI will make us better diagnosticians).

Professionalism in dentistry includes how well we work with our dental colleagues – even the dentists we have never met. So, when that patient comes in to ask me a second opinion on their oral health, I keep to the plain thing the main thing. I tell them what I see right here and right now and what I would recommend and why I would recommend it.  I assume the best in my colleagues and hold onto the hope that they are assuming the best in me. We all work within a broader spectrum of approaches and philosophies but the one thing that unites us all is the plainest and “mainest” of all concepts. We were placed on this earth to help people.

I wish you happy journal reading and encourage you to keep up the good work on those CE courses. And…let’s all remember to stop and look around once in a while. Take in the bigger picture just like Ferris taught us to do. Embrace that broader spectrum of the dental profession and support your dental colleagues in our collective pursuit of wellbeing.