Posts on social media forums regularly highlight the wide diversity in clinical decision making, something that we have known about for a long time. There is no doubt that a philosophy regarding caries management – ‘if in doubt, fill’ - still persists in some circles. This sits alongside concerns that ‘watching’ or monitoring a caries lesion is akin to supervised neglect. Yet the evidence is clear that active preventive interventions (such as silver diamine fluoride, oral hygiene instruction and dietary modification) work to prevent or arrest caries.
Why then do we see so many examples of clinical judgement trumping evidence-based practice? Translation of evidence to practice has long been an issue. It can take up to 17 years for research to find it’s way into practice. There are challenges too. Prevention is not sexy, and the private fee-for-service model disproportionately favours restoration over prevention. This is particularly evident with the Child Dental Benefits Schedule where several common preventive items are not included for reimbursement.
But it’s also hard to change some of the myths and dogma that exist in clinical practice.
In this episode of the Dental As Anything podcast, I talk to Dr Tim Keys, a specialist paediatric dentist, whose research found that Australian dental practitioners are some of the most invasive internationally when it comes to treating caries. In a thought provoking episode, Tim challenges us to explore the current evidence and consider a more preventive approach.
You can listen to the podcast here, and it is also available on Spotify and Apple Podcasts - don’t forget to follow/subscribe, and share with your friends.
For clinicians interested in learning more, the current International Caries Classification and Management System (ICCMS) guidelines can be found here.
Previous Episodes
Episode 1: Mouthwash
Episode 2: Ethics, professionalism and the imagination
Episode 3: Public dental funding lacks teeth, but is change coming?
If in doubt, fill ... dogma, myths and clinical judgement in caries management.