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Minimum Intervention Oral Healthcare Delivery – Is There Consensus?

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Minimum Intervention Oral Healthcare Delivery – Is There Consensus? UPFRONT EDITORIAL Minimum intervention oral healthcare delivery – is there consensus? Aviit Banerjee, Guest Editor BDJ Minimum Intervention Themed Issue and Professor of Cariology & Operative Dentistry; Hon. Consultant, Restorative Dentistry; Head of Department, Conservative & MI Dentistry; Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Guy’s Dental Hospital, London, SE1 9RT, UK. The BDJ Upfront section includes editorials, letters, news, book reviews and interviews. Please direct your correspondence to the News Editor, Kate Quinlan at [email protected]. Press releases or articles may be edited, and should include a colour photograph if possible. irstly, I’d like to take this opportunity in the BDJ, so increasing their exposure to a dependent on longitudinal susceptibility to ofer all BDJ readers my sincere best wider audience. He agreed and hey presto, in assessments).1 wishes in what has been a trying 2020 so 2012 and 2013 in BDJ volumes 213 and 214, Ffar. At the beginning of a new decade, heralded they were published and proved to be of real Four years later, I was again delighted and by many as a fresh chance for humanity to interest and inspiration to the readership. honoured this time to coordinate, co-author embrace and nurture all that is positive in Suitably enthused, in 2013, Stephen then and present the frst MI-themed BDJ issue as global and local society, we fnd ourselves kindly invited me to author an editorial its guest editor, commissioning a selection of having to re-adjust radically, both personally opinion piece introducing and outlining high quality manuscripts from national and and professionally in such unusual times, to the concept of prevention-based minimum- international renowned professionals and dear a new ‘norm’ and there is still much to evolve intervention oral care (MIOC) provision colleagues with an acknowledged expertise in in this regard. I have purposely avoided the and the challenges it might face in gaining MI dentistry.2 As can be seen from the range of over-used descriptor, ‘unprecedented’ to acceptance in the mainstream profession.1 papers published in that issue, alongside many describe the events that have transpired. Te MIOC team-delivery framework is based other important publications in the dental Pandemics are not unprecedented. Indeed, they have and continue to afect humankind ‘ Through such adversity comes the with a certain biological regularity over history. glimmer of opportunity to change What is unprecedented is the reaction of humankind. As society has begun the complex and develop new strategies and reactionary re-adjustment, it is clear that in the healthcare sector, many work practices and mechanisms to deliver better oral health tenets of care delivery will be forced to change. programmes’ Positive opportunities need to be taken by all stakeholders in dentistry involved in delivering the best oral healthcare management to around four interlinked domains, applicable literature, the clinical academic evidence for MI patients. Tese stakeholders include the to any of the restorative disciplines, across dentistry is now far-reaching and more widely clinical/research profession, educators, the all ages and patient groups (with suitable accepted as to be considered a mainstream needs, wants and expectations of the public/ adaptions where necessary) (Figure 1): approach in the profession and not solely for patients, industry partners, service providers, • Identifying problems (detection, risk/ caries management as many still perceive. indemnity associations and service regulators. susceptibility assessment, diagnosis and Te advances in clinical operative techniques/ Terefore, this second minimum intervention patient-focused care planning) technologies/materials, behaviour management (MI)-themed issue is in my opinion, quite • Prevention & control (primary, secondary and another form of MI, motivational timely in its planning, production and release. and tertiary prevention of lesions, control interviewing, are all enabling oral healthcare MI association with the BDJ began in early of the disease process) teams to deliver successfully this contemporary 2012. An informative series of MI-related • MI treatments/procedures (minimally approach to achieve and maintain oral health papers in conservative dentistry had been invasive operative management of carious/ and long term wellbeing in our patients.3,4,5,6 published in a French journal, Réalités periodontal lesions, pulp pathology, However, even with such evidence laid bare, it Cliniques, the previous year. I felt compelled broken-down or missing teeth) is clear that the uptake of minimally invasive to speak to my dear friend, colleague and • Review/recall (reassessment of any operative principles/approaches, for example BDJ editor-in-chief, Stephen Hancocks to treatment provided, patient behavioural in caries management, is not universal in see if these could be adapted and reprinted adherence to change, recall periodicity primary care practice.7,8 Terefore, it is timely BRITISH DENTAL JOURNAL | VOLUME 229 NO. 7 | OCtoBER 9 2020 393 © 2020 British Dental Association. All rights reserved. UPFRONT Identify documentation between the team and patient Anamnesis, susceptibility assessment, of decisions made and the reasons as to why. clinical detection, investigations, diagnosis prognosis: personalised care plan So, where are MI guidelines? What Caries, periodontal disease, tooth wear evidence, if any, should be considered, (tooth surface loss), trauma, congenital accepted or discarded?11 Which stakeholders disorders are responsible for generating and updating Dentist/therapist/hygienist/EDDN them? How can guidelines be validated locally, Recall regionally, nationally or globally? Should there Minimally invasive Prevent lesions & Longitudinal susceptibility be nationwide/global coordination/training? treatments assessment, motivation control disease Direct/indirect restorations, (COM-B), maintenance, 1° 2° 3° prevention, Tere are many important guideline pulpotomy/root canal therapy (endo), review periodicity non-invasive/micro-invasive, COM-B publications available for each of the bridges/implants/dentures (prostho), behaviour management, standard home Dentist/therapist/ diferent disciplines in restorative dentistry, root surface debridement, hygienist care, active/enhanced team care orthodontics/paediatrics (Hall crowns) Dentist/therapist/hygienist/EDDN/OHE/ including periodontology, prosthodontics (1° 2° 3° care provision) receptionist/specialist and endodontics. Tese ofen concentrate on Specialist/dentist/therapist/ hygienist standardising specifc operative treatment protocols for more clearly defned clinical Fig. 1 The MIOC framework applied to the diferent disciplines within restorative dentistry (conservative dentistry and endodontics, periodontology, prosthodontics and orthodontics), showing the four interlinked situations. Tese are published by expert domains and the oral healthcare team members responsible in each (EDDN – extended duties dental nurse, panels representing learned societies, royal OHE – oral health educator). Minimally invasive operative dentistry forms one of the domains within the MIOC colleges and government bodies. Tese framework for delivering better oral health. TSL – tooth surface loss groups are sometimes assisted by industry partners to help convene the discussions. It is that in 2020 this second MI-themed issue has of care with underlying team-delivered important, however, that industry partners do been published, collating international experts’ communications to patients, to value and not infuence the outcomes and these are kept outputs on how the accepted principles of take responsibility of their own general and strictly independent to avoid inappropriate bias. MIOC/minimally invasive operative dentistry oral health. Tis message has never been as Te discipline of conservative & MI dentistry (MID) can be implemented in the broader pertinent and meaningful as it is now.9 in primary care covers a great breadth and world of ‘real-life’ primary care dentistry, for variety of clinical situations afecting a large, the beneft of our patients long term. MIOC underpins care throughout the heterogeneous population. Many management Tis issue, which should be read and life-course variables (technologies, procedures, materials, digested in conjunction with the contents of Dental caries is still one of the most prevalent operator skills, knowledge, experience and a the frst MI-themed issue, focuses on clinical non-communicable diseases afecting multitude of patient factors including attitudes/ implementation strategies across the various humankind globally.10 Tere is clear need and behaviour/socio-economic status etc) all disciplines of clinical dentistry that primary beneft to have guidance as to how to deliver need to be considered when attempting to care practitioners and their teams experience MIOC and MID to individuals, local regions develop suitable treatment guidelines to help on a daily basis. One year ago, I gave the and country-specifc populations. Of course, practitioners and their teams.12 Tanks to authors the brief to summarise knowledge as all clinicians appreciate, there is always this complex interaction of variables, there and ofer potential solutions/guidance for variation between practitioners as to how to is a relative paucity of clear-cut, high quality the use of MIOC principles to manage resolve particular clinical challenges, with evidence (for example,
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