Dento-legal considerations about an MI approach

Compromised Teeth Preserve or Extract: A Review of the Literature

Multiple systems and associated factors have been described in the literature to assess the prognosis of teeth with periodontal disease. Nowadays there is a tendency among clinicians to consider implants as the best solution after tooth extraction, in cases of teeth with a questionable prognosis. However, the value of the natural tooth must be considered, as the proprioception of the periodontal ligament is preserved, and it adapts to stress during functional loads. We first review the literature focusing on analyzing the factors that should guide decision-making to maintain or extract a tooth with a compromised periodontium. Then, we propose a schematic diagram of prognostic indicators to reflect the main factors to consider and the survival rate that each one represents when preserving or extracting a tooth.

A scoping literature review on minimum intervention dentistry for children with dental caries

Background Dental caries in children's permanent teeth remains a global burden. In contrast to the traditional approach of treating the disease through surgical operative intervention, minimum intervention has increasingly been recommended for managing children with dental caries.Aim This scoping review aimed to describe the literature related to the provision of minimum intervention dentistry for children with caries and to identify research gaps.Methods Electronic databases (Medline via Ovid, PubMed, Web of Science and Scopus) were searched, together with grey literature databases, and key organisation websites. Data was extracted on a piloted extraction template and a thematic analysis was undertaken.Results Sixty-seven relevant articles were identified. No empirical literature was identified that assessed a complete minimum intervention care pathway to managing caries. Five themes were identified from the scoping literature: evidence base, clinician attitude and skills, practice implementation, acceptability and environmental factors.Conclusions The majority of articles were opinion papers. There is a paucity of empirical evidence supporting the clinical and cost-effectiveness of a minimum intervention pathway for children with dental caries in primary dental care. The scoping review has identified some potential barriers to the implementation of such a care pathway, including regulatory and remunerative frameworks and clinical training/education.

Herodontics - is there a place for maintaining the apparently hopeless tooth?

The population is ageing and people are keeping their own teeth for much longer due in part to the efforts of the dental profession in restoring teeth and reducing the number of teeth being extracted. Along with this there is now an increasing expectation by patients that they will retain their own teeth as they age and that dental practitioners will have the knowledge and skills to help them retain their own teeth. Contemporary restorative materials and techniques have increased the range of options available to assist with maintaining the dentition, and many of these procedures enable minimally invasive and cost effective management of the teeth as an alternative to complex and expensive procedures. This paper discusses the restoration of compromised and failing teeth in the ageing patient, and looks at the various issues facing the ageing dentate patient and the dilemma of when to restore or when to extract. Ultimately it is hoped that maintaining healthy teeth for life may not only improve oral function and quality of life, but may in fact reduce the impact of the physical and psychological aspects of ageing.