Understanding and managing dental caries: a medical approach

This article has taken a medical approach toward the understanding and managing of dental caries. Caries has been defined as a point in a person's life when there is an imbalance between protective and pathologic factors such that the process of demineralization of tooth structure by acid from bacteria in the tooth biofilm exceeds the patient's ability to remineralized tooth structure. The patient diagnosed with caries is out of balance. Caries is a diagnosis of a person. People have caries, teeth have lesions. Caries lesion detection, classification, and analysis are done at the level of the tooth surface. Caries is a process in time. Today we establish a diagnosis. For the future we establish a prediction. Patients can be diagnosed as caries active, caries balanced, or caries undetermined. For an improved treatment plan, future risk and prognosis assessments are accomplished by classifying all patients as either low, moderate, or high risk. A combination of diagnosis and risk or prognosis assessment leads to five treatment groups, each with an appropriate protocol for managing the disease process. The five protocols follow from the use of the four-step medical model for caries management. In the end, there are two treatment plans for these patients: a restorative therapy plan that treats the holes and a disease management plan that treats the disease. Surgical treatment does not manage the disease. Today we are managing tooth decay with medicine instead of a drill.