Preventive versus restorative management of dental caries

Dental caries is a preventable disease and established lesions can become arrested. Traditional restorative treatment has many shortcomings and there is a need for dentists to manage carious lesions as far as possible by preventive means. Patients should be motivated to accept responsibility for changing the environment of their teeth so that the calcium and phosphate balance favours remineralization, but the dentist should still make use of therapeutic fissure sealants or place restorations when necessary. As long as dentists continue to be obsessed with a restorative approach to caries management, the repeat restoration cycle with its accompanying escalating costs seems likely to continue. The implications of this change in philosophy are enormous, for areas of the world where oral care services are comprehensive, and for countries like South Africa where services are still being developed in some regions.