Changing paradigms in restorative dentistry

Dramatic improvements in oral health have occurred during the last twenty years. Success is most noticeable in children and young adults, but also extends to the general population. The impact from declining disease rates, improved restorative materials and techniques, new diagnostics and treatments, a broad array of preventives, and better ways to deliver products and services to the public are demonstrated in the decline in the number of restorative procedures performed each year, including a 40% decline in the use of amalgam over the last eleven years. The new paradigm for restorative dentistry calls for an increasingly conservative approach to treatment. The question now is not primarily whether amalgam, composite, or any other material will fill a cavity. The real issue is to make the distinction between caries as a disease and caries as a lesion. Treating caries as a disease requires a new approach to patient management. A diagnosis of caries requires that a patient risk profile be established. We can no longer be limited in our efforts to merely restore the individual tooth surface. This paper discusses the need to cure disease and restore the total integrity of our patients' oral health.