H Akers: written in 2001 about Minimally Invasive Dentistry

Minimum Intervention Dentistry:

Maximum chemical intervention with minimum physical invasion
Over the last thirty years, most forms of caries in Australia have declined. Modern philosophy is
preventive and minimally invasive with emphasis on risk assessment and appropriate chemical and
minimal physical intervention. Why? Researchers have provided a better understanding of the nature
and progression of dental caries, which in conjunction with other developments have outmoded many
of Black’s principles. Black’s era was one of rampant caries, where patients with a reduced life
expectancy, eventually lost teeth. Epidemiological evidence confirms the magnitude of iatrogenic
dental destruction (the repeat restorative cycle). Contemporary dentistry uses adhesive and bioactive
materials. Fluoridation (water, toothpaste) has significantly influenced caries disease patterns.
Sacrificing tooth structure for access, visibility, resistance form, retention form or “prevention”
principles is increasingly questioned. Caries treatment today involves targeted chemical and non-
specific preventive strategies like oral hygiene, education about dietary influences, salivary analysis,
sealants and restorations.
Better comprehension of the carious processes:
Concepts of demineralization and demineralization
Chemical treatments for caries
Role of bacteria
Caries without cavitation
Affected and infected dentine
Individualized risk assessment
Role of saliva
Better diagnostic criteria:
Improved lighting
Finer instrumentation
Transillumination
Radiographs
Microbial tests
Salivary assessments
Magnification
Caries detecting dyes
Diagnodont
Better communication skills and technologies
Intra-oral cameras
Better epidemiological evidence
Iatrogenic dentistry – fillings fail, teeth break
Reassessment of the shortened dental arch
Better cutting technologies
High speed
Air abrasion
Diamond bur
Manage the oral environment: OHI; change the microflora, sealants, chemicals enhance the fluoride
reservoir and the quality of the enamel; limit the frequency, type and form of fermentable carbohydrate
intake; increase the quality and quantity of saliva; chlorhexidines, fluorides, CPP- ACP. Desensitise if
possible, stabilise and remineralise with conservative preparation, restoration, manintain and recall.