Australian Dental Perspectives

At the most recent meeting of the PDF in October 2005, Associate Professor Hien Ngo from the University of Adelaide provided interesting insight into the concept of Minimal Intervention and how it could be used with great success in contemporary dental practice.

The World Congress of Minimally Invasive Dentistry defines Minimal Intervention as "a comprehensive, evidence-based standard of care that offers patients the benefits of risk-assessed diagnosis and prevention with the most effective detection, early intervention and the most conservative treatment for their oral diseases."

For this concept to work effectively, Associate Professor Ngo believes dentists need to change the way they define themselves and expand the range of services they provide. Instead of acting predominantly as surgeons, only carrying out restorative work, dentists need to also view themselves as oral physicians who provide advice, support, and preventive treatment to patients as needed.

According to Associate Professor Ngo, a change in mindset is not only required from the dental profession. For the concept of Minimal Intervention to work, patients need to take a more active role in the management of their oral health. Moving towards a medical model of care, Minimal Intervention seeks to put the patient in greater control of their oral health through education and motivation. It involves the patient maintaining a daily oral health care routine and having consultations with their dentist, who can then advise on the most appropriate course of action.

However, for Minimal Intervention to gain wider acceptance in the dental community, Associate Professor Ngo suggested there needs to be significant changes to the way that dentists and dental auxiliaries are trained and educated. While Minimal Intervention dentistry is part of the curriculum at many dental schools, it is not routinely being implemented in clinical practice. Associate Professor Ngo argued that the benefits of this approach must be communicated to dental students early on, giving them the confidence to implement it when they start practicing. He also recommended a collaborative approach be taken, with industry, educational and medical institutions, and health insurance companies all working together to implement Minimal Intervention programs.

As part of this new approach, the oral cavity is viewed as a living and evolving environment. Essential to a healthy mouth is the presence of a healthy biofilm. Associate Professor Ngo outlined four main strategies that should be followed when practicing Minimal Intervention dentistry. Firstly, he stated that mechanical modes of plaque removal cannot be discounted and should form the basis of any sound oral health care routine.

Secondly, people should restrict their daily intake of food and drinks containing fermentable sugar to the three main meals.

Thirdly, he argued that chemical-based treatments also have a role in Minimal Intervention. One option is a highly concentrated antimicrobial product, such as an antiseptic mouthwash, that would be used for a set period of time to address a specific problem.

Associate Professor Ngo also recommended the use of what he referred to as "probiotic" products. These are products featuring a low concentration of fluoride, xylitol and Recaldent™ that can be used regularly to promote the production of good biofilm.

Following Associate Professor Ngo's thought-provoking presentation, the PDF members further discussed the role of antiseptic mouthwashes, such as ListerineTM, in Minimal Intervention dentistry.

The PDF agreed these products offer dental professionals and consumers alike a range of benefits and can be used with great effectiveness as part of a Minimal Intervention program.

Firstly, the group agreed that Listerine is effective against a broad range of bacteria, fungi and lipophilic viruses found in oral biofilms, as it penetrates the cell membrane and diffuses through the biofilm to slow its growth (even in hard to reach places). With its long-term anti-plaque and anti-gingivitis effects, Listerine is indicated for use for patients with orthodontic appliances or fixed prostheses, over-denture abutments and implants as well as maintenance of peri-implant soft tissue health, making it a valuable addition to any oral health care routine. Listerine is also effective when used to combat the effects of halitosis (caused by intra-oral factors).

Secondly, Listerine's availability through common consumer channels (grocery and pharmacy), coupled with its affordability, increases patient compliance, obviously an important factor in any program which relies on patient involvement and commitment.

The PDF also discussed the best way to communicate the benefits of Listerine in Minimal Intervention dentistry to consumers.

They agreed that Listerine should be positioned to consumers as an important element of an effective oral health care routine. The group stated it was important that consumers be aware that it was not a product to be used in isolation. Rather, that Listerine will assist consumers in achieving good oral health, when used in conjunction with mechanical oral hygiene measures, such as brushing and flossing or using interdental aids, and regular visits to the dentist.

PDF members also suggested identifying some of the problems with other oral health mechanisms that can be faced by consumers. For example, patients are often unable to reach all areas of the mouth when brushing or flossing, as well as the difficulty of brushing and flossing effectively. Even those who know the correct technique for flossing and brushing and are willing and able to complete the required steps on a daily basis invariably leave some bacteria behind, a fact that is reflected in figures which show two out of three Australians suffer from gingivitis.¹ Listerine should be promoted as a product that is easy to use and effective on all areas of the mouth (including interproximally.)

Lastly, the PDF agreed that consumers should be made aware that Listerine can reduce dental caries and aid in remineralisation through the presence of fluoride in the Listerine Teeth Defence variety.

The concept of Minimal Intervention offers dentists and their patients a range of benefits. Through his presentation, Associate Professor Ngo provided an overview of this important theory, while the ensuing group discussion confirmed the important role of antiseptic mouthwashes in the implementation of Minimal Intervention within the dental practice. They also provided valuable insight into how the benefits of such products should be communicated to dental professionals and their patients.

1. Newspoll National Omnibus, April 1997.

The Preventive Dentistry Forum

The Preventive Dentistry Forum brings together some of Australia’s leading oral health experts. Attendees at the last meeting were: