Conclusion
I am not going to say that this approach is suitable is for every practice but every practice could take part of it and use as required. Cost. In relative terms it costs very little to risk assess our patients for caries and other illnesses. More use of questionnaires is not expensive. The mercuric amalgam may cost slightly less as against the newer improved biomimetic products but it is far outweighed by the benefits of these products …. ease of use / aesthetics / biocompatabilty. The longevity of non-amalgam materials is now up there with that of amalgam. Look at the number of countries that have banned its use. What would your preference of filling material mercuric amalgam or a biocompatible option?
Safety. The risk assessing of diet and bruxing can be done at home prior to a visit online or in the practice by the use of tablet under social distancing along with the essential oral health education. The techniques and materials can be used without the need for aerosols or drilling. You can use them under damp conditions so air drying is not required.
NHS/ Private. All practices and dentists have to decide what is best for themselves and their patients. They have to decide when to stay in and uphold the NHS system. This time more than any is the time to decide what you are going to do as regards private and NHS. The MID format of dentistry has no boundaries it is not governed by rules, regulations and targets as those within the NHS. Dentistry has been reset and we shall see reviews of contracts and regulations.
Science and evidence based. These principles, products and techniques are evidence based. Tried, tested and proven. Careful and full note taking at all stages and patient acceptance noted. Patient compliance is essential. We have an obligation to investigate and look into what we have out there in the dental world as it is so exciting, helping us through this critical and immensely stressful time. We have to massively retrain our practice and practices. AND OUR TEAM! We have to look at alternative ways of treating and move away from invasive treatments. We have to look around as to what we have available. We have products that AVOID drilling entirely! We can move away from a drill and fill culture. Repair instead of replace!
Anecdotally. The use of older materials with precious metals seem to have had quite a success rate yet have been overtaken by newer more expensive materials. Silver nitrite was used by G.V.Black to treat children’s teeth and it has been used in Japan for over 50 years. Zinc phosphate is one of the oldest and widest used cement / liner and has proven antibacterial properties. Amalgam contains a number of precious metals. Copper has now been recognised as useful in the current virus fight such that handles are being replaced with copper. Gold is still the “Gold Standard “ as a restorative material!
