Pitts N B
Dental Health Services Research Unit and Centre for Clinical Innovations, University of Dundee, Dundee, UK.
Caries Res. 2004 May-Jun;38(3):294-304. doi: 10.1159/000077769.
This review focuses on the clinical interactions between patients and the dental team, not on caries prevention at a public health level. Many dentists no longer take a narrow surgical view seeking to apply interventive treatment as a one-off event at a certain trigger point of disease severity and the evidence that caries is an initially reversible, chronic disease with a known multi-factorial aetiology is being appreciated more widely. The caries process should be managed over time in an individualized way for each patient. Very few individuals can be considered to be truly 'caries free' when initial lesions as well as more advanced dentine lesions are considered. It is now very clear that, by itself, restorative treatment of the disease does not 'cure' caries. The caries process needs to be managed, in partnership with patients, over the changing challenges of a lifetime. The answer to the question posed in the title should be, in many cases, that we are ready to move to non-operative/preventive care (if we have not done so already). However, this should be for appropriate stages of lesion extent and in patients who respond to advice on recall frequency and preventive behaviours.
本综述聚焦于患者与牙科团队之间的临床互动,而非公共卫生层面的龋齿预防。许多牙医不再持狭隘的外科观点,试图在疾病严重程度的某个触发点进行一次性干预治疗,而且龋齿是一种最初可逆转的慢性疾病,其病因已知是多因素的,这一证据正得到更广泛的认可。对于每位患者,应随着时间的推移以个体化方式管理龋齿进程。当考虑到初始病变以及更严重的牙本质病变时,很少有人能被认为是真正“无龋”的。现在非常清楚的是,疾病的修复性治疗本身并不能“治愈”龋齿。龋齿进程需要与患者合作,应对一生不断变化的挑战进行管理。在许多情况下,对标题中提出的问题的答案应该是,我们准备好转向非手术/预防性护理(如果我们尚未这样做)。然而,这应该针对病变程度的适当阶段以及对复诊频率和预防行为建议有反应的患者。