1 School of Dentistry, University of Dundee, Dundee, UK.
2 Faculty of Dentistry, University of Hong Kong, Hong Kong.
J Dent Res. 2019 Jun;98(6):611-617. doi: 10.1177/0022034519837252.
Better understanding of dental caries and other oral conditions has guided new strategies to prevent disease and manage its consequences at individual and public health levels. This article discusses advances in prevention and minimal intervention dentistry over the last century by focusing on some milestones within scientific, clinical, and public health arenas, mainly in cariology but also beyond, highlighting current understanding and evidence with future prospects. Dentistry was initially established as a surgical specialty. Dental caries (similar to periodontitis) was considered to be an infectious disease 100 years ago. Its ubiquitous presence and rampant nature-coupled with limited diagnostic tools and therapeutic treatment options-meant that these dental diseases were managed mainly by excising affected tissue. The understanding of the diseases and a change in their prevalence, extent, and severity, with evolutions in operative techniques, technologies, and materials, have enabled a shift from surgical to preventive and minimal intervention dentistry approaches. Future challenges to embrace include continuing the dental profession's move toward a more patient-centered, evidence-based, less invasive management of these diseases, focused on promoting and maintaining oral health in partnership with patients. In parallel, public health needs to continue to, for example, tackle social inequalities in dental health, develop better preventive and management options for existing disease risk groups (e.g., the growing aging population), and the development of reimbursement and health outcome models that facilitate implementation of these evolving strategies. A century ago, almost every treatment involved injections, a drill or scalpel, or a pair of forceps. Today, dentists have more options than ever before available to them. These are supported by evidence, have a minimal intervention focus, and result in better outcomes for patients. The profession's greatest challenge is moving this evidence into practice.
对龋齿和其他口腔状况的更好理解指导了新的策略，以在个人和公共卫生层面预防疾病和管理其后果。本文通过关注科学、临床和公共卫生领域的一些里程碑，主要是在龋病领域，但也超越了龋病，讨论了上个世纪预防和最小干预牙科的进展，强调了当前的理解和证据以及未来的前景。
牙科最初是作为一门外科专业建立的。100 年前，龋齿（类似于牙周炎）被认为是一种传染病。由于其普遍存在和猖獗的性质，加上有限的诊断工具和治疗选择，这些牙科疾病主要通过切除受影响的组织来治疗。随着手术技术、技术和材料的发展，对这些疾病的认识以及其流行程度、范围和严重程度的变化，使得人们从手术治疗转向预防和最小干预牙科治疗方法。未来需要应对的挑战包括继续推动牙科专业朝着以患者为中心、以证据为基础、对这些疾病的侵入性更小的管理方法转变，重点是与患者合作促进和维持口腔健康。与此同时，公共卫生需要继续解决牙科健康方面的社会不平等问题，为现有的疾病风险群体（如日益增长的老龄化人口）开发更好的预防和管理选择，并开发促进这些不断发展的策略实施的报销和健康结果模型。
一个世纪前，几乎每一种治疗都涉及注射、钻头或手术刀，或一对钳子。今天，牙医比以往任何时候都有更多的选择。这些都有证据支持，以最小的干预为重点，为患者带来更好的结果。该行业面临的最大挑战是将这些证据付诸实践。
