Only after reading "A Clinical Evaluation of Air-Abrasion Treatment of Questionable Carious Lesions" by Dr. Hamilton and colleagues (June JADA) did I learn that there might be a fox in the henhouse.
An inconspicuous acknowledgment at the end of the article stated, "This investigation was partially supported by Delta Dental Fund of Michigan." What dentistry does not need is the involvement of third-party payers in the investigation and determination of what constitutes sound clinical judgment and practice. It particularly troubles me that the data presented in the article do not seem to support the conclusions reached by the authors.
Still, I was gratified to discover that the authors of this Delta-supported investigation do advocate one of the most conservative treatment protocols adopted by most air-abrasion users. That is, if the preparations included in the study did not extend into dentin, they were restored using sealants. Hopefully, JADA readers will be motivated to follow their lead, to conservatively explore pits and fissures with air abrasion and then to effectively seal those found to be free of caries.
Most dentists who have already adopted air-abrasion technology have found that the conventional means of preparing teeth for sealants is woefully inadequate because masticated food debris within the depths of the pit or fissure is beyond the reach of cleaning bristles and prophy paste.
Even though the air–abrasion assisted sealant protocol for adults is generally nonreimbursable by Delta, it should be followed as a matter of good clinical practice. If the exploration of the pit or fissure does reveal enamel cavitation and lateral spread of caries at the primary teeth, then in most cases it can be handled nearly as conservatively as if it were a sealant.
There is the rub for Delta: universal application of conservative-care options resulting in either sealant or restorative treatment will dramatically alter utilization rates upon which policy premiums are based. In the short term, this will cost third parties more. They do not realize that they will save lots of money over time.
Conservative operative dentistry techniques that remove minimal amounts of healthy tooth structure serve us in many ways. First, they allow conscientious practitioners to apply sealants that do not merely delay caries, but actually prevent caries.
Second, if pathology is present, they allow for its removal when it is first identifiable, not when it creates symptoms or has unnecessarily destroyed healthy tooth structure. "Watching" caries progress to a macroscopic state is no longer a defensible option.
Third, they allow dentists to avoid initiating the cycle of re-restoration that until now has been an unavoidable nightmare for both dentists and their patients. The economic benefits of early intervention will encourage more patients to seek dentists who are like-minded.
Finally, these conservative techniques offer hope to patients who fear the needle, drill and pain, and to dentists who truly put the welfare of their patients first.
Everyone wins with conservative-care dentistry. What a great time to be involved in the high-tech revolution. Thank you for publishing such a thought-provoking article that should motivate more of us to explore the potential of air abrasion and microdentistry.
