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Dr. Hays may have misunderstood our conclusion, which was, "Judged on the basis of the weight of the preparation impression (a surrogate measure of volume), there was no benefit gained from early treatment of questionable carious lesions." That is, tooth structure was not conserved by early treatment.

We are not recommending that carious lesions into dentin not be diagnosed and treated, but in our study, early treatment led to 56 percent of those teeth being treated unnecessarily by current standards. This can be viewed as a needless expense in terms of the patient’s time and, in a fee-for-service environment, the patient’s money.

Equally important is the necessity of continued maintenance^1,2 of these restorations, which will lead to additional losses. There is also the unnecessary loss of tooth structure in 56 percent of the teeth treated, which carries some ethical considerations.

Considering the volume of tooth structure lost due to the unnecessary early operative intervention (not analyzed in our study) of 56 percent of the teeth, it is felt that additional tooth structure was lost, not conserved, by early treatment. This is a major negative factor for the patient, without any proven benefit.

	REFERENCES

TOP REFERENCES

1. Romcke RG, Lewis DW, Maze BD, Vickerson RA. Retention and maintenance of fissure sealants over 10 years. J Can Dent Assoc 1990;56(3):235–7.
   
   
2. Wendt LK, Koch G, Birkhed D. Replacements of restorations in the primary and young permanent dentition. Swed Dent J 1998;22(4):149–55.[Medline]
   
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hamilton, J. C. Articles by Dennison, J. B. Search for Related Content PubMed Articles by Hamilton, J. C. Articles by Dennison, J. B.