The Role of Dental Hygiene in Caries Management: A New Paradigm

Purpose: Dental caries is the most common disease of children and re-mains a significant oral health problem worldwide for both children and adults. The traditional paradigm of treating dental caries solely by “drilling and filling, ” brushing and flossing and lowering sugar intake has evolved. Current science in the management of dental caries suggests a clear fo-cus on the reduction of responsible infectious agents, remineralization of non–cavitated lesions and minimally invasive restorative approaches whenever possible. The paradigm shift is away from a purely surgical ap-proach toward more preventive and curative clinical protocols. This paper provides a review of this caries management methodology and explores the role of the dental hygienist in this paradigm change. Key words: caries balance, CAMBRA, remineralization, non–cavitated lesion, minimally invasive dentistry This study supports the NDHRA priority area, Clinical Dental Hygiene Care: Assess how dental hygienists are using emerging science through-out the dental hygiene process of care; Investigate how dental hygienists use emerging science to reduce risk in susceptible patients (risk reduction strategies). The concept of prevention as the most ideal approach to car-ies reduction is not new to den-tal hygiene. It was this very idea that motivated Dr. Alfred Fones to create the school which gradu-ated the first formally educated dental hygienists in 1914.1 In ad-dition to providing clinical instru-mentation, the larger historical role of dental hygiene has been in helping to prevent dental disease through education. This has been accomplished primarily by an emphasis on removal of biofilm by mechanical means including brushing, flossing, tongue scrap-ing and, in more recent years, che-motherapeutic modalities. Data has shown that these strategies are proven to be beneficial in patients with oral biofilm control problems.6 However, the majority of adults do not follow an adequate home–care routine. Average brushing times are low, and only a minority of patients regularly floss.2 The advantages of topical fluoride in a variety of forms has been firm-ly established.3 In 2001 the Cente