response week 5
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Considering that it is a teaching clinic, I would consult privately with the dentist and suggest that we allow the student to proceed with the preventative approach for the sake of education. I would justify this rationale with the following information:
In an effort to avoid overlooking deep decay, dentist tend to focus more on caries detection than sound tooth evaluation (Gomez, 2015). Dental hygienists are as capable at identifying decay as dentists are (Daniel & Kumar, 2017). It is possible that the dentist is defining the lesion based on G.V. Black system and not the new ADA caries classification system (CCS) that addresses non cavitated lesions (Young et al., 2015). I would double check that the dentist used a rounded explorer to check for the “stick (Young et al., 2015).” In my experience, a sharp enough explorer can create a “stick” or cavitation in just about any groove. This is especially true if the enamel is already weakened due to initial demineralization (Young et al., 2015). I would ask the dentist to try and determine if there is decay by using instead a ball-end probe, air, and light (Young et al., 2015).
Additionally, considering that this is a teaching clinic, many other caries detecting tools should be made available to both the student and dentist to justify their conclusion. Quantitative Light-induced Fluorescence (QLF), DIAGNOdent (DD), Electrical Conductance (EC), Transillumination, or fiber-optic transillumination (FOTI) can all be used to create a visual aid and supplement to the initial clinical evaluation with quantifiable data (Gomez, 2015). Moreover, the Soprocare intra oral camera has been shown to be a more consistent decay detection tool than visual examination especially when considering incipient lesions (Dhanavel et al., 2023). Such lesions are defined by the International Caries Detection and Assessment System (ICDAS) as classification 0, 1, or 2 (non-cavitated lesions) (ICDAS, n.d.). The International Caries Classification and Management System (ICCMS) recommends treating non-cavitated lesions with topical fluoride, fluoridated dentifrice (1000 ppm) and traditional toothbrushing (Dhanavel et al., 2023).
If the dentist is insistent on the presence of decay, I would suggest he/she show the student, on the radiograph, where the underlying radiolucency is in the dentin (Young et al., 2015). The extent of that radiolucency can then be measured, defined by a classification, and documented (Gomez, 2015). This more systematic approach would give the dentist an opportunity to justify the rational for a restorative approach (ICDAS, n.d.). If an agreement cannot be reached, then it may be best to classify the lesion as “undetermined (UD)” and allow the student to proceed with remineralizing measures. If all remineralizing measures fail, then I would suggest that the dentist allow the student to shadow during a restorative procedure. If it is true decay and a cavitated lesion, then the student should be able to “see” the difference between healthy tooth structure and decay.
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