According to the World Health Organization, dental caries remains a major oral health problem in most industrialized countries, affecting 60% to 90% of schoolchildren and the vast majority of adults. Caries is the most prevalent oral disease causing major public health problems. The impact on individuals, families, and communities, as a result of pain and suffering, impairment of function, and reduced quality of life, is substantial. Moreover, the traditional surgical treatment for caries is extremely costly; it is the fourth most expensive disease to treat in most industrialized countries. According to the Global Burden of Disease study in 2010, caries shares common risk factors with obesity and other noncommunicable diseases, such as cardiovascular diseases and diabetes. Therefore, strategies to reduce the common risk factors for these diseases can improve the overall health of the population worldwide. Clearly, we cannot restore away the disease of caries, as managing the end point of this disease has not resulted in a decrease in caries prevalence. We must go beyond a surgical approach.
There is robust evidence that caries is a preventable disease; however, translating existing knowledge into practical and effective actions is a challenge. It is well known today that many behavioral and psychosocial factors can affect the lifestyle of an individual and family, and consequently, impact caries risk, treatment options, and clinical outcomes. Thus, management of caries in modern dentistry has evolved over decades from care of the patient by a single health care professional to care of the patient by a health care team. Interprofessional awareness and collaboration are essential to prevent and manage caries based on individual risk factors, and aid in decreasing disease disparities and enable access to care.
This issue of Dental Clinics of North America has the intent to provide an overall understanding of the impact that other health care providers have in the management of caries as well as the most current evidence associated with its cause and management. The current issue begins with the scientific principles of caries cause from the biofilm ecology perspective to dietary approaches on nutritional counseling. Subsequent articles offer updates on nonsurgical and surgical management of cavitated and noncavitated caries lesions and a framework to guide clinical decisions on how to implement strategies in a personalized manner.
Person-centered care and management focus on the elements of care, support, and treatment that matters most to the patient and their family, taking in consideration multiple factors. Heath care providers, such as social workers, nurses, physicians, psychologists, and dieticians, have a critical role in the management of caries disease, and a continuous collaboration with appropriate referral is necessary. Thus, health and social services should be viewed as equal partners. “Building on the relationships with better communication in referrals, bidirectionally, reintegrates the mouth into the body and oral health into systemic health, with improvement in patient care and provider satisfaction” (Fisher-Owens).
Another aspect that challenges our profession and influences the management of caries is the financial system for oral health care. This is also discussed in this issue. Governments, payers, providers, and consumers are affected in different ways and should make meaningful progress in how caries management benefits are delivered and paid for in the future. Value models around the management of oral diseases should be a priority and an opportunity to reduce the long-term cost of treatments. The initial and long-term costs associated with the type of treatment used will have consequences in the overall health of the population and in many ways guide the providers’ clinical decision making.
The ultimate goal of this issue is to provide an overall understanding of the influence of oral diseases in the overall health of our patients. Therefore, collaborating with other health care providers is essential.