Minimally Invasive Dentistry 1

minimally invasive NHR cover copyby Chris Edwards, DDS

May/June 2009

National Health Review

Minimally invasive dentistry conserves healthy tooth structure by focusing on prevention,remineralization and minimal dentist intervention.

Using scientific advances, minimally invasive dentistry allows dentists to perform the appropriate amount of dentistry needed without ever removing more of the tooth structure than is required to restore teeth to their optimal condition.

An additional benefit is minimally invasive dentistry’s reliance on long-lasting dental materials that conserve the maximum tooth structure, so the need for future repairs is reduced. While the vast majority are non-metallic restorations, they do include gold crowns and onlays.

Dentistry has come a long way since the early 1800’s, when amalgam fillings first appeared. These fillings, made with silver powder, liquid mercury and some tin, copper and a few trace minerals are worrisome to patients who fear the effects on their health. However, patients may not realize how destructive amalgam fillings can be to the tooth.

To place amalgam fillings, dentists need to clean the decay and then drill away healthy tooth structure to include grooves or pits in the tooth. This approach further weakens an already decay-compromised tooth. Since silver-mercury fillings are brittle when thin, dentists have to drill deeper into the tooth in order to achieve sufficient strength. These amalgam fillings do not bond to the tooth, so the dentists must place undercuts in the tooth to keep the filling from falling out.

The amalgam fillings expand and contract at different rates than tooth structure and fractures usually develop in the tooth, even with relatively small fillings. Pain when biting, particularly a sharp “zing” if you bite a certain way, is a strong indication that the fracture is irritating the nerve inside the tooth. At this time, a crown or onlay to cover the tooth and hold the fracture is the best hope to save the tooth. Sometimes the tooth will actually fracture and a piece will break off. A favorable fracture can often be restored with a crown; others will need periodontal crown lengthening surgery or a root canal before being crowned. A small percentage can catastrophically fracture and must be extracted.

The best way to avoid these painful and costly problems is prevention. Xylitol therapy has been very successful in reducing decay-causing streptococcus bacteria, which results in a rise in the pH. Xylitol products include bioavailable minerals to rebuild enamel that has been demineralized by the acid-causing streptococcus bacteria. A higher pH enables these minerals to flow back into the tooth, changing the ecology of the mouth and warding off decay and gum disease. Small cavities on the smooth surfaces of the tooth can actually be arrested and reversed with remineralization. Xylitol tray therapy is the most effective delivery, but four to six grams a day, available in many different forms, is also beneficial.

Technologically advanced dentists utilize the Diagnodent Laser Cavity detector to find decay when itis small, particularly in the poorly formed grooves on the chewing surface of the tooth. Air abrasion techniques can eliminate decay and clean the tooth and grooves while saving as much tooth structure as possible to create the strongest bond to the tooth. The Waterlase MD Laser can cut into the tooth with much greater sensitivity and less pain. Both the air abrasion technique and the Waterlase MD Laser are able to work on a live tooth with minimal pain, no shots and often no drill.

For teeth that have fractures or have already been compromised with large fillings, a stronger restoration is indicated. CEREC onlays technology enables the preservation of healthy tooth structure. No longer does the crown need to go all the way to the gum but ends higher on the healthy enamel. Onlays are undetectable-to-the-eye ceramic restorations that preserve the healthy part of the tooth and replace only the missing portion. The convenience of CEREC’s one-visit procedure does away with temporary crowns.

Minimally invasive dentistry is all about patient education and prevention as the optimal way to eliminate costly and oftentimes painful situations. There is no synthetic material as good as your own natural tooth structure, and minimally invasive dentistry maintains as much of your pearly whites as possible. With minimally invasive dentistry, less is indeed more.


Dr. Edwards graduated from the United States Merchant Marine Academy and Temple University School of Dentistry. He completed a general practice residency at the Queens Medical Center in Honolulu. To reach Dr. Edwards you may call 321-751-7775 or visit