3.1 Surgical Model

Under the traditional surgical model, dental caries treatment has been a process of identifying carious lesions and restoring them. This process results in the gradual accumulation of restored tooth surfaces, missing teeth, and increasingly complex prosthetic appliances over a patient’s lifetime.1 Risk assessment is rarely taken into account. Dental caries and periodontal disease are considered universal. This has led to diagnostic and treatment misconceptions that underscore conventional dental caries treatment, even though there is no scientific evidence to support them. These misconceptions are as follows:

• All dental plaque is pathogenic (nonspecific plaque hypothesis).
• Dental caries is inevitable.
• Dental caries diagnosis is easy.
• Diagnosed or suspected dental caries should lead to restoration.
• Carious lesions don’t heal.
• Everyone needs to visit the dentist every 6 months.
• Any type of materials failure mandates restoration replacement.

Restoration often leads to a long-term compromise in tooth integrity and vitality through a cycle of restoration and re-restoration that begins early and spans a lifetime. This results in repeated exposures with risks related to anesthesia, instrumentation, X-rays, and dental materials, as well as increased cost.

Consider the following analogy in which the surgical model of dental caries treatment is applied to the treatment of tuberculosis. A physician diagnoses the disease through a skin test, a sputum sample, and X-rays. After diagnosis, a surgeon excises the diseased portion of the lung and then fills that area with a restorative material. Following recovery from surgery, the patient is discharged from care and recalled every 6 months until new lung lesions develop and are diagnosed. At that point, a surgeon operates again.

This would be medical malpractice because the physician treated only the clinical signs of the disease while failing to address its bacterial etiology.2

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