3.4 Surgical Model Misconceptions

Following is a discussion of the misconceptions underpinning the traditional surgical model of dental caries treatment, as well as evidence refuting these misconceptions.

All dental plaque is considered pathogenic (nonspecific plaque hypothesis).
Historically, dentists have assumed that dental plaque causes dental caries and that, since everyone has plaque, everyone should follow the same preventive regimens. Ultimately everyone will need treatment for caries.

Current Evidence: Not all dental plaque is pathogenic for dental caries. Under the medical model for caries management, caries is viewed as a continuum of disease, caused by specific pathogens such as the Mutans streptococci (MS) bacterial group and Lactobacillus and a lack of arginolytic (alkali-producing) bacteria.14–17 Not everyone requires the same treatment, because not all plaque harbors pathogens that cause dental caries.18 A diagnosis based on likely or actual plaque content is required. Furthermore, new lesions are an indication that the infection was not adequately controlled.2

All dental caries is inevitable.
In the past, dentists believed that dental caries resulted from patients’ inability to keep their teeth clean. A carious lesion was proof that patients did not keep plaque off their teeth. Restoration was considered the ultimate treatment.

Current Evidence: Dental caries is viewed as a transmissible infection rather than as a “lesion.” Under the medical model of caries management, dentists consider the following when assessing patients and determining treatment and management options:

• The presence of specific pathogens such as MS and Lactobacillus.
• The transmission of dental infection from person to person.
• Prevention and treatment options that control the infection as well surgical repair of defects.
  

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