ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY 13 5

Dental and Craniofacial Research

II. DENTAL AND CRANIOFACIAL RESEARCH IN THE FUTURE

Advances in understanding the etiology, pathogene-
sis, and diagnosis of oral diseases and conditions have
led, and will lead to, improved methods of disease
management. Dental practice must evolve and broad-
en to incorporate this knowledge. Furthermore, dif-
ferences in the burden of oral disease, evident through-
out the United States, will challenge the profession to
take a leadership role in improving access to care and
delivery of dental services.
As noted, the disease-specific discussions illustrate
many changes and advances that can be anticipated
by the dental profession. But these nine oral disease
categories are hardly inclusive of all dentistry.
One topic not addressed in this chapter but dis-
cussed elsewhere in the report of the Future of
Dentistry is the aging of the population. It should be
noted that with fewer severe carious lesions and fewer
dental extractions, a continuing decrease in eden-
tulism means that older individuals will retain more
teeth, thus increasing risk for periodontal diseases and
root caries. These individuals will require more pre-
ventive and therapeutic dental care. Conservative
management of periodontally involved teeth will be
the rule for this segment of the population. General
dentists and dental hygienists can be expected to
assume most of this increasing responsibility. To ade-
quately treat older patients, who often have concomi-
tant medical problems, it will be essential that dentists
become more familiar with geriatric medicine.

FUTURE CHANGES IN DENTAL CARIES
RESEARCH/DENTAL BIOMATERIALS RESEARCH

The future of dentistry will require new approach-
es and new ways of delivering proven methods if the
profession is to be successful in further reducing
or eradicating dental caries. New thinking in relation
to public health dentistry and community dental health
measures are needed to address the dental caries prob-
lem that occurs in underserved populations.
Dental caries remains a problem for a significant
portion of the population, and is the most common
disease of childhood. Certain high-risk children and
adults suffer from extensive disease. Nevertheless,
early identification of at-risk individuals is elusive, and
research effort towards this outcome is required.
Approaches to the management of carious lesions
in the near future will rely on remineralization. When

restoration is required, conservative repair without

unnecessary removal of uninvolved tooth structure

will be the rule. The shift in restorative dentistry to

metal-free restorations is likely to expand with the

introduction of improved composite-based materials,

and new "smart" biomaterials to provide improved

resistance to recurrent caries and wear.

The same bacteria involved in other forms of

caries cause early childhood caries, especially

among disadvantaged populations, but there are

also other causal factors that are not yet fully under-

stood. Future efforts are needed to treat the infec-

tion of the mother and/or the caregiver who is the

primary infective agent in bacterial transfer to the

child. Addressing this aspect in the environment of

families and extended families is a major public

health issue for the future. The association of

increased caries incidence and impaired cognitive

development needs further study.

Caries Risk Assessment

Caries management by risk assessment will be

essential in the future of dentistry (Anusavice, 2000;

and Featherstone, 2000). Risk assessment must be

conducted prior to the removal of active caries and

the placement of restorations. Future risk assessment

strategies will include:

u Analysis of the frequency of cariogenic chal-

lenge/diet.

u Assessment of the oral status of caregivers.

u Quantitative determination of cariogenic bacteria

with molecular biology tools. Antibodies designed

to interact with the surfaces of specific species of

cariogenic bacteria have been developed and can be

tagged by fluorescent molecules that can be meas-

ured photometrically. This technology will enable

rapid, chair-side assessment of the level of the bac-

terial challenge (Krasse, 1988).

u Assessment of the quantity and quality of sali-

vary function.

u Measures of dietary challenge and salivary pro-

tective factors.