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If it is not broken, don’t fix it!

By: George Malkemus
August 17, 2018

“If it’s not broken, don’t fix it” is a good rule of thumb to live by; however, what should we do if something is broken? In the past, many dentists would simply fix the problem and go forward. In dentistry today, there is another movement that is gathering momentum around the world: Minimal Intervention.

Minimal Intervention Dental Philosophy

Minimal intervention is a treatment philosophy that promotes, “If it’s not broken, don’t fix it and if it is broken, find out why it is broken.” Then, form a treatment plan that involves the least amount of trauma to the patient and the patient’s healthy oral tissues. Minimal intervention’s basic goal is to conserve healthy tooth structure.

Catching treatment early is the best way to conserve teeth and gums.  Not being able to treat dental issues when they are in the early stages of disease has always bothered me. In the early stage, less treatment is typically necessary, which is better for the patient physically and emotionally, as well as financially. With the rapid advancements in technology, I now have many more methods to identify dental disease and fix it before it gets to the critical surgical stage.

Minimal intervention promotes the patient’s well-being through early identification, early intervention, minimal treatment and prevention.

At one time, dentistry was a “drill and fill” kind of treatment. Those days are gone. Now regular dental maintenance therapy is the goal.  Depending on one’s condition, a patient could have one to four or more check-ups and cleaning each year and take an active role in their own oral health care. Yes, that means those brushing and flossing routines for healthy people, but also an array of techniques and devices for improved home care, such as electric toothbrushes and tongue cleaners. It also means a good balanced diet. The minimal intervention philosophy believes that little changes in your behavior will have a big impact on your total health! 

New technologies

Dentists have many new techniques and equipment in their offices today that were only imagined as few as 10 years ago. These techniques are used to detect dental disease early, before it becomes critical. Today, we have the marvel of digital x-rays, digital photos, intraoral cameras, lasers, electric hand-pieces and fiber optics. Computers have moved from the receptionist’s desk to the exam room (in dentist terms called the “operatory” or “treatment room”). Computer technology is now a premier detection tool when used to show digital x-rays and digital photographs.  Computer software can manipulate the digital image to increase cavity detection. The image can be enlarged and then zoomed onto a specific area of concern. The contrast can be changed to improve cavity detection and the brightness and darkness of an image can be adjusted for better viewing. Dental x-rays also use 90 percent less radiation than traditional x-ray films, along with the added benefit of no need for toxic film development chemicals.

Cavity detection

For decades the primary instrument available to the dentist for detecting decay was the “dental explorer.” The dental explorer was poked into the grooves and pits in teeth, feeling for soft spots. Soft spots, which stick with an explorer, indicated that there was a deep cavity that had broken through the enamel of a tooth. Enamel is the outer hard protective coating around teeth; it is the second hardest substance in nature after diamonds. However, acid dissolves enamel and bacteria produce acid to break down enamel. Once through the enamel, the decaying bacteria penetrate to the live tissue inside the tooth, the dentinal pulp. Eventually if left untreated, the nerve becomes infected, causing pain and need for root canal therapy or an extraction. 

In the past, decay was not removed until it penetrated through the enamel. That is because amalgam fillings [made of half silver and half mercury] would have to have a large hole prepared in the tooth to allow them to lock into place and a substantial thickness to keep them from breaking.  A little cavity would need a large amount of drilling to make a hole big enough for an amalgam-filling placement. Now with the advent of tooth colored bonded fillings, less tooth structure is removed and the treatment is less invasive. Bonding is a way of gluing the filling to the tooth so the only drilling necessary is the decay removal. Therefore, it is better to catch the decay early while still just in the enamel. Unlike the internal dentin of the tooth, enamel has no nerve ending so usually numbing is not necessary for the bonded filling preparation and placement. 

Studies have shown that the sticking of the explorer from one tooth to the next is actually transferring decay and inoculating teeth that did not have decay before the explorer checking process began. Along with digital x-rays, decay in my practice is now detected using visual magnification with a video camera. With the video camera, I am able to inspect all the surfaces of the teeth, looking for darkness in the grooves and pits of the enamel. Thus, I am able to catch decay early and prevent its spread through preventive tooth colored fillings with minimal drilling.  The video camera has the added benefit of allowing patients to see the decay for themselves. 

Cavity detector dye                   

When cleaning out decay in a tooth with an instrument or with a burr in a dental drill, cavity detector dye can be placed on the tooth to identify if there is any remaining decay. The dye, which comes in green or red, sticks to only degraded collagen, which shows if any decay remains.  

In the past, dentists could only use vision to determine if all the decay was removed. However, often the dentine looks dark like decay but is actually only stained healthy dentine from a previous silver/mercury filling. By using cavity detector dye, tooth structure is preserved and the dark area is left alone. Also in the past, decay could be missed and left; whereas with cavity detector dye, the decay will stain, so will be found and then removed.

Preventive dentistry

The minimal invasive movement evaluates the whole person. If an individual has a cavity, it is important to determine why they have a cavity. When the reason for their cavity is identified, preventative measures can be recommended that will extend the life of their teeth.  Minimally invasive procedures help patients feel good about receiving dental treatment and create a new attitude about dental and oral health care.

So take advantage of preventive dentistry and the new non-invasive technologies. Even if you have waited too long, there is still hope! It is never too late to get into great dental health and begin a healthy maintenance program. With the use of modern dental methods, including conscious sedation [often called Sleep dentistry], it can all be done in complete comfort. 


George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at