Episode Details

If you showed the same bitewing to 10 dentists, would they all agree on whether to pick up the drill?

Why does the word monitoring mean nothing to a patient — and how does swapping it for active surveillance change everything from your notes to your indemnity to your government policy meetings?

Is it overtreatment to act on an E2 lesion — or is “watch and wait” actually the lazy answer dressed up as minimally invasive?

And what should you actually do with AI caries detection that flags shadows your eye doesn’t see?

In this episode, Professor Avijit Banerjee — Professor of Cariology & Operative Dentistry at King’s College London, Honorary Consultant at Guy’s & St Thomas’, and First Dean of the Faculty of Dentistry at the College of General Dentistry — sits down with Jaz for what is genuinely one of the most important caries conversations on the podcast. Part one of two.

Avijit doesn’t do soft answers. The drill-fill-bill model is broken. “Monitoring” needs to go. “Treatment planning” is antiquated terminology medics dropped twenty-five years ago. And AI in caries diagnosis? Useful — but the moment it gets things wrong, you are the one with indemnity, not the software.

What you walk away with is a framework (MIOC), a decision filter (three factors that decide whether to pick up a bur), and a vocabulary shift you can implement tomorrow. Part two covers peptides, SDF, hydroxyapatite, stepwise excavation, and managing caries in xerostomia.

Protrusive Dental Pearl: Delete the Word “Monitor” from Your Vocabulary

Stop saying monitor. Start saying active surveillance.

⚠️ Active surveillance must not mean passive delay — document your reasoning, risk assessment, and what would trigger intervention.

✅ Explain it to patients as structured, proactive care: clinical checks, radiographs, risk review, behaviour support, and timely action if things change.

Key Takeaways

• Minimum intervention oral care is bigger than minimally invasive dentistry.
• MIOC is prevention-based, person-focused, susceptibility-related, and delivered by the whole oral healthcare team.
• MID is only one part of MIOC: operative dentistry when a tooth actually needs intervention.
• The four MIOC domains are: identify the problem, prevent lesions and control disease, provide minimally invasive operative care, then reassess.
• A care plan is more useful than a treatment plan because it includes justification, prevention, behaviour change, and review.
• Ask patients what matters to you, not just what’s the matter with you.
• Cavitation, cleansability, and lesion activity should guide whether to intervene operatively.
• A cavitated lesion that cannot be cleaned is much more likely to remain active.
• Smooth surface lesions may sometimes be made cleansable without conventional drilling.
• Restorations are not just about filling holes; they help recreate a cleansable tooth surface.
• There is no single perfect caries detection technology — clinical examination and good radiographs remain fundamental.
• If using NIRI, fluorescence, scanners, or AI, understand how the technology works and where it fails.
• AI should support diagnosis, not replace clinical judgement.
• For uncertain early lesions, triangulate: clinical findings, radiographs, risk, technology, and patient