Lasting Impressions | Summer 2016

4 x NSU LASTING IMPRESSIONS quote has arrived. When students of the cariology and restorative dentistry department head out into the world as professionals, Galka hopes they keep five important letters in mind during their day-to-day practice: ICCMS™. “This is the new model that we are using to train future dentists,” said Galka about the International Caries Classification and Management System™ (ICCMS™) that has become the overarching philosophy and mission of the department. In June 2013, Galka headed to King’s College London Dental Institute as part of the ICCMS™ Implementation Workshop. When she returned, she set out to put a process in place at NSU’s College of Dental Medicine. “We have had cariology here for 14½ years, and the philosophy of minimally invasive dentistry, including caries risk assessment, is reinforced by our faculty members. But now, we will have a formal ICCMS™ pathway,” she said. The ICCMS™ concept uses a standardized system in a prevention-oriented approach. “ICCMS™ classifies the stages of severity of the caries process—which is the decay—and the activity status of lesions. This relates directly to whether and how to treat,” Galka explained. “Today, the evidence supports that if we get to the lesion early, using preventive strategies and motivational training for patient compliance, we can reverse the caries process.” The protocol calls for a comprehensive manage- ment plan that first assesses the patient’s risk for caries. “Students are taught to evaluate the patient’s history, X-rays, and clinical examinations to determine whether the patient is low, moderate, or high risk and to stage caries severity and lesion activity. The diagnosis governs the clinical treatments, which include an individualized preventive treatment plan (based on risk level) and nonsurgical or surgical care for individual lesions,” Galka said. The emphasis is on prevention and minimally invasive dentistry. A coded system ranks caries severity beginning at zero, with six being the most severe. For patients with early stage caries, students are taught that they should work with the patient for a remineralizing plan and monitor these lesions over time before resorting to an irreversible surgical proce- dure. For moderate and severe caries, minimally invasive restorations are recommended. “The depart- ment supports the philosophy that controlling the caries process and preservation of tooth tissue are paramount,” Galka said. GOODBYE, EXPLORER Galka supports the view that traditional use of the dental explorer for caries detection be replaced with the less-invasive visual assessment model. She explained that if “you take that explorer and you have the initial stage caries—that white spot lesion—or the start of chalkiness, you can actually cavitate the tooth with the explorer.” Galka added that it is challenging to get buy-in from dentists and faculty members who have been using the explorer instrument as their right-hand man for 40 years. “We’re in the process of ensuring that all our faculty members are trained to use the ICCMS™ survey,” she said. “The CDM has a rigorous cariology pre-clinic and clinical component, and we are excited about this initiative,” said Evren Kilinc, D.D.S., Ph.D., a cariology content expert. The treatment plans created by the students trained in the classification will result in a more comprehensive caries diagnosis. “They will become more attuned to looking at these initial active lesions and taking all steps necessary to try to remineralize these early lesions, before intervening with surgical care,” Galka said. Amir N. Farhangpour, D.D.S., predoctoral director and restorative director of the CDM Clinic, said the ICCMS™ creates a common language between students, faculty members, and patients. “It provides a guideline of what stages we should be looking for,” he explained. “It makes sure that we are looking at the entire picture and not just one tooth. Let me simplify it. In years past, if we saw a small spot, we treated it in the same way we would treat a large, active lesion. Now, we say, ‘Let’s see if we can give this a second chance with our preventive approach.’ ” MINIMALLY INVASIVE STRATEGY Students working in the clinic are taught to look at the caries risk of the patient to develop an individual preventive treatment plan and to make decisions about borderline lesions. “That’s where that minimally invasive strategy comes in. We say, let’s prescribe fluoride to stop the progression of the lesion. It may need a restoration many years down the road, or maybe never,” said