A Practical Guide to Modern Caries Management - MIOC and MID Part 1

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.

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.

- 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.

- Restorations are not just about filling holes; they help recreate a cleansable tooth surface.-If using NIRI, fluorescence, scanners, or AI, understand how the technology works and where it fails.

Highlights

00:00 Teaser

02:17 Protrusive Dental Pearl: Active Surveillance, Not Monitoring

09:14 Minimum Intervention Oral Care vs Minimally Invasive Dentistry

11:28 Core Principles of MIOC

11:48 Domain 1: Identify the Problem

12:46 Domain 2: Prevention of Lesions and Control of Disease

13:18 Microinvasive Care Options

14:41 Domain 3: Minimally Invasive Operative Dentistry

16:38 Why “Active Surveillance” Matters

18:24 MIOC as a Practical Framework

19:43 Applying MIOC in Patient Communication

22:38 Sustainability & Salutogenesis

29:05 When to Pick Up a Drill

30:23 Biofilm as the Engine of Caries

31:33 Purpose of a Restoration in Caries Management

36:13 Caries Detection Technologies

42:44 Watch and Wait vs Detect and Manage

01:02:52 Outro

Professor Avijit Banerjee’s recommended reading and ongoing work: New textbook: A Clinical Guide to Advanced Minimum Intervention Restorative Dentistry (Banerjee A., Elsevier, 2024) — the most comprehensive single reference for modern MIOC and MID.ISBN 978-0-443-10971-3 (https://www.uk.elsevierhealth.  com/a-clinical-guide-to-advanced-minimum-intervention-restorative-dentistry-9780443109713.html)