In the first installment of our conversation, Dr. Brian Novy challenged one of dentistry’s most deeply rooted assumptions: that dental caries is primarily a localized disease requiring localized treatment.
Instead, he argued that caries is a biologic process influenced by saliva, diet, microbiome ecology, and systemic physiology. If that’s true, then the obvious question becomes: What should we do differently?
The second half of our discussion moves beyond biology and into clinical practice. Could recurring caries be an early warning sign for broader medical conditions? Should physicians and dentists collaborate more closely when unexplained disease persists? How might prevention reshape the economics of dental practice? And are today’s dental schools preparing graduates for a future in which disease management carries as much importance as restorative excellence?
Michael Ventriello.
As our conversation continued, it became increasingly clear that Novy isn’t simply advocating for different restorative materials or treatment protocols. He’s asking dentistry to reconsider its relationship with disease itself.
One idea from our earlier discussion continued to resonate with me. If a healthy oral microbiome reflects a healthy biologic system, perhaps recurring disease is telling us something far more significant than simply “another cavity.”
Michael Ventriello: Could active caries function as an early biologic dashboard -- a warning sign that something larger may be happening within the patient?
Dr. Brian Novy: I think that’s an excellent way to look at it. Healthy people generally maintain healthy, symbiotic microbiomes. When that balance shifts toward dysbiosis, we begin seeing consequences throughout the body, not just in the mouth.
Unfortunately, our response has often been to attack the symptoms. We scrub plaque with nylon bristles, floss, or switch toothpastes while paying less attention to understanding why the microbiome changed in the first place. The disease process deserves at least as much attention as the disease itself.
If a patient continues developing caries despite doing everything right, should that prompt a medical referral similar to periodontal findings?
We already see those patients every day. Dentists understand that many medications dramatically increase caries risk, and we all have patients whose disease simply doesn’t fit traditional expectations.
The challenge is that integrated referral pathways still don’t exist in most communities. That’s a vision for healthcare’s future rather than today’s reality.
If physicians became more aware of oral disease patterns, I’d hope they would pay particular attention to conditions such as diabetes, kidney disease, and the growing number of patients taking GLP-1 agonists. Those relationships deserve much more attention than they’re currently receiving.
As dentistry shifts to prevention and minimally invasive care, investors are paying attention. Companies developing diagnostics, salivary testing, preventive therapeutics, and biologically based treatments attract significant investment. Investors increasingly talk about 'moving upstream.' Could a better understanding of caries change where investment dollars flow?
Dr. Brian Novy.
I think we’re already beginning to see that happen. Preventive therapies and minimally invasive treatment approaches have the potential to create entirely new revenue models, particularly for practices willing to embrace value-based reimbursement.
As reimbursement evolves, public expectations will evolve with it. Whether that transformation happens quickly is another question. Investors tend to want results immediately, while healthcare innovation usually moves at a much slower pace.
If cariology is entering a new era, how should tomorrow’s dentists be educated? Are dental schools teaching enough medical thinking, or are we still primarily educating proceduralists?
Dental education is changing. You can see that reflected in the updated Commission on Dental Accreditation standards, and schools are working hard to integrate minimally invasive treatment into their curricula.
The challenge is obvious: How do you train excellent surgeons while simultaneously teaching them to intervene less surgically? Ultimately, dentists should become the final destination on the disease continuum, not the first.
I’d also like to see hygienists and dental assistants assume even larger roles in disease management. That allows dentists to focus on the complex surgical procedures that will always require their expertise while the preventive team manages oral health more comprehensively.
You’re the president of the National CAMBRA Coalition. For clinicians unfamiliar with CAMBRA, what is the coalition’s mission?
We’re a community of people committed to treating dental caries as a reversible disease whenever possible. We’re intentionally inclusive. We aren’t limited to academics or specialists, and we don’t currently have formal membership requirements. Anyone who wants to rethink how caries is managed is welcome to participate.
We meet monthly because we believe meaningful change happens through continuous learning and collaboration. The more people willing to challenge conventional thinking, the stronger our profession becomes.
Twenty years from now, what will dentists say we misunderstood about caries?
I think they’ll wonder why we knew better and still waited so long to change. They’ll hear stories about amalgam restorations the way today’s students hear stories about procedures we’ve long abandoned.
I hope they’ll practice within healthcare systems that reward disease management rather than simply disease repair. We’ve talked about that vision for decades. The opportunity now is to make it commonplace instead of aspirational.
I’m also excited to see how long-term evidence develops around technologies such as nanohydroxyapatite, silver diamine fluoride, and Curodont. The important thing won’t be marketing claims. It will be real-world outcomes. That’s ultimately what will determine which innovations truly improve patient care.
Conclusion
One of the reasons I enjoy writing Dental Duets is that every so often a conversation challenges my own thinking as much as I hope it challenges the reader’s. I believe my two-part discussion with Dr. Novy accomplished exactly that.
Perhaps the next great advances in dentistry won’t come from stronger restorative materials or faster handpieces. Perhaps they’ll come from asking better questions long before treatment begins.
After all, every meaningful change in healthcare begins with someone willing to ask,"What if we’ve been looking at this differently all along?"
Michael Ventriello is widely regarded as the "Dental Product Launch Expert" and is the owner and founder of Ventriello Communications and the co-founder and chief communications officer of the Personify Group. Ventriello is an award-winning copywriter, a former journalist, broadcaster, and frequently published author and dental industry pundit. Connect with him on LinkedIn.
Dr. Brian Novy is a nationally recognized expert in cariology, preventive dentistry and evidence-based oral healthcare. He serves as president of the National CAMBRA Coalition and holds faculty appointments at the Harvard School of Dental Medicine and other leading institutions. Dr. Novy has served on the American Dental Association Council on Scientific Affairs and as consumer representative to the U.S. FDA Dental Products Panel. Dr. Novy is also the cariology and preventive dentistry advisor for Personify Group.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
