The minimally invasive mandate: Are UK dental schools keeping pace?

The philosophy of MID has fundamentally redefined modern oral healthcare. Over the years, dental professionals realised that the traditional surgical and restorative approach, rooted in G.V. Black’s “extension for prevention”, had become financially non-viable and was putting immense pressure on global healthcare systems.¹ This led to a shift from the surgical model of caries management to a conservative one.² This modern framework prioritises risk assessment, early detection, remineralisation and defect-driven conservative preparation. However, as the dental profession transitions towards this preventive mandate, a critical question has arisen: is undergraduate dental education in the UK keeping abreast of contemporary clinical realities?

The current landscape suggests a noticeable disconnect between contemporary knowledge and foundational training. This knowledge gap was addressed in a study published in the British Dental Journal.³ The study revealed that only 28% of the UK general dental practitioners surveyed accurately responded to the three basic scenarios posed in relation to contemporary MID. Furthermore, while 58% of respondents reported having some knowledge on MID, only 11% reported knowing a great deal.

More concerning is the systemic nature of this educational lag. Most dental curricula either lack undergraduate-level teaching on MID or do not emphasise its importance in contemporary clinical dentistry enough.

A recent publication by Santamaría et al. summarised the university- and country-level challenges faced regarding the implementation of the Core Curriculum in Cariology, developed by the European Organisation for Caries Research.⁴ The study showed that 73% of the participants agreed that caries management in participating universities was still centred primarily on traditional surgical and restorative protocols in all dental specialties, instead of MID. Moreover, 96.0% of respondents agreed on the need to implement a standard Core Curriculum in Cariology, while 93.7% agreed that getting all universities in their country to adopt such a curriculum remained very challenging.

“The current landscape suggests a noticeable disconnect between contemporary knowledge and foundational training.”

Since dental students are not exposed to the MID philosophy during undergraduate training, they continue to follow the drill-and-fill ideology during clinical practice. This often necessitates fresh graduates to undergo additional training programmes to align with the contemporary caries management strategies. This is evident from the recently launched MSc degree programme on MID by Queen Mary University of London. The programme’s official description states that “MID bridges the traditional gap between prevention and surgical procedures”.⁵ This clearly signifies the gap between contemporary knowledge on MID and the traditional surgical and restorative training that is being imparted to our students at the undergraduate level.

This educational lag is most evident in the realm of diagnostics. While modern clinical practice increasingly relies on advanced diagnostic adjuncts such as infra-red laser fluorescence, electrical caries monitors and the International Caries Detection and Assessment System, many curricula still heavily emphasise traditional visual and tactile examination. The continued reliance on the sharp dental explorer—an instrument shown to potentially cause iatrogenic damage to remineralising enamel—exemplifies the delayed adoption of contemporary evidence-based practices.

A 2025 multinational survey clearly illustrated this issue.⁶ When presented with clinical scenarios of deep carious lesions in young patients, the majority of undergraduate dental students defaulted to the traditional, highly invasive non-selective caries removal protocol rather than relying on MID principles. Alarmingly, for both young and older symptomatic patients, these undergraduates tended to opt for maximum surgical intervention, such as complete pulpectomies and root canal treatments. Postgraduate students—those who had undergone advanced, secondary training—more often applied conservative, age-appropriate vital pulp therapies.

This stark contrast reflects the ongoing need to update undergraduate dental curricula and indicates that foundational training is failing to embed modern biological logic. Furthermore, as National Health Service dental contracts increasingly signal a shift towards preventive pathways and risk-based care, new graduates must enter the workforce equipped with a firm grasp of minimally invasive protocols. If newly qualified practitioners lack confidence in non-operative caries management or selective excavation, the default inevitably becomes overtreatment.

To bridge this divide, it is high time that dental institutions actively transition from a purely surgical mindset to a preventive, disease management model of care. Integrating comprehensive MID protocols into the core of undergraduate curricula—rather than offering them as postgraduate afterthoughts—is essential for the future of patient care. Dental students should spend more time learning the contemporary, non-invasive caries management strategies instead of practising the traditional, outdated treatment protocols.