How to Manage Caries in Your Dental Practice: ADA Recommendations

Caries has been conceptualized as a recurrent disease cycle involving different states of demineralization and remineralization by experts in the field of cariology. As a result, caries management involves relying on a patient-centric philosophy that gives importance to prevention and early detection and uses treatments that take non-invasive and microinvasive approaches.

In the modern world, clinicians and patients have access to a wide range of resources, however, they do not have enough guidance on their appropriate use. Additionally, the ‘drill and fill’ approach is still the predominant course of treatment in many settings. This, as a result, fails to fully address the underlying process of caries.

Due to the massive research conducted over the years, there have been many improvements and developments in tools to detect and diagnose carious lesions and treatment strategies. This research also includes a number of systematic reviews and clinical practice guidelines assessing the clinical effectiveness, safety, and accuracy of diagnostic tests and treatments of caries.

Unfortunately, most of these reviews simply report pairwise comparisons and do not use meta-analysis to make indirect comparisons of various treatments not covered directly in the literature. Moreover, the existing guidelines do not use the Grading of Recommendations Assessment, Development, and Evaluation approach, the most widely accepted norm for assessing the accuracy of evidence. Nor do they compare the efficacy of therapeutic or preventive interventions or the accuracy of diagnostic tests across different tooth surfaces, age groups, and dentition.

Hence, the American Dental Association was asked to provide up-to-date, evidence-based guidelines for the management of dental caries. The purpose of these guidelines is to provide recommendations to patients and clinicians to enable them to make clinical decisions at each stage to formulate a comprehensive and evidence-based strategy.

The guidelines will be prepared using systematic reviews that procure the best available evidence and employ advanced statistical techniques like network meta-analysis. Furthermore, this series of guidelines will be developed by clinicians, experts, and evidence-based dentistry methodologists, who are fully equipped and trained to assess the evidence and offer trustworthy pre-appraised tools to aid in clinical decisions.

Since the scope and magnitude of this project are monumental, the caries management guideline series has been organized into the following four chapters of recommendations:

  • Nonrestorative Treatments for Carious Lesions (published October 2018)|
    This chapter summarizes the list of non-invasive and microinvasive interventions that are currently being used to curtail or reverse carious lesions in children as well as adults. These interventions include, but are not limited to:
    • Sodium fluoride
    • Sealants
    • Resin infiltration
    • Silver diamine fluoride

 

  • Caries Prevention (planned publication in 2019)
    The second chapter evaluates the effect of interventions and treatments in addition to management strategies such as reduced sugar consumption and OTC oral hygiene on decreasing the occurrence of caries in children and adults. This chapter will also incorporate and update three existing evidence-based guidelines.

 

  • Restorative Treatments for Carious Lesions (planned publication in 2020)
    This chapter will explore the effect of restorative treatments for carious lesions in both, adults and children.

 

  • Carious Lesion Detection and Diagnosis (planned publication in 2021)
    The final chapter of this series is aimed at assessing the diagnostic test accuracy of different tools and methods employed for the early detection and diagnosis of caries.

 

These guidelines will prove to be of great help and aid in bridging the gap between research and practice. As a result, they will advance the profession of dentistry and help practitioners to provide a higher standard of healthcare to their patients.

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