Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions

Abstract

Background. An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. Types of Studies Reviewed. The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. Results. The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptideeamorphous calcium phosphate. Conclusions and Practical Implications. Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.

The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics

“…In summary, the current MID techniques offer great options for tooth structure preservation, such as repair rather than replacement of composite (Gordan et al, ), the atraumatic experience associated with glass ionomer restorations in Atraumatic Restorative Technique (ART) (Banerjee, ), and the use of Silver Diamine Fluoride as a nonrestorative option to asymptomatic cavities (Slayton et al, ). However, U.S. dental schools in the time of the current study did not appear ready to phase out training their dental students on the use of amalgam.…”

Carious lesions and first restorative treatment

“…Further options are the use of fissure sealant in occlusal lesions and may include resin infiltration in proximal lesions into the outer third of the dentine. In patients who cannot cooperate with treatment, silver diamine fluoride can be an intermediate alternative . Follow up is essential in all cases.…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…The most significant of these was the publication of a practice guideline for the nonrestorative treatment of carious lesions. 223 This guideline was the product of an expert panel convened by the American Dental Association that developed 11 clinical recommendations specific to lesion types, tooth surfaces, and primary or permanent dentitions. The critical pathways for decision support around each of those recommendations were also presented as flow diagrams.…”

“…In the "Evidence-Based Clinical Practice Guideline on Nonrestorative Treatment for Carious Lesions," the decision matrix pertaining to noncavitated lesions on occlusal surfaces lists sealants plus 5% NaF varnish as the highest priority recommendation for both primary and permanent teeth. 223 In addition, for noncavitated approximal surfaces, sealants in the form of resin infiltration are listed as the second option behind 5% NaF varnish every 3 to 6 months. Once again, this document provides valuable guidance in selecting the most appropriate indications for use.…”