How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement

Abstract

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.

Comparison of Survival Rates of Stainless-Steel Crowns Placed with and without Pulpotomy: A Two-Year Retrospective Study

“…Although there was no significant impact of performing a pulpotomy, it is interesting to note that the teeth that were restored without pulp therapy actually showed a longer projected survival time. This seems to lend credence to recent work on the placement of SSCs chair-side that has shown that if there is appropriate case selection, the survival of teeth with proximal caries is not affected by the performance of a pulpotomy [ 10 , 11 ].…”

“…This meant that the SSC, especially when performed under GA, has been combined with a pulpotomy or pulpectomy [ 8 , 12 ]. However, with advent of the Hall technique, there has been an increased recognition of the SSC as a form of minimal intervention dentistry [ 11 ]. This study aimed to evaluate if placing a pulpotomy on teeth with no history of spontaneous pain and proximal dental caries improved the survival outcomes for SSCs placed under GA.…”

“…The management of early childhood caries in children is often carried out under general anesthesia [ 8 , 9 ]. The management of proximal caries in primary teeth is a controversial topic [ 10 , 11 ]. While there is consensus that the restoration of choice for a primary tooth with multiple carious surfaces is a stainless-steel crown, there is no consensus on pulp therapy for proximal caries that does not reach the pulp on a radiograph [ 11 ].…”

“…The management of proximal caries in primary teeth is a controversial topic [ 10 , 11 ]. While there is consensus that the restoration of choice for a primary tooth with multiple carious surfaces is a stainless-steel crown, there is no consensus on pulp therapy for proximal caries that does not reach the pulp on a radiograph [ 11 ]. While some authors have recommended that all teeth with a marginal ridge destroyed by dental caries should be pulp-treated [ 12 ], others have suggested that covering teeth with a stainless-steel crown without a pulpotomy would be just as effective [ 8 , 10 , 11 ].…”

Minimum intervention oral healthcare delivery - is there consensus?

“…The European Federation of Conservative Dentistry (EFCD) and the European Organisation for Caries Research (ORCA) have collaborated in an attempt to collate and generate pragmatic, evidence-based guidance for primary care practitioners. 19,20,21,22,23 These, along with many other published efforts, are trying to help the relevant stakeholders to manage patients, improve oral health linked to general health and increase awareness in populations of their role in valuing and taking responsibility for their personal healthcare future. 24,25 Education and training courses exist to help dentists, dental therapists and team members learn about and implement MIOC (for example, the online, distance-learning master's programme in Advanced Minimum Intervention Dentistry).…”