How to Intervene in the Caries Process: Early Childhood Caries – A Systematic Review

Abstract

For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child's cooperation, or a general anaesthesia setting.

Recommended procedures for the management of early childhood caries lesions – a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

“…Based on our results, it can be concluded that there is no difference among recommendations from different places and from different years about the management of dental caries. Similarly, to the conclusions of a previous systematic review, we endorsed the use of SDF for cavitated or non-cavitated lesions, the use of fluoride varnish for non-cavitated lesions, and a cautious indication of restorative approaches, especially for anterior teeth [43].…”

“…Nonetheless, SDF showed to be more effective than other interventions for control caries progression in primary teeth [48] as well as to prevent dental caries in the entire dentition [49]. Accordingly, one systematic review pointed out that there is a high level of evidence for the potential of the SDF for arrest carious lesion (cavitated and noncavitated) [43]. This recommendation is confirmed in a document recently published by the World Health Organization [50].…”

“…Almost all documents recommended restoring cavitated lesions, which historically is the approach used to management of caries [13]. Nonetheless, it is recognized that although restorative approaches are possible for the management of ECC, low scientific evidence was found for this intervention in anterior teeth [43]. It is known that there is a variety of nonrestorative procedures that can be used to treat carious lesions both on anterior and posterior teeth [41].…”

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

“…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 ].…”

“…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 ]. Investigators have cited the success of the use of the “Hall Technique” to support the concept of minimal intervention [ 10 ].…”