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Science in the News

Data Shows Caries Progression Prevention Can Work for Those Who Stick with It

December 11, 2015

Key Points

  • Dental caries is a chronic disease process that involves an interaction between a tooth surface, oral bacteria, dietary sugars and salivary factors.
  • Management of the disease process through regular oral hygiene practices, i.e. use of fluoridated toothpaste, professionally applied fluoride varnish, sealants, and reduced consumption of dietary sugars has been effective in preventing the incidence of new caries lesions.

Swan-song for dental fillings? If it sounds too good to be true…

A follow-up of a randomized controlled clinical trial of the Caries Management System in Australia is getting a lot of media attention with catchy titles like “Goodbye to dental fillings? ‘No-drill’ techniques can treat tooth decay just as well, study finds”.  What is this magical intervention that supposedly eradicates the need for dental fillings?

Spoiler alert, the Caries Management System is only ‘no-drill’ for management of early caries lesions, such as those in ICDAS 1 or 21 or labeled ‘initial’ in the ADA Caries Classification System.2 So it is inaccurate to conclude that adoption of this approach will mean an end of dental fillings.  It is worth recognizing that a non-surgical approach to caries lesions management is a component of all approaches to caries classification.

The key point of this study is that caries, as a disease process, can and should be managed to prevent cavitated lesions that require restoration.  Prior to cavitation, there is opportunity to arrest or reverse the demineralization process and avoid the need to restore the tooth.  In general, this can be accomplished with good oral hygiene by the patient, e.g., twice daily brushing with toothpaste containing fluoride, daily flossing or other method effective for cleaning between teeth, and limiting ingestion of sugary foods and drinks, as well as regular visits to the dentist for procedures such as sealing susceptible pits and fissures on molar teeth.  Active surveillance by a dentist is also necessary to monitor progression or regression of lesions using visual and radiographic methods.  It is important to note that caries lesions progress at different rates, which underscores the importance of regularly assessing caries risk for each patient.  It is also important to remember that caries progression is more rapid in primary teeth.  This is because enamel in primary teeth is thinner, thus, once cavitated, progression into dentin can occur in 6-12 months unless preventive interventions are implemented.

  • Study Details
  • References

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