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ADA releases evidence-based clinical guideline on nonrestorative treatments for caries

Article, two years in the works, represents first in a series of guidelines on caries management

By Michelle Manchir

2018 October JADA coverA clinical practice guideline published in the October issue of The Journal of the American Dental Association lays out the evidence that certain nonrestorative interventions for carious lesions are effective.

“Evidence-based Clinical Practice Guideline on Nonrestorative Treatments for Carious Lesions” presents 11 clinical recommendations, each specific to lesion type, tooth surface and dentition.

Over two years, an expert panel convened by the ADA Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated the recommendations, which are available to view online at

“Clinicians will find this very helpful when they are faced with making a decision about treatment for a specific patient,” said Dr. Rebecca Slayton, chair of the panel that developed the guideline and former member of the ADA Council on Scientific Affairs. “It is a comprehensive review of the available literature on this topic that has been vetted by both an expert panel and highly skilled methodologists to determine the quality of evidence for each intervention.”

The panel’s recommendations include the use of 38 percent silver diamine fluoride, sealants, resin infiltration, 5 percent sodium fluoride varnish, 1.23 percent acidulated phosphate fluoride gel and 5,000 parts per million fluoride toothpaste or gel, among others.

The guideline released in October is the first of four in a series on caries management that the ADA is working on. Topics such as the importance of diet, oral hygiene and other factors that contribute to caries will be addressed in guidelines that are already in the works, said Dr. Slayton. The next three, scheduled to be released in 2019, 2020 and 2021, will cover recommendations for caries prevention; recommendations for the use of restorative treatments for carious lesions; and recommendations for detection and diagnosis of carious lesions, respectively.

Dr. Slayton
Dr. Slayton

“We decided to tackle the guideline on nonrestorative management of caries first because the U.S. Food and Drug Administration had recently cleared silver diamine fluoride for use as a desensitizing agent and it was anticipated that clinicians would be using this off label for caries management or arrest, since that is how it has been used in other countries for many years,” said Dr. Slayton.

Dr. Slayton, a dentist with a Ph.D. and professor emeritus in the department of pediatric dentistry at the University of Washington School of Dentistry, said she encourages dentists to read through the entire article to get an appreciation for how the guidelines were developed.

“The tables and the decision tree at the end of the paper nicely summarize the recommendations for each scenario and provide the quality of evidence for each treatment option,” she said.

The ADA Council on Scientific Affairs and Center for Evidence-Based Dentistry are responsible for developing a number of clinical practice guidelines that aim to help dentists make evidence-based decisions. In 2017, the groups published “Evidence-based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity” to inform clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions, including potentially malignant disorders, in the oral cavity. To view this guideline, visit

For more information about the ADA Center for Evidence-Based Dentistry, visit