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Introduction This study was designed to assess whether a dental caries management protocol combining a single application of 38% silver diamine fluoride (SDF) with comprehensive oral health education will successfully divert high-risk children from dental treatment under dental general anaesthesia (DGA), arrest active caries in primary teeth, and improve parent-reported child oral health–related quality of life (OHRQoL). Methods Children aged 2 to 10 years, who attended two public dental agencies in Victoria, Australia, and were unable to tolerate restorative treatments in the clinic setting, elected to participate in either a 38% SDF intervention protocol or, alternatively, referral for DGA. Follow-up examinations were completed at 6 months to assess caries progression, decayed missing filled tooth index, PUFA index (pulpal involvement, ulceration, fistula, abscess), DGA referral rates, and OHRQoL (Early Childhood Oral Health Impact Scale [ECOHIS]). Results Of the total sample, 89.5% of children (n = 102) [mean (SD) age, 4.1 (1.0) years] with 401 active carious lesions elected to participate in the 38% SDF protocol; 10.5% (n = 12) of parents opted for referral for treatment under DGA. The proportion of active caries subsequently arrested at follow-up (number of arrested lesions/number of lesions treated) was 0.78 (95% CI, 0.69 to 0.87). There was an 88% reduction in referrals for DGA in eligible children over the 6-month period. The 38% SDF intervention group showed a significant improvement in ECOHIS scores at follow-up (P Discussion Adoption of the 38% SDF intervention protocol resulted in a significant reduction in the rate of preventable dental hospitalisations. Most parents opted against referral for DGA. Parent-reported OHRQoL for children improved significantly.

Dental caries is a dynamic, preventable, reversible, complex biofilm-mediated, multifactorial disease that involves a series of demineralization/neutrality/remineralization of dental hard tissue in primary and permanent dentition. An imbalance in the continuum with a net demineralization over time results in the initiation of caries lesions. Visual inspection and intraoral radiographs are vital in caries detection, although they are of suboptimal sensitivity for early caries lesions. Shifting toward a conservative, noninvasive approach to caries management has resulted in the development of innovative-sensitive technologies. These newer techniques may serve as adjunct for the dental practitioner in detecting earliest changes in tooth structure.

Caries is a chronic disease, with long-term sequelae, often initiated early in life. Managing caries and carious lesions often has long-term consequences. These consequences involve the health (or its absence) generated by a caries management strategy, but also costs. This article discusses the long-term health and costs consequences resulting from different caries management strategies. It is demonstrated why, and under which circumstances, minimal invasive caries management may be beneficial for patients, but also for health services, with regard to both health gained and costs generated. Moreover, possible factors influencing the cost-effectiveness of different caries management strategies will be discussed.

Early childhood caries is a major unmet population health care need that negatively affects the overall health of children, especially those from diverse racial/ethnic backgrounds and disadvantaged socioeconomic groups. Nurses and midwives who work with pregnant women to nurses and nurse practitioners who work with young children and their families have an opportunity to positively influence the health of these populations. Primary care settings are ideal for integrating oral health into the overall health care of children and adolescents. The nursing profession is well positioned to have a positive impact on oral health and, in so doing, their overall health.

Frail older adults and persons with special needs are at higher risk of oral diseases including dental caries. Considering the diverse background of the population, a personalized approach for each patient is mandatory to successfully manage their oral health needs. This article describes a succinct way to assess and categorize the risk of rapid oral health deterioration (ROHD) among this group. The procedures for assessing ROHD risk examine the ROHD risk categories, how risk factors impact treatment strategies, what techniques and materials exist for caries prevention and treatment, and how one effectively communicates caries management plans for this population.

Medical providers are important allies in the prevention of dental caries. Through raising the issue by asking about risks and strengths, offering anticipatory guidance and counseling, encouraging and following up on referrals, and applying preventive fluoride, medical providers can have a direct, positive impact on oral health. Further, improving communication with referrals, bidirectionally, benefits patient care as well as provider satisfaction. By collaborating on advocacy efforts, medical and dental providers can broaden their impact while building relationships, with the end goal of improved health for patients throughout their lifetime. Reintegrating the mouth into the body and oral health into systemic health has benefits for patients and providers alike, and can and should be accomplished in the medical home.

The purposes of this article are to (1) offer a critical thinking skill set in decision-making and synthesis for caries diagnosis, and risk-adjusted and personalized management based on emulating the intended activity of the expert, (2) offer patient/case scenarios for application of the critical thinking skill set, (3) compare and contrast the results of applying an algorithm and expert thought process approach to patient analyses, (4) offer characteristics of the person making decisions and synthesizing information, and (5) for patients with complex health and social histories, include perspectives from other health care team members.

This article explores psychosocial barriers to dental care and implications for caries management. At-risk populations experience an increased potential for stressors and obstacles that interrupt oral health care and lessen the potential for these groups to pursue dental treatment. These impediments may include financial restrictions, lack of reliable transportation, or inappropriate informed consent. Involving a social worker in dental caries management can help patients to overcome the barriers that hinder oral health care. An increased awareness of these barriers, along with the resources that are available, may help dental providers to better reach their patients and manage dental caries.

Objective Carious tissue discrimination in clinical operative caries management relies traditionally on the subjective hardness of carious dentine. Biochemical alterations within the lesion have the potential to discriminate the lesion zones objectively. This study aimed to determine the correlation between the biochemical proportions of amide I and phosphate moieties as these are the most prominent peaks found in dentine with the Knoop microhardness of carious dentine zones, using non-contact Raman spectroscopy. The null hypothesis investigated was that there was no correlation between Raman peak ratios, amide I: phosphateν1, and the Knoop microhardness within specific zones of a carious lesion. Methods 423 scan points from 20 carious dentine lesion samples examined using high-resolution Raman spectroscopy. The peak ratio of the characteristic vibration mode of amide I (1650 cm−1) and phosphate (960 cm−1) bands were calculated, following a straight line path through the lesion to the pulp and correlated to corresponding Knoop microhardness measurements. Results Using logistic regression analysis, clear correlations were found between the Knoop microhardness and Raman peak ratio cut-off values between caries-infected and caries-affected dentine (81.5 % sensitivity / 92.7 % specificity), with a lower specificity (2.7 %) found between caries-affected and sound dentine. Conclusion This study concluded that non-contact Raman spectroscopy can be used in vitro to discriminate objectively between the different zones of a carious dentine lesion at high resolution, using the Raman peak ratios, amide I : phosphate ν1. Clinical Significance Specific biochemical alterations have the potential to be used in-vitro and in-vivo to identify the end-point of selective carious lesion excavation.

Article Title and Bibliographic Information The Caries Management System: are preventive effects sustained postclinical trial? Evans RW, Clark P, Jia N . Community Dent Oral Epidemiol 2016;44(2):188-97 . Sources of Funding Foundation: Oral Health Foundation, University of Sydney; and the Australian Dental Research Foundation; government: National Health and Medical Research Council; other: Dental Board of New South Wales Type of Study/Design The original 3-year study was a multicenter cluster randomized controlled clinical trial

Statement of problem Whether topical anticaries medicaments used in the oral environment will affect the surface integrity of restorative materials is uncertain. Purpose The purpose of this in vitro study was to investigate the effect of various anticaries agents on the surface roughness of 3 different restorative materials. Material and methods Sixty-four specimens of each restorative material (feldspathic porcelain, Ni-Cr metal ceramic alloy, and Ti-6Al-4V titanium alloy) were prepared and separated into 4 equal groups for soaking in anticaries agents (Prevident Dental Rinse, ACT mouth wash, chlorhexidine gluconate, and water). A profilometer was used to measure surface roughness before and after soaking the materials for 2 years of simulated usage. The mean change in surface roughness for each specimen was calculated. Statistical analysis was performed with a 2-way ANOVA, followed by the Tukey HSD test (α=.05). Results A significant interaction was found between the materials and anticaries agents (F=2.64, P =.02). The significant interaction was between Prevident and chlorhexidine gluconate. Porcelain specimens soaked in Prevident produced a negative change (−0.072 ±0.35 μm) in surface roughness (smoother surface), while chlorhexidine gluconate produced a positive change (0.094 ±0.42 μm) in surface roughness (rougher surface). Conclusion Within the limitations of this in vitro study, it can be concluded that Prevident Dental Rinse and chlorhexidine gluconate may cause a change in the surface roughness of feldspathic porcelain.

Few studies have evaluated clinical outcomes following caries risk assessment in large datasets that reflect risk assessments performed during routine practice. Objectives From clinical records, compare 18-month caries incidence according to baseline caries risk designation. Methods For this retrospective cohort study, data were collected from electronic records of non-edentulous adult patients who completed an oral examination and caries risk assessment (CRA) at a university instructional clinic from 2007 to 2012 (N = 18,004 baseline patients). The primary outcome was the number of new decayed/restored teeth from the initial CRA to the ensuing oral examination, through June 30, 2013 (N = 4468 patients with follow-up). We obtained doubly-robust estimates for 18-month caries increment by baseline CRA category (low, moderate, high, extreme), adjusted for patient characteristics (age, sex, payer type, race/ethnicity, number of teeth), provider type, and calendar year. Results Adjusted mean decayed, restored tooth (DFT) increment from baseline to follow-up was greater with each rising category of baseline caries risk, from low (0.94), moderate (1.26), high (1.79), to extreme (3.26). The percentage of patients with any newly affected teeth (DFT increment > 0) was similar among low-risk and moderate-risk patients (cumulative incidence ratio, RR: 1.01; 95% confidence interval, CI: 0.83, 1.23), but was increased relative to low-risk patients among high-risk (RR: 1.28; 95% CI: 1.10, 1.52), and extreme-risk patients (RR: 1.52; 95% CI: 1.23, 1.87). Conclusions These results lend evidence that baseline caries risk predicts future caries in this setting, supporting the use of caries risk assessment to identify candidate patients for more intensive preventive therapy. Clinical significance Identification of patients at greater risk for future caries helps clinicians to plan appropriate personalized care. In this study, a multifactorial approach to caries risk assessment effectively stratified patients into groups of higher or lower caries propensity. Dentists can apply risk assessment in practice antecedent to patient-tailored caries management.

The development of an oral care path focuses on the identification of the early indicators of disease. Once the risks have been identified and diagnosed, the proper therapies can be selected and prescribed. The experienced practitioner must meld clinical experience and observation with evidence-based scientific dentistry and information on the treatment and prevention of continued disease for the prosthodontic patient after restorations have been completed. The incorporation of dental implants has not allowed for complications of caries and periodontal disease on teeth and implants. Osseoseparation is necessary for justification of continued maintenance.

Article Title and Bibliographic Information Caries Management Strategies for Primary Molars: 1-Yr Randomized Control Trial Results. Santamaria RM, Innes NPT, Machiulskiene V, Evans DJP, Splieth CH. J Dent Res 2014;93(11):1062–9. Reviewer Veerasamy Yengopal, MChD (Community Dentistry) Purpose/Question This randomized clinical trial sought to evaluate the clinical efficacy of three caries management options for occlusoproximal cavitated lesions in primary molars. Source of Funding Study funded by the Pediatric Dentistry Department of Greifswald University, Germany Type of Study Randomized Controlled Trial Level of Evidence Level 1: Consistent, good-quality patient-oriented evidence Strength of Recommendation Grade Not applicable

Nanotechnology has been applied to dental materials as an innovative concept for the development of materials with better properties and anticaries potential. In this review we discuss the current progress and future applications of functional nanoparticles incorporated in dental restorative materials as useful strategies to dental caries management. We also overview proposed antimicrobial and remineralizing mechanisms. Nanomaterials have great potential to decrease biofilm accumulation, inhibit the demineralization process, to be used for remineralizing tooth structure, and to combat caries-related bacteria. These results are encouraging and open the doors to future clinical studies that will allow the therapeutic value of nanotechnology-based restorative materials to be established.

Background The authors conducted a study to survey the perspectives of dentists regarding the 2010 American Dental Association (ADA) recommendation to seal non-cavitated carious lesions (NCCLs) in children and young adults. Methods The authors mailed a questionnaire to a randomly selected sample of 2,400 general dentists (GDs) and pediatric dentists (PDs) in the United States. The sample was chosen by the ADA's Survey Center. The questionnaire included two photographs of NCCLs (permanent first molar and premolar) in a 12-year-old child. Respondents were provided with radiographic findings and asked to choose from several management options. Results In the absence of radiographic evidence of caries, 37.4 percent and 42.3 percent of GDs and PDs, respectively, indicated that they would seal the NCCL in the molar. For the premolar, a significantly lower percentage of GDs than of PDs indicated that they would seal the NCCL. With radiographic evidence of caries in dentin, less than 4 percent of all dentists surveyed indicated that they would seal the NCCLs, and more than 90 percent indicated that they would remove the caries and place restorations. Less than 40 percent of dentists indicated that they sealed NCCLs in their practice. Conclusions The U.S. dentists surveyed have not adopted evidence-based clinical recommendations regarding the sealing of NCCLs. Practice Implications New educational and dissemination programs should be developed regarding these evidence-based caries management approaches.

This introductory article provides an overview of the caries disease process that will help guide readers into the world of evidence-based caries management in the beginning of the twenty-first century and help them understand the ongoing need to update in this field. This issue of Dental Clinics of North America provides clinically relevant reviews, full of chair-side recommendations based on best available evidence, on epidemiology, nomenclature, disease process, and management. A glossary of common terms in cariology is included.

This article provides evidence to support the use of more conservative cavity preparation techniques with adhesive restorative resins. The authors discuss the issue of conservative operative techniques related to hidden or occult caries. The support for contemporary technology also concerns methods of caries detection and the role of magnification, caries risk assessment of the patient, conservative caries management, instrumentation, materials, and techniques.

Traditionally, dentists have been trained in the surgical model for caries management whereby detection is akin to diagnosis. This model unfortunately has been translated to patient expectations. Nevertheless, a growing body of clinical evidence suggests that noncavitated lesions, even those extending into dentin, can be managed by nonsurgical means with an expectation for remineralization.

Background It has been suggested that dentists manage patients' treatment according to their risk of developing caries, as determined on the basis of scientific findings—an example of applying evidence-based dentistry, or EBD, to caries management. This article evaluates the barriers to adopting EBD and suggests possible outcomes for dentists and patients if new EBD caries strategies are adopted. Methods The author estimated the complexity of adopting EBD for a general dentist by means of flowchart analysis. He considered the ease of collecting comprehensive patient screening data, identifying risk factors and classifying risk. He examined the adequacy of conventional caries charting methods for representing the different stages and behavior of carious lesions, as well as the difficulty of producing treatment plans according to different caries risk levels. He also modeled the possible financial and organizational results of applying EBD caries management methods and increasing the use of hygienists. Results Traditional caries management strategies required only one flowchart page, while EBD needed 16 pages. Two full-time hygienists and 25 percent of a dentist's time, managing only patients at low risk of developing caries, could generate the equivalent gross income of a full-time dentist working conventionally. Adding a third hygienist and devoting 75 percent of a dentist's time to managing the remaining patients (those at medium or high risk of developing caries and periodontal disease) could gross a similar amount again. Conclusions Changing from traditional to risk-based management of caries requires complex decision making that is unlikely to occur with paper chart methods. Computers are ideal for collecting patient screening data and automating the treatment planning process to reduce the complexity of clinical management. Conventional methods of charting caries are not suited for evidence-based caries risk management. Practice Implications One dentist who uses risk-based management of caries and makes efficient use of three hygienists may see a doubling of income and a fourfold increase in the practice's patient population.

Background and Overview Dental caries is a bacterially based disease. When it progresses, acid produced by bacterial action on dietary fermentable carbohydrates diffuses into the tooth and dissolves the carbonated hydroxyapatite mineral—a process called demineralization. Pathological factors including acidogenic bacteria (mutans streptococci and lactobacilli), salivary dysfunction, and dietary carbohydrates are related to caries progression. Protective factors—which include salivary calcium, phosphate and proteins, salivary flow, fluoride in saliva, and antibacterial components or agents—can balance, prevent or reverse dental caries. Conclusions Caries progression or reversal is determined by the balance between protective and pathological factors. Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes. Clinical Implications Fluoride in drinking water and in fluoride-containing products reduces caries via these topical mechanisms. Antibacterial therapy must be used to combat a high bacterial challenge. For practical caries management and prevention or reversal of dental caries, the sum of the preventive factors must outweigh the pathological factors.