Dental Caries Management
Dental caries management should follow a comprehensive non-invasive approach that prioritizes prevention, early intervention, and minimally invasive treatments before resorting to operative repair. 1
Prevention Strategies
Community and Home-Based Fluoride Use
- Community water fluoridation is the most cost-effective and equitable method for preventing dental caries across all age groups and socioeconomic levels 1
- Fluoride toothpaste should be used twice daily:
- For children under 36 months: rice grain-sized amount
- For children over 36 months: pea-sized amount
- Begin with eruption of first tooth under supervision 1
Dietary Modifications
- Reduce frequent consumption of sugar-containing drinks and snacks
- Promote access to healthy foods
- Without sugar, caries would be negligible 2
Early Interventions
- Establish a dental home by 12 months of age ("two is too late")
- Promote exclusive breastfeeding for the first 6 months 1
Risk Assessment and Management
The Caries Management System provides a structured approach to caries management based on individual risk assessment 3:
- Assess patient risk factors (bacterial load, salivary flow, fluoride exposure, oral hygiene, diet)
- Evaluate status of each lesion
- Implement patient and clinical management protocols
- Monitor outcomes 3
Risk factors include:
- High numbers of cariogenic bacteria
- Inadequate salivary flow
- Insufficient fluoride exposure
- Poor oral hygiene
- Inappropriate infant feeding methods
- Socioeconomic factors 4
Non-Invasive Treatment Approaches
Remineralization Strategies
- Fluoride varnish applications every 3-6 months (can be applied by dental or non-dental healthcare providers)
- Fluoride works by inhibiting demineralization and enhancing remineralization 1
Sealants and Protective Barriers
- Pit and fissure sealants are cost-effective in reducing caries progression
- 74% of sealed primary molars remain caries-free 1
Arresting Active Lesions
- Silver Diamine Fluoride (SDF) for arresting cavitated caries lesions in primary teeth
- Biannual applications of 38% SDF recommended 1
- Interim therapeutic restorations using glass ionomer products for managing cavitated lesions in young or uncooperative children 1
Operative Treatment
Operative repair should be reserved for cases where non-invasive approaches are insufficient:
- Follow minimally invasive, tissue-preserving principles
- Each child requiring operative repair represents a failure of preventive systems 1
Common Pitfalls and Caveats
Over-reliance on restorative treatment: Traditional restorative treatment has many shortcomings and can lead to a "repeat restoration cycle" with escalating costs 5
Neglecting risk assessment: Failing to identify and address individual risk factors can lead to continued disease progression despite treatment
Delayed intervention: Early intervention is critical - establishing preventive measures after significant damage has occurred is less effective
Focusing only on treatment without patient education: Patients must be motivated to accept responsibility for changing the environment of their teeth to favor remineralization 5
Ignoring socioeconomic factors: Poverty and access to care are significant determinants of caries risk and must be addressed in management strategies 4
The evidence strongly supports a shift from the traditional restorative approach to a preventive, risk-based management strategy that emphasizes non-invasive interventions and addresses the underlying causes of dental caries 3, 4, 2.