How is dental caries managed?

Management of Dental Caries

Dental caries management should prioritize non-invasive preventive strategies first, with operative repair reserved only for cases where preventive approaches are insufficient. 1

Prevention Strategies

Community and Home-Based Prevention

• Community water fluoridation is the most cost-effective and equitable method for preventing dental caries 1
• Fluoride toothpaste use should be promoted with twice-daily supervised brushing:
  • Rice grain-sized amount for children under 36 months
  • Pea-sized amount for children over 36 months 1
• Dietary modifications are essential:
  • Reduce frequent consumption of sugar-containing drinks and snacks
  • Promote access to healthy foods 1
  • Sugar control is one of the three most practical approaches to caries prevention 2

Professional Preventive Interventions

• Fluoride varnish applications every 3-6 months by dental or non-dental healthcare providers 1
• Pit and fissure sealants are cost-effective in reducing caries progression (74% of sealed primary molars remain caries-free) 1
• Silver Diamine Fluoride (SDF) for arresting cavitated caries lesions in primary teeth:
  • Biannual applications of 38% SDF recommended 1

Early Intervention and Risk Assessment

• Establish a dental home by 12 months of age - "two is too late" emphasizes the importance of early interventions 1
• Risk assessment-based management should guide treatment planning:
  • Evaluate patient-specific risk factors including bacterial load, salivary flow, fluoride exposure, oral hygiene, and dietary habits 3
  • Develop comprehensive caries management treatment plans based on risk group assessment 4

Treatment Approach

Non-Invasive Management

1. Remineralization strategies:

   • Fluoride works by inhibiting demineralization and enhancing remineralization 1
   • Fluoride concentrated in plaque and saliva helps establish improved enamel crystal structure that is more acid-resistant 1

2. Interim therapeutic restorations:

   • Glass ionomer products can be used for managing cavitated lesions in young or uncooperative children 1

Minimally Invasive Operative Treatment

• Operative repair should follow minimally invasive, tissue-preserving principles 1
• Each child requiring operative repair represents a failure of preventive systems 1
• The Caries Management System provides a ten-step non-invasive strategy to arrest and remineralize early lesions 5

Common Pitfalls and Caveats

• Overreliance on restorative approaches: Traditional restorative treatment has many shortcomings; continuing with a primarily restorative approach leads to a "repeat restoration cycle" with escalating costs 6
• Neglecting risk assessment: Failure to consider individual risk factors can lead to inappropriate treatment selection 3
• Delayed intervention: Waiting until age 2 or later for initial dental evaluation misses critical prevention opportunities 1
• Focusing only on the lesion: Caries management must include consideration of the patient at risk, the status of each lesion, patient management, clinical management, and monitoring 5

The management of dental caries requires a shift from the traditional surgical/restorative model to a medical model focused on disease prevention and management, with the ultimate goal of reducing caries incidence and improving patient outcomes 5.