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When to intervene in the caries process? A Delphi consensus statement

British Dental Journal volume 229, pages 474–482 (2020)Cite this article

Abstract

Objectives To define an expert Delphi consensus on when to intervene in the caries process and existing carious lesions.

Methods Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.

Results Lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations may be placed for form, function, aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated lesions which are cleansable. Cavitated lesions which are not cleansable usually require minimally invasive management. In specific circumstances, mixed interventions may be applicable. Occlusally, cavitated lesions confined to enamel/non-cavitated lesions extending radiographically into deep dentine may be exceptions. Proximally, cavitation is hard to assess tactile-visually. Most lesions extending radiographically into the middle/inner third of dentine are assumed to be cavitated. Those restricted to the enamel are not cavitated. For lesions extending radiographically into the outer third of dentine, cavitation is unlikely. These lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.

Conclusions Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions.

Key points

  • Provides much needed guidance for the primary care practitioner to help in their management of dental caries.

  • Considers the quality of the evidence available to provide pragmatic guidelines for caries management interventions.

  • Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions

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Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Authors and Affiliations

  1. Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s Health Partners, King’s College London, UK

    Avijit Banerjee

  2. Preventive & Pediatric Dentistry, University of Greifswald, Greifswald, Germany

    Christian Splieth

  3. Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna-Alma Mater Studiorum, Bologna, Italy

    Lorenzo Breschi

  4. Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan; Ann Arbor, Michigan, USA

    Margherita Fontana

  5. Department of Operative and Preventive Dentistry, Charité – Universitätsmedizin Berlin, Germany

    Sebastian Paris & Falk Schwendicke

  6. Faculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong SAR, China

    Michael Burrow & Edward Lo

  7. Melbourne Dental School, University of Melbourne, Australia

    Felicity Crombie

  8. Department of Oral Sciences, Faculty of Dentistry, University of Otago, New Zealand

    Lyndie Foster Page & William Murray Thomson

  9. Department of Dentistry, University of Barcelona, Spain and Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, SP, Brazil

    Patricia Gatón-Hernández

  10. Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile

    Rodrigo A. Giacaman

  11. Department of Pediatric and Preventive Dentistry, DAV (C) Dental College, Yamunanagar, Haryana, India

    Neeraj Gugnani

  12. Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany

    Reinhard Hickel

  13. Institute of German Dentists, Cologne, Germany

    Rainer A. Jordan

  14. Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brazil

    Soraya Leal

  15. Faculty of Dentistry, AMU University, Marseille, France

    Hervé Tassery

  16. Melbourne Dental School, University of Melbourne, Australia; Centrum van Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, A. Deusinglaan 1, 9700 AD, University of Groningen, The Netherlands

    David J. Manton

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Corresponding author

Correspondence to Avijit Banerjee.

Ethics declarations

The corresponding author formally requested a declaration of possible conflicts of interest from each of the consensus panel members. No relevant conflicts of interest at the organisational and individual levels related to this consensus document were identified.

Funding

The conference was kindly sponsored by DMG (Hamburg, Germany). This included travel, accommodation and conference costs for panel members. The sponsor had no role in design or conduct of the conference or the content of this manuscript and were not present during the conference. No honoraria were given to any of the panel members.

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Banerjee, A., Splieth, C., Breschi, L. et al. When to intervene in the caries process? A Delphi consensus statement. Br Dent J 229, 474–482 (2020). https://doi.org/10.1038/s41415-020-2220-4

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