Published: 15 March 2022
Management of non-cavitated and cavitated caries in primary, permanent, and mixed dentition. An evidence review
The purpose of this overview of reviews is to provide evidence to assist with the development of clinical guidelines on the management of non-cavitated and cavitated caries in primary and permanent teeth. Cavitated caries include caries in both crown and root of the tooth.
Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance in this process over time, where there is net demineralisation of tooth structure by organic acids formed from the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars).
This overview updates an existing evidence review that was completed in 2019 and is based on 106 systematic reviews.
The HRB found that there are effective alternatives to manage early carious lesions and avoid invasive restorative procedures through non-invasive (fluoride-based and other products), and microinvasive (sealants and resin infiltration) treatments. In addition, there are viable alternatives to using dental amalgam to restore cavitated caries through either direct or indirect restorations. The promising direct alternates to dental amalgam are resin-modified glass ionomer cement, compomers, and different composite resins. In addition, there are promising indirect alternates including ceramics and resin composites. Crowns fabricated from gold, metal ceramic, all ceramic, or zirconia are other alternates in specific situations. Some of these alternatives are not quite as successful as dental amalgam and some are more successful.
In addition, the HRB found that there are also improved support materials and techniques available to dentists to enhance the effectiveness of interventions and acceptability of their treatments. The techniques include methods (such as selective caries removal as well as chemical or laser caries removal methods) to maximise the conservation of dentine and reduce pain experienced by the patient. The support materials include using the most appropriate adhesive for the specific intervention.