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Monographs in Oral Science

Klaus W Neuhaus, Adrian Lussi
The difference between carious lesion diagnosis and carious lesion detection is discussed here. Concerning carious lesions, 3 diagnostic requirements should be fulfilled: to detect lesions, to assess surface integrity, and to assess lesion activity to support clinical decision making. The first and most important diagnostic method is meticulous visual-tactile inspection. This is the only method that potentially contributes to all 3 diagnostic requirements. All other methods that are presented in this chapter, i...
2018: Monographs in Oral Science
Sophie Doméjean, Brigitte Grosgogeat
This chapter aims to discuss the way dental practitioners manage deep carious lesions (DCL) in routine practice and the barriers and incentives/facilitators to changes in accepted practice. In concert with the philosophy of minimal intervention dentistry, the concept of quaternary prevention (actions taken to prevent overtreatment and reduce harm to the patient) emerges in dentistry. This can be applied to carious tissue removal (CTR) in DCL given the risks associated with this procedure (high risk of pulp exposure, pulpal complications, tooth substance loss, and unsuccessful invasive, expensive outcomes)...
2018: Monographs in Oral Science
David Ricketts, Nicola Innes, Falk Schwendicke
Describing and quantifying how much carious tissue should be removed prior to placing a restoration has been a long-debated issue stretching back as far as G.V. Black's "complete caries removal," now known as non-selective carious tissue removal. Originating in the 1960s and 1970s, from the differentiation between different layers of carious dentine, an outer contaminated ("infected") layer and an inner demineralised ("affected") layer, the former of which needed to be removed during cavity preparation and the latter not, selective carious tissue removal was born...
2018: Monographs in Oral Science
Nicola Innes, Falk Schwendicke, Jo Frencken
Understanding the carious process as a biofilm disease rather than an infectious disease has changed lesion management focus towards less invasive options. This has led to new and ongoing changes in recommendations for practitioners. However, the lack of clarity over what to do, and when, is complicated by different teaching, research, and policy documents containing different terms and definitions for carious lesions and management strategies. Lack of clear messages and communication over recommendations hampers moving evidence into practice...
2018: Monographs in Oral Science
Ruth Santamaría, Nicola Innes
In line with reducing the invasiveness of interventions in permanent teeth and changes towards more biological approaches, there have also been moves away from traditional restorative approaches to managing primary teeth where carious dentine/lesions were completely excised and a restoration placed. The Hall Technique is a method for managing carious primary molar teeth where a preformed stainless-steel crown, also known as a preformed metal crown, is seated over a tooth, sealing in, and not removing carious tissue...
2018: Monographs in Oral Science
Nicola Innes, Mark Robertson, Falk Schwendicke
Dental caries, the most common chronic disease in the world, affects over 3 billion people globally. Its management comprises a large proportion of dental care providers' clinical responsibility, yet despite the extensive evidence base for the management of cavitated carious lesions, gaps in the evidence persist. This promotes uncertainty and debate among providers. This chapter reiterates the 3 key components of evidence-based practice (EBP): clinical expertise, an awareness and appreciation of patient values, and use of best available evidence...
2018: Monographs in Oral Science
Guus van Strijp, Cor van Loveren
Non-restorative cavity control (NRCC) is a 3-part treatment option for dentine cavities in the primary dentition, for root carious lesions and cavitated coronal smooth surface lesions. The first part is that the patient's oral hygiene procedure/habits improve and involve the exposed dentine. For this, it may be necessary to expose the cavity (second part) so that it is accessible for the toothbrush (the lesion exposure method). As long as the dentine carious lesion is diagnosed as active or there is increased risk that carious lesion activity will recur, it is advisable to support the treatment with a 38% silver diamine fluoride (SDF) or a 5% sodium fluoride (NaF) varnish therapy (third part)...
2018: Monographs in Oral Science
Soraya Leal, Clarissa Bonifacio, Daniela Raggio, Jo Frencken
Atraumatic restorative treatment (ART) is a method of managing dental caries based on 2 pillars: sealants for preventing carious lesions in pits and fissures, and restorations for cavitated dentine carious lesions. ART uses only hand instruments for opening/enlarging the cavity and for removing carious tissue. The amount of carious tissue that should be removed depends mainly on the cavity depth. In cavities of shallow and medium depth, carious tissue is removed up to firm dentine. In deep/very deep cavities, in which there is no sign of pulp exposure, pulp inflammation and/or history of spontaneous pain, some soft dentine can be left in the pulpal floor/wall with the aim of avoiding pulp exposure...
2018: Monographs in Oral Science
Jo Frencken
Despite their limitations, caries epidemiology continues to rely predominantly on visual/tactile indices for detecting and assessing carious lesion-related conditions. Over the last 4 to 5 decades, the prevalence and severity of dental caries in primary and permanent dentitions have been reduced in a number of countries based on the published studies. Despite this achievement, the prevalence and severity of dental caries remains too high at a world level. Pits and fissures in occlusal surfaces of first molars and pits in buccal surfaces of lower first molars are most vulnerable for developing a carious lesion...
2018: Monographs in Oral Science
Falk Schwendicke
Caries is no longer seen as an infectious disease, and the aim of treating carious lesions is to control their activity, not to remove the lesion itself. Such control can be implemented by sealing off the lesion from the environment, with sealed bacteria being deprived from carbohydrates and thus inactivated. For cavitated lesions, controlling them usually involves the placement of restorations to rebuild the cleansability of the surface. In this case, dental practitioners have traditionally removed carious tissues prior to the restoration...
2018: Monographs in Oral Science
Margherita Fontana, Nicola Innes
One of the most conservative ways to retain tooth structure, preserve pulpal health, and avoid invasive treatment is to simply completely seal established carious lesions. A tight seal to isolate the biofilm and arrest the lesion can be successfully achieved using a sealant material such as resin or glass-ionomer for non-cavitated lesions, a restorative material for cavitated lesions, or, for primary teeth, preformed stainless-steel crowns. This chapter focuses on sealants and restorative materials. Sealant materials are a viable treatment option for controlling non-cavitated lesions in occlusal and proximal surfaces where there is no significant breach in the surface integrity of the tooth, even if the lesion extends into dentine...
2018: Monographs in Oral Science
Falk Schwendicke, Jo Frencken, Nicola Innes
Non-cleansable carious lesions where sealing is no longer an option should be restored in the vast majority of cases. Prior to restoring the cavity, carious tissue removal is performed, mainly to increase the longevity of the restoration. Such removal, however, should not be conducted in a way that the vital pulp is harmed. This means that in teeth with shallow or moderately deep lesions, selective removal to firm dentine is recommended, while in deep lesions (radiographically extending into the pulpal third or quarter of the dentine) selective removal to soft dentine should be performed...
2018: Monographs in Oral Science
Gerd Göstemeyer, Falk Schwendicke, Uwe Blunck
Restoring carious lesions can be challenging, especially for deep lesions in proximity to the pulp. A number of factors can influence restoration longevity. This chapter will discuss aspects that should be considered when restoring carious lesions. In the first part, factors that might have an effect on the pulp such as preparation trauma, tooth hypersensitivity, and the use of liners will be described. In the second part, the challenges and limitations of adhesive bonding to (sound and carious) dentine will be discussed...
2018: Monographs in Oral Science
Gerd Göstemeyer, Colin Levey
Clinical trials are the cornerstone of evidence-based medicine. By directly comparing different interventions they produce evidence on their relative efficacy and effectiveness This, in turn, can inform secondary research and guideline development to facilitate evidence-based clinical decision making. However, the quality of evidence stemming from clinical trials is frequently poor. Here, the pathway of evidence from basic research to the generation of implementable clinical guidelines will be described. Relevant factors related to trial design and reporting, such as the choice of trial comparators, outcomes and outcome measures, will be described and their influence on evidence synthesis will be discussed...
2018: Monographs in Oral Science
Georg Conrads, Imad About
Carious lesion dynamics are dependent predominantly on the availability of fermentable sugars, other environmental conditions, bacteria, and host factors. Our current understanding of the microorganisms involved in the initiation and progression of caries is still rather incomplete. The most relevant acidogenic-aciduric bacterial species known to date are Streptococcus mutans, bifidobacteria, and lactobacilli. Whereas mutans streptococci are initiators, bifidobacteria and lactobacilli are more enhancers for progression...
2018: Monographs in Oral Science
Falk Schwendicke, Thomas Lamont, Nicola Innes
Historically, traditional carious lesion management focused on the importance of removal of all carious tissue, with little thought to the lesion origins. The surgical removal of any sign of a carious lesion was prioritised with little, or no, consideration to pulp vitality, loss of tooth structure, or caries disease management. This symptomatic approach concentrating on lesions rather than on the cause of the disease, focused on preventing secondary carious lesion development. Early detection and improved understanding of the caries process - that lesion progress can be arrested or slowed - has led to preventive measures and less destructive management as a focus...
2018: Monographs in Oral Science
Lars Bjørndal
The most recent inspiration for stepwise carious tissue removal in 2 stages originates from the knowhow on intralesion changes in deep carious lesions. The environmental change that takes place during the first stage of carious tissue removal is aiming for the arrest of the deep lesion, by placing a temporary restoration on top of the soft carious dentine. The cavity is optimised during the second stage for a final restoration, as potential shrinkage of the retained dentine may occur during the period of carious dentine arrestment...
2018: Monographs in Oral Science
Marcela Rocha de Olivera Carrilho
Case reports and clinical trials conducted in different countries (i.e., the United States, Canada, Brazil, Germany, Finland, Sweden, Japan, India, and Sri Lanka) tend to find a positive relationship between the presence of more retained teeth in older ages and the prevalence of root caries in older adults. As this tendency has been shown to prevail globally, it is estimated that the predicted demographic elderly expansion may cause, in near future, a significant increment in the number of older population requiring an effective means of preventing and treating root surface caries...
2017: Monographs in Oral Science
Alessandra Reis, Paulo Vinícius Soares, Juliana de Geus, Alessandro D Loguercio
This chapter describes the clinical performance of restorations placed in root caries lesions. The prevalence of root caries and other types of cervical lesions, caused by abfraction, erosion, and abrasion (non-carious cervical lesions) are high, mainly in the elderly; and therefore, restorative procedures are indicated. We will revise the restorative materials used to restore these types of lesions and present evidence-based findings to provide clinicians with better evidence for choosing them. Additionally, some steps of the restorative procedure for the placement of resin-based composites will be revised and common clinical questions related to these steps will be answered based on high evidence level, produced by randomized clinical trials and systematic reviews of the literature...
2017: Monographs in Oral Science
Michael F Burrow, Margaret A Stacey
The prevalence of root caries among the elderly is increasing. The lesion shape can vary considerably from a broad shallow saucer-shape to a deeper defined cavity. The variety of shapes poses a series of complications when considering restorative management. This is accompanied with a paucity of clinical evidence on treatment techniques and clinical outcomes. The current philosophy centered on conservative management of root caries will most likely provide patients with the greatest chance of maintaining their teeth...
2017: Monographs in Oral Science
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