Nonrestorative Treatments for Carious Lesions

Publication Date: October 1, 2018

PRIMARY DENTITION Recommendations

To arrest advanced cavitated carious lesions on any coronal surface of primary teeth, the expert panel recommends clinicians prioritize the use of 38% SDF solution (biannual application) over 5% NaF varnish (application once per week for 3 weeks). (S, M)
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To arrest or reverse noncavitated carious lesions on occlusal surfaces of primary teeth, the expert panel recommends clinicians prioritize the use of sealants plus 5% NaF varnish (application every 3-6 months) or sealants alone over 5% NaF varnish alone (application every 3-6 months), 1.23% APF gel (application every 3-6 months), resin infiltration plus 5% NaF varnish (application every 3-6 months), or 0.2% NaF mouthrinse (once per week).) (S, M)
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To arrest or reverse noncavitated carious lesions on approximal surfaces of primary teeth, the expert panel suggests clinicians use 5% NaF varnish (application every 3-6 months), resin infiltration alone, resin infiltration plus 5% NaF varnish (application every 3-6 months), or sealants alone. (C, )
(certainty: low to very low)
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To arrest or reverse noncavitated carious lesions on facial or lingual surfaces of primary teeth, the expert panel suggests clinicians use 1.23% APF gel (application every 3-6 months) or 5% NaF varnish (application every 3-6 months. (C, )
(certainty: moderate to low)
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To arrest or reverse noncavitated carious lesions on coronal surfaces of primary teeth, the expert panel suggests clinicians do not use 10% CPP-ACP paste if other fluoride interventions, sealants, or resin infiltration is accessible. (C, L)
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PERMANENT DENTITION Recommendations

To arrest advanced cavitated carious lesions on any coronal surface of permanent teeth, the expert panel suggests clinicians prioritize the use of 38% SDF solution (biannual application) over 5% NaF varnish (application once per week for 3 weeks). (C, L)
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To arrest or reverse noncavitated carious lesions on occlusal surfaces of permanent teeth, the expert panel recommends clinicians prioritize the use of sealants plus 5% NaF varnish (application every 3-6 months) or sealants alone over 5% NaF varnish (application every 3-6 months), 1.23% APF gel (application every 3-6 months), or 0.2% NaF mouthrinse (once per week). (S, M)
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To arrest or reverse noncavitated carious lesions on approximal surfaces of permanent teeth, the expert panel suggests clinicians use 5% NaF varnish (application every 3-6 months), resin infiltration alone, resin infiltration plus 5% NaF varnish (application every 3-6 months), or sealants alone. (C, )
(certainty: low to very low)
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To arrest or reverse noncavitated carious lesions on facial or lingual surfaces of permanent teeth, the expert panel suggests clinicians use 1.23% APF gel (application every 3-6 months) or 5% NaF varnish (application every 3-6 months). (C, )
(certainty: moderate to low)
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To arrest or reverse noncavitated carious lesions on coronal surfaces of permanent teeth, the expert panel suggests clinicians do not use 10% CPP-ACP paste if other fluoride interventions, sealants, or resin infiltration is accessible. (CL)
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To arrest or reverse noncavitated and cavitated carious lesions on root surfaces of permanent teeth, the expert panel suggests clinicians prioritize the use of 5,000 parts per million fluoride (1.1% NaF) toothpaste or gel (at least once per day) over 5% NaF varnish (application every 3-6 months), 38% SDF plus potassium iodide solution (annual application), 38% SDF solution (annual application), or 1% chlorhexidine plus 1% thymol varnish (application every 3-6 months). (CL)
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* SDF: Silver diamine fluoride.
† Clinicians refers to the target audience for this guideline, but only those authorized or trained to perform the specified interventions should do so.
‡ In keeping with the concept of informed consent, clinicians should offer or explain all nonsurgical and restorative treatment options and their potential adverse effects (such as blackened tooth surfaces treated with SDF) to all patients.
§ NaF: Sodium fluoride.
†† The order of treatments included in this recommendation represents a ranking of priority defined by the panel when accounting for treatment effectiveness, feasibility, patients’ values and preferences, and resource utilization. Considerations such as a particular patient’s values and preferences, special needs, or insurance status should inform clinical decision making.

Recommendation Grading

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Overview

Title

Nonrestorative Treatments for Carious Lesions

Authoring Organizations

Publication Month/Year

October 1, 2018

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults.

Target Patient Population

Patients with dental caries

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Outpatient, School

Intended Users

Dentist, nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D003731 - Dental Caries, D003945 - Diagnosis, Oral, D009909 - Oral Health, D003736 - Dental Cavity Lining, D003733 - Dental Caries Susceptibility, D009910 - Oral Hygiene

Keywords

oral cavity, cavity, carious lesion, caries