Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association.

Background: An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth.

Types Of Studies Reviewed: The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.

Systematic review and meta-analysis on the effect of self-assembling peptide P-4 on arrest, cavitation, and progression of initial caries lesions.

Background: Simple noninvasive evidence-based interventions for caries are needed to overcome limitations in the restorative paradigm. The self-assembling peptide P-4 is a noninvasive intervention that regenerates enamel in initial caries lesions.

Studies Reviewed: The authors conducted a systematic review and meta-analysis on the effectiveness of the P-4 products Curodont Repair (Credentis; now manufactured by vVARDIS) (CR) and Curodont Repair Fluoride Plus (Credentis; now manufactured by vVARDIS) on initial caries lesions.

Clinical Instructions for Using Silver Diamine Fluoride (SDF) in Dental Caries Management.

Unlabelled: Manufacturer instructions for 38% silver diamine fluoride (SDF) are limited to current FDA clearance for tooth desensitization. There is a need for instructions to provide best-practice recommendations for off-label use of SDF for caries prevention and arrest.

Methods: The authors considered existing clinical approaches to the use of 38% SDF at pH 10 for the prevention and arrest of active dental caries, in light of the best current evidence.

Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association.

Background: 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.

Types Of Studies Reviewed: The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions.

Secondary Sjögren syndrome: A case report using silver diamine fluoride and glass ionomer cement.

Background And Overview: The authors describe dental treatment for a patient with a complex medical history of secondary Sjögren syndrome with systemic lupus erythematosus and rheumatoid arthritis.

Case Description: An 18-year-old woman's rheumatology group referred her for oral evaluation; she had secondary Sjögren syndrome, systemic lupus erythematosus, and rheumatoid arthritis. The patient had multiple advanced carious lesions, extreme sensitivity, and hyposalivation.

Dental Care for Geriatric and Special Needs Populations.

This article reviews considerations for oral health care associated with the most common causes of mortality and morbidity in older adults. Many of these diseases result in functional or cognitive impairments that must be considered in treatment planning to ensure appropriate, safe, and effective care for patients. Many of these considerations parallel those of adults who have lived with developmental disabilities over a lifetime and similar principles can be applied.

The Effect of Calibration on Caries Risk Assessment Performance by Students and Clinical Faculty.

Caries management requires a complete oral examination and an accurate caries risk assessment (CRA). Performing Caries Management by Risk Assessment (CAMBRA) is inefficient when the caries risk level assignment is incorrect. The aim of this study was to evaluate the ability of faculty members and students at one U.

The Effects of Faculty Calibration on Caries Risk Assessment and Quality Assurance.

Accurate caries risk assessment (CRA) plays a pivotal role in managing the disease of dental caries. The aim of this quality assurance study was to determine if faculty calibration training using a specific set of guidelines in a single session would improve the faculty members' CRA decision making. A calibration seminar was held in December 2014 at the Virginia Commonwealth University School of Dentistry, during which seven completed CRA forms for simulated patients were used to test 55 faculty members' risk assignment level before and after an instructional lecture was given.

The American Dental Association Caries Classification System for clinical practice: a report of the American Dental Association Council on Scientific Affairs.

Background: The caries lesion, the most commonly observed sign of dental caries disease, is the cumulative result of an imbalance in the dynamic demineralization and remineralization process that causes a net mineral loss over time. A classification system to categorize the location, site of origin, extent, and when possible, activity level of caries lesions consistently over time is necessary to determine which clinical treatments and therapeutic interventions are appropriate to control and treat these lesions.

Methods: In 2008, the American Dental Association (ADA) convened a group of experts to develop an easy-to-implement caries classification system.

A best practices approach to caries management.

Unlabelled: Caries management by risk assessment represents best practices and is an evidence-based model that focuses on treating and preventing disease at the patient level rather than a surgical/restorative approach at the tooth level.

Background: Dental caries is a multifactorial, biofilm and pH mediated disease that affects people of all ages and disproportionally affects certain populations at epidemic proportions. Simply restoring cavitated teeth does nothing to resolve the disease.

Raisins and oral health.

Traditionally, raisins have been thought to promote dental caries due to their suspected "stickiness" and sugar content. Current research identifies some evidence contrary to traditional thought, suggesting that raisins may not contribute to dental caries. This article reviews new findings with regards to raisins and the 3 conditions that are thought to contribute to the formation of dental caries; low oral pH, adherence of food to teeth, and biofilm (bacterial) behavior.

Caries management by risk assessment.

Caries disease is multifactorial. Whether caries disease will be expressed and damage dental hard tissue is dependent on the patient's own unique make-up of pathogenic risk factors and protective factors. Objectives This manuscript will review the science of managing caries disease based on assessing caries risk.

Caries management pathways preserve dental tissues and promote oral health.

In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc.

New directions in the etiology of dental caries disease.

This review explores the multifactorial etiology of dental caries disease. Current theories suggest that a singular focus on mutans streptococci and lactobacillus as the sole causative microbiological agents is no longer a viable strategy in treatment of this prevalent disease. Dental caries is an infectious transmissible disease process where a cariogenic biofilm in the presence of an oral status that is more pathological than protective leads to the demineralization of dental hard tissue.

Implementing caries risk assessment and clinical interventions.

This article suggests a practical methodology to implement the scientific information presented in the earlier articles into clinical practice. The Caries Balance/Imbalance Model and a practical caries risk assessment procedure for patients aged 6 years through adult illustrate evidence-based treatment options. Neither the forms nor the clinical protocols are meant to imply that there is currently only one correct way that this can be achieved; they are used in this article only as examples.

Defining dental caries for 2010 and beyond.

This introductory article provides an overview of the caries disease process that will help guide readers into the world of evidence-based caries management in the beginning of the twenty-first century and help them understand the ongoing need to update in this field. This issue of Dental Clinics of North America provides clinically relevant reviews, full of chair-side recommendations based on best available evidence, on epidemiology, nomenclature, disease process, and management. A glossary of common terms in cariology is included.

The role of dental hygiene in caries management: a new paradigm.

Dental caries is the most common disease of children and remains a significant oral health problem worldwide for both children and adults. The traditional paradigm of treating dental caries solely by "drilling and filling," brushing and flossing and lowering sugar intake has evolved. Current science in the management of dental caries suggests a clear focus on the reduction of responsible infectious agents, remineralization of non-cavitated lesions and minimally invasive restorative approaches whenever possible.

A clinician's guide to CAMBRA: a simple approach.

Caries risk assessment identifies those factors that are pathologic and suggests ways an astute clinician can implement protective strategies that can prevent progression and/or return the patient to health. Caries management by risk assessment (CAMBRA) focuses on treating and preventing the cause of the disease at an early stage, rather than waiting until it causes damage to tooth structure. This article summarizes and simplifies information previously published about CAMBRA implementation from the perspective of today's practicing clinician.

Evidence-based caries, risk assessment, and treatment.

Dental caries is a dietary and host-modified biofilm disease process, transmissible early in life that, if left untreated, will cause destruction of dental hard tissues. If allowed to progress, the disease will result in the development of caries lesions on tooth surfaces, which initially are noncavitated (eg, white spots), and eventually can progress to cavitation. The "medical model," where the etiologic disease-driving agents are balanced against protective factors, in combination with risk assessment, offers the possibility of patient-centered disease prevention and management before there is irreversible damage done to the teeth.

Caries management by risk assessment: implementation guidelines.

ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.

The role of dental hygienists, assistants, and office staff in CAMBRA.

The role of the dental team in caries management by risk assessment is critical to successful patient outcomes. Positive patient interactions and communication, proper appointment scheduling, diagnostics and data gathering, as well as implementation of noninvasive or minimally invasive procedures can be the responsibility of all members of the dental team. This article will evaluate the role of the clinical and administrative staff in maintaining a practice with a focus on disease prevention and management.

Clinical protocols for caries management by risk assessment.

This article seeks to provide a practical, everyday clinical guide for managing dental caries based upon risk group assessment. It is based upon the best evidence at this time and can be used in planning effective caries management for any patient. In addition to a comprehensive restorative treatment plan, each patient should have a comprehensive caries management treatment plan.