We don’t have to drill and fill every cavity. That’s right! Sometimes, the best option to manage caries is with a preventive agent, not a handpiece.
The American Dental Association (ADA) Council on Scientific Affairs and the Centre for Evidence-Based Dentistry convened an expert panel to do a systematic review and create evidence-based recommendations for stopping and reversing caries without restorative treatment.1 This article summarizes those recommendations to help you decide which non-restorative treatment to use.
The recommendations differ between non-cavitated and cavitated lesions. Non-cavitated lesions are macroscopically intact and have no clinical evidence of cavitation. They are also called white-spot, incipient, initial, or early lesions. A cavitated surface is not macroscopically intact and can observe with visual or tactile means. Caries may reverse with chemical preventive agents or arrest with chemical or physical preventive agents. Examples of these agents are 5% sodium fluoride varnish (NaF), 1.23% acidulated phosphate fluoride (APF) gel, silver diamine fluoride (SDF), sealants, resin infiltration, prebiotics, probiotics, calcium phosphate, hydroxyapatite, and chlorhexidine.
These are the panel’s top recommendations for non-restorative treatment of cavitated and non-cavitated lesions on primary and permanent teeth.1
To arrest cavitated lesions on any coronal surface on primary and permanent teeth:
- Apply SDF biannually
To arrest or reverse non-cavitated lesions on primary and permanent teeth:
- Sealants plus 5% NaF varnish every 3-6 months
- 5% NaF varnish every 3-6 months
- Resin infiltration
- Resin infiltration and 5% NaF varnish every 3-6 months
Facial or Lingual Surfaces
- 1.23% APF every 3-6 months
- 5% NaF every 3-6 months
- 5000 ppm NaF toothpaste or gel
The recommended agents are preventive therapeutics but can also be used to arrest or reverse caries. SDF is the best non-restorative technique for cavitated lesions to arrest caries on primary or permanent teeth.2 SDF may be a better option than restoring a tooth if patients are uncooperative, if there are medical contraindications to treatment, if there are time and/or cost concerns, or if the lesion is difficult to access.3
Regularly monitor cavitated and non-cavitated lesions by gently probing with an explorer and looking at radiographs. If caries arrest or reversal is not seen, additional treatment options should be considered.
If caries need to be removed and restored, refer to the ADA’s Evidence-Based Clinical Practice Guideline on Restorative Treatments for Caries Lesion.2 And, of course, a great way to decrease caries is to have good oral hygiene and a low-sugar diet. Just like we don’t have to reach for that chocolate bar, we don’t have to reach for the drill to treat caries. Consider non-restorative ways to manage caries and refer to the ADA’s Evidence-Based Clinical Practice Guideline on Non-Restorative Treatments for Carious Lesions for the best recommendations.1
- Slayton, R., Urquhart, O., Araujo, M., Pilcher, L., Banfield, L., Carrasco-Labra, A., Fontana, M., Guzman-Armstrong, S., Nascimento, M., Novy, B., Tinanoff, N., Weyant, R., Wolff, M., Young, D., Zero, D., & Tampi, M. (2018, July). Evidence-based clinical practice guideline on nonrestorative treatments … The Journal of the American Dental Association. https://jada.ada.org/article/S0002-8177(18)30469-0/fulltext
- Dhar, V., Pilcher, L., Fontana, M., Urquhart, O., O’Brien, K., Carrasco-Labra, A., Gonzalez-Cabezas, C., Keels, M. A., Mascarenhas, A. K., Nascimento, M., Platt, J., Sabino, G., Slayton, R., Tinanoff, N., Young, D., Zero, D., & Pahlke, S. (2023, April). Evidence-based clinical practice guideline on restorative treatments … The Journal of the American Dental Association. https://jada.ada.org/article/S0002-8177(23)00258-1/pdf
- Mohanta, S. (2021, March 9). Silver diamine fluoride. Oral Health. https://www.oralhealthgroup.com/features/silver-diamine-fluoride/
About the Author
Sanjukta Mohanta is a general dentist who graduated from the University of Toronto in 1999. She practices in Brampton, Ontario. She can be reached by email: email@example.com