How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement

• Published in: Clinical Oral Investigations
• Main Authors: Schwendicke, Falk, Splieth, Christian, Bottenberg, Peter, Breschi, Lorenzo, Campus, Guglielmo, Doméjean, Sophie, Ekstrand, Kim, Giacaman, Rodrigo, Haak, Rainer, Hannig, Matthias, Hickel, Reinhard, Juric, Hrvoje, Lussi, Adrian, Machiulskiene, Vita, Manton, David, Jablonski-Momeni, Anahita, Opdam, Niek, Paris, Sebastian, Santamaria, Ruth, Tassery, Hervé, Zandona, Andrea, Zero, Domenick, Zimmer, Stefan, Banerjee, Avijit
• Other Authors: Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne 2017-2020 (UCA 2017-2020 ), CHU Estaing Clermont-Ferrand, CHU Clermont-Ferrand, Laboratoire de Bioingénierie et NanoSciences (LBN), Université de Montpellier (UM)
• Format: Article in Journal/Newspaper
• Language: English
• Published: HAL CCSD 2020
• Subjects: [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition; [SDV.CAN]Life Sciences [q-bio]/Cancer; [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie; Orca
• Online Access: https://hal.science/hal-02956222; https://hal.science/hal-02956222/document; https://hal.science/hal-02956222/file/Schwendicke%20et%20al%202020%20How%20To%20Intervene%20In%20The%20Caries%20Proces%20Cli%20oral%20Investig.pdf; https://doi.org/10.1007/s00784-020-03431-0

International audience Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/ inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiograph-ically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in ...