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Table of Contents
Vol. 38, No. 3, 2004
Issue release date: May–June 2004
Section title: Paper
Caries Res 2004;38:294–304
(DOI:10.1159/000077769)

Are We Ready to Move from Operative to Non-Operative/Preventive Treatment of Dental Caries in Clinical Practice?

Pitts N.B.
Dental Health Services Research Unit and Centre for Clinical Innovations, University of Dundee, Dundee, UK
email Corresponding Author

Abstract

This review focuses on the clinical interactions between patients and the dental team, not on caries prevention at a public health level. Many dentists no longer take a narrow surgical view seeking to apply interventive treatment as a one-off event at a certain trigger point of disease severity and the evidence that caries is an initially reversible, chronic disease with a known multi-factorial aetiology is being appreciated more widely. The caries process should be managed over time in an individualized way for each patient. Very few individuals can be considered to be truly ‘caries free’ when initial lesions as well as more advanced dentine lesions are considered. It is now very clear that, by itself, restorative treatment of the disease does not ‘cure’ caries. The caries process needs to be managed, in partnership with patients, over the changing challenges of a lifetime. The answer to the question posed in the title should be, in many cases, that we are ready to move to non-operative/preventive care (if we have not done so already). However, this should be for appropriate stages of lesion extent and in patients who respond to advice on recall frequency and preventive behaviours.

© 2004 S. Karger AG, Basel


  

Key Words

  • Clinical management
  • Dental caries
  • Treatment planning
  • Treatment strategies

References

  1. American Dental Association Policy on Evidence-Based Dentistry: American Dental Association Position Statements, 2002:www.ada.org/prof/resources/positions/statements/evidencebased.asp.
  2. Backer-Dirks O, van Amerongen J, Winkler KE: A reproducible method for caries evaluation. J Dent Res 1951;30:346–359.
  3. Bader JD, Shugars DA: Variation in dentists’ clinical decisions. J Public Health Dent 1995;55:181–188.
  4. Bader JD, Shugars DA, Bonito AJ: Systematic reviews of selected dental caries diagnosis and management methods. J Dent Educ 2001;65:960–968.
  5. Baelum V, Fejerskov O: Caries diagnosis: A mental resting place on the way to intervention?; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 101–110.
  6. Department of Health: NHS Dentistry: Options for Change. London, Department of Health, 2002. www.doh.gov.uk/cdo/optionsforchange.
  7. Elderton RJ: Clinical studies concerning re-restoration of teeth. Adv Dent Res 1990;4:4–9.
  8. Fejerskov O, Manji F: Risk assessment in dental caries; in Bader JD (ed): Risk Assessment in Dentistry. Chapel Hill, University of North Carolina Dental Ecology, 1990, pp 215–217.
  9. Fejerskov O, Nyvad B: Is Dental Caries an Infectious Disease? Diagnostic and Treatment Consequences for the Practitioner. Nordic Dentistry 2003. Copenhagen, Quintessence Copenhagen, 2003, pp 141–152.
  10. Fejerskov O, Nyvad B, Kidd EAM: Clinical and histological manifestations of dental caries; in Fejerskov O and Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 71–97.
  11. Heidman J, Holund U, Poulsen S: Changing criteria for restorative treatment of approximal caries over a 10-year period. Caries Res 1987;21:460–463.
  12. Ismail AI, Hasson H, Sohn W: Dental caries in the second millenium. J Dent Educ 2001;65:953–959.
  13. Kidd EAM: The carious lesion in enamel; in Murray JJ (ed): Prevention of Oral Disease, ed 3.. Oxford, Oxford University Press, 1996, pp 95–106.
  14. Kidd EAM, Nyvad B: Caries control for the individual patient; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 303–312.
  15. Machiulskiene V, Nyvad B, Baelum V: A comparison of clinical and radiographic caries diagnoses in posterior teeth of 12-year-old Lithuanian children. Caries Res 1999;33:340–348.
  16. MacLeod HST, Morris AJ, Hill KB: Evaluation of personal dental services (PDS) first wave pilots: The alternative to general dental services (GDS) offered by the capitation based pilots. Br Dent J 2003;195:644–650.
  17. Magitot E: Therapeutic indications in dental caries. Part 1. Br J Dent Sci 1886;29:405–410.
  18. Manji F, Fejerskov O, Baelum V, Luan W-M, Chen X: The epidemiological features of dental caries in African and Chinese populations: Implications for risk assessment; in Johnson NW (ed): Risk Markers for Oral Diseases. Dental Caries Markers of High and Low Risk Groups and Individuals. Cambridge, Cambridge University Press, 1991, vol 1, pp 62–100.
  19. Marthaler TM: The caries-inhibiting effect of amine fluoride dentifrices in children during three years of unsupervised use. Br Dent J 1965;119:153–163.
  20. Mjör I, Toffenetti F: Secondary caries: A literature review with case reports. Quintessence Int 2000;31:169–71.
  21. Møller IJ: Clinical criteria for the diagnosis of the incipient carious lesion. Adv Fluorine Res 1966;4:67–72.
  22. Murray JJ, Pitts NB: Trends in oral health; in Pine CM (ed): Community Oral Health. Dundee, University of Dundee, Reed Educational and Professional, 1997, pp 126–146.
  23. National Institutes of Health: The diagnosis and management of dental caries throughout life. National Institutes of Health Consensus Development Conference, Washington March 26th–28th 2001. J Dent Educ 2001;65:1162–1168.
  24. National Institute for Clinical Excellence: Dental Recall: Recall Interval between Routine Dental Examinations – Guideline. London, National Institute for Clinical Excellence (NICE), Department of Health, in press.
  25. NHS Centre for Reviews and Dissemination: Restoration Longevity: Effectiveness Matters Bulletin. York, 1999.
  26. Nyvad B, Machiulskiene V, Baelum V: Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999;33:252–260.
  27. Nyvad B, Machiulskiene V, Baelum V: Construct and predictive validity of clinical caries diagnostic criteria assessing lesion activity. J Dent Res 2003;82:117–122.
  28. Pitts NB: Review of ICW-CCT meeting and philosophy and approach of ICDAS. Proc Third Indiana Conf Early Detect Dent Caries, Indiana, in press.
  29. Pitts NB, Fejerskov O, von der Fehr FR: Caries epidemiology, with special emphasis on diagnostic standards; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 140–163.
  30. Pitts NB, Fyffe HE: The effect of varying diagnostic thresholds upon clinical caries data for a low prevalence group. J Dent Res 1988;67:592–596.
  31. Pitts NB, Longbottom C: Preventive Care Advised (PCA)/Operative Care Advised (OCA) – Categorising caries by the management option. Community Dent Oral Epidemiol 1995;23:55–59.
  32. Pitts NB, Renson CE: Monitoring the behaviour of posterior approximal carious lesions by image analysis of serial standardised bitewing radiographs. Br Dent J 1987;162:15–21.
  33. Pitts NB, Stamm JW: Proceedings of the International Consensus Workshop on Caries Clinical Trials ICW-CCT. J Dent Res, in press.
  34. Poulsen S, Heidman J, Vaeth M: Lorenz curves and their use in describing the distribution of ‘the total burden’ of dental caries in a population. Community Dent Health 2001;18:68–71.
  35. Scottish Intercollegiate Guidelines Network: SIGN guidelines: A Guideline Developer’s handbook. Edinburgh, Scottish Intercollegiate Guidelines Network, 2001, SIGN publication No 50.
  36. Scottish Intercollegiate Guidelines Network Guideline: Targeted Caries Prevention in 6- to 16-Year-Olds Attending for Dental Care. Edinburgh, Scottish Intercollegiate Guideline Network, 2000.
  37. Sheiham A, Fejerskov O: Caries control for populations; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 313–325.
  38. Silverstone LM: Structure of carious enamel including the early lesion. Oral Sci Rev 1973;3:100–160.
  39. Sjogren P, Ordell S, Halling A: Validation methodology in publication describing epidemiological registration methods of dental caries: A systematic review. Community Dent Health 2003;20:251–259.
  40. Swedish Council on Technology Assessment in Health Care: http://www.sbu.se.
  41. The Cochrane Library: CD ROM Update Software Ltd, Oxford, 2003. http://www.cochrane.co.uk.
  42. World Health Organization: A Guide to Oral Health Epidemiological Investigations. Geneva, World Health Organization, 1979.

  

Author Contacts

Prof. N.B. Pitts
Dental Health Services Research Unit, The Mackenzie Building
Kirsty Semple Way
Dundee DD2 4BF (UK)
Tel. +44 1382 420067, Fax +44 1382 420051, E-Mail n.b.pitts@dundee.ac.uk

  

Article Information

Number of Print Pages : 11
Number of Figures : 3, Number of Tables : 0, Number of References : 42

  

Publication Details

Caries Research (Journal of the European Organization for Caries Research (ORCA))
Journal founded 1967 by Y. Ericsson; edited 1970–1987 by K.G. König; 1987–1994 by J.M. ten Cate; 1994–2000 by J. Tenovuo

Vol. 38, No. 3, Year 2004 (Cover Date: May-June 2004)

Journal Editor: R.P. Shellis, Bristol
ISSN: 0008–6568 (print), 1421–976X (Online)

For additional information: http://www.karger.com/journals/cre


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

This review focuses on the clinical interactions between patients and the dental team, not on caries prevention at a public health level. Many dentists no longer take a narrow surgical view seeking to apply interventive treatment as a one-off event at a certain trigger point of disease severity and the evidence that caries is an initially reversible, chronic disease with a known multi-factorial aetiology is being appreciated more widely. The caries process should be managed over time in an individualized way for each patient. Very few individuals can be considered to be truly ‘caries free’ when initial lesions as well as more advanced dentine lesions are considered. It is now very clear that, by itself, restorative treatment of the disease does not ‘cure’ caries. The caries process needs to be managed, in partnership with patients, over the changing challenges of a lifetime. The answer to the question posed in the title should be, in many cases, that we are ready to move to non-operative/preventive care (if we have not done so already). However, this should be for appropriate stages of lesion extent and in patients who respond to advice on recall frequency and preventive behaviours.

© 2004 S. Karger AG, Basel


  

Author Contacts

Prof. N.B. Pitts
Dental Health Services Research Unit, The Mackenzie Building
Kirsty Semple Way
Dundee DD2 4BF (UK)
Tel. +44 1382 420067, Fax +44 1382 420051, E-Mail n.b.pitts@dundee.ac.uk

  

Article Information

Number of Print Pages : 11
Number of Figures : 3, Number of Tables : 0, Number of References : 42

  

Publication Details

Caries Research (Journal of the European Organization for Caries Research (ORCA))
Journal founded 1967 by Y. Ericsson; edited 1970–1987 by K.G. König; 1987–1994 by J.M. ten Cate; 1994–2000 by J. Tenovuo

Vol. 38, No. 3, Year 2004 (Cover Date: May-June 2004)

Journal Editor: R.P. Shellis, Bristol
ISSN: 0008–6568 (print), 1421–976X (Online)

For additional information: http://www.karger.com/journals/cre


Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 5/21/2004
Issue release date: May–June 2004

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 0

ISSN: 0008-6568 (Print)
eISSN: 1421-976X (Online)

For additional information: http://www.karger.com/CRE


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. American Dental Association Policy on Evidence-Based Dentistry: American Dental Association Position Statements, 2002:www.ada.org/prof/resources/positions/statements/evidencebased.asp.
  2. Backer-Dirks O, van Amerongen J, Winkler KE: A reproducible method for caries evaluation. J Dent Res 1951;30:346–359.
  3. Bader JD, Shugars DA: Variation in dentists’ clinical decisions. J Public Health Dent 1995;55:181–188.
  4. Bader JD, Shugars DA, Bonito AJ: Systematic reviews of selected dental caries diagnosis and management methods. J Dent Educ 2001;65:960–968.
  5. Baelum V, Fejerskov O: Caries diagnosis: A mental resting place on the way to intervention?; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 101–110.
  6. Department of Health: NHS Dentistry: Options for Change. London, Department of Health, 2002. www.doh.gov.uk/cdo/optionsforchange.
  7. Elderton RJ: Clinical studies concerning re-restoration of teeth. Adv Dent Res 1990;4:4–9.
  8. Fejerskov O, Manji F: Risk assessment in dental caries; in Bader JD (ed): Risk Assessment in Dentistry. Chapel Hill, University of North Carolina Dental Ecology, 1990, pp 215–217.
  9. Fejerskov O, Nyvad B: Is Dental Caries an Infectious Disease? Diagnostic and Treatment Consequences for the Practitioner. Nordic Dentistry 2003. Copenhagen, Quintessence Copenhagen, 2003, pp 141–152.
  10. Fejerskov O, Nyvad B, Kidd EAM: Clinical and histological manifestations of dental caries; in Fejerskov O and Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 71–97.
  11. Heidman J, Holund U, Poulsen S: Changing criteria for restorative treatment of approximal caries over a 10-year period. Caries Res 1987;21:460–463.
  12. Ismail AI, Hasson H, Sohn W: Dental caries in the second millenium. J Dent Educ 2001;65:953–959.
  13. Kidd EAM: The carious lesion in enamel; in Murray JJ (ed): Prevention of Oral Disease, ed 3.. Oxford, Oxford University Press, 1996, pp 95–106.
  14. Kidd EAM, Nyvad B: Caries control for the individual patient; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 303–312.
  15. Machiulskiene V, Nyvad B, Baelum V: A comparison of clinical and radiographic caries diagnoses in posterior teeth of 12-year-old Lithuanian children. Caries Res 1999;33:340–348.
  16. MacLeod HST, Morris AJ, Hill KB: Evaluation of personal dental services (PDS) first wave pilots: The alternative to general dental services (GDS) offered by the capitation based pilots. Br Dent J 2003;195:644–650.
  17. Magitot E: Therapeutic indications in dental caries. Part 1. Br J Dent Sci 1886;29:405–410.
  18. Manji F, Fejerskov O, Baelum V, Luan W-M, Chen X: The epidemiological features of dental caries in African and Chinese populations: Implications for risk assessment; in Johnson NW (ed): Risk Markers for Oral Diseases. Dental Caries Markers of High and Low Risk Groups and Individuals. Cambridge, Cambridge University Press, 1991, vol 1, pp 62–100.
  19. Marthaler TM: The caries-inhibiting effect of amine fluoride dentifrices in children during three years of unsupervised use. Br Dent J 1965;119:153–163.
  20. Mjör I, Toffenetti F: Secondary caries: A literature review with case reports. Quintessence Int 2000;31:169–71.
  21. Møller IJ: Clinical criteria for the diagnosis of the incipient carious lesion. Adv Fluorine Res 1966;4:67–72.
  22. Murray JJ, Pitts NB: Trends in oral health; in Pine CM (ed): Community Oral Health. Dundee, University of Dundee, Reed Educational and Professional, 1997, pp 126–146.
  23. National Institutes of Health: The diagnosis and management of dental caries throughout life. National Institutes of Health Consensus Development Conference, Washington March 26th–28th 2001. J Dent Educ 2001;65:1162–1168.
  24. National Institute for Clinical Excellence: Dental Recall: Recall Interval between Routine Dental Examinations – Guideline. London, National Institute for Clinical Excellence (NICE), Department of Health, in press.
  25. NHS Centre for Reviews and Dissemination: Restoration Longevity: Effectiveness Matters Bulletin. York, 1999.
  26. Nyvad B, Machiulskiene V, Baelum V: Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999;33:252–260.
  27. Nyvad B, Machiulskiene V, Baelum V: Construct and predictive validity of clinical caries diagnostic criteria assessing lesion activity. J Dent Res 2003;82:117–122.
  28. Pitts NB: Review of ICW-CCT meeting and philosophy and approach of ICDAS. Proc Third Indiana Conf Early Detect Dent Caries, Indiana, in press.
  29. Pitts NB, Fejerskov O, von der Fehr FR: Caries epidemiology, with special emphasis on diagnostic standards; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 140–163.
  30. Pitts NB, Fyffe HE: The effect of varying diagnostic thresholds upon clinical caries data for a low prevalence group. J Dent Res 1988;67:592–596.
  31. Pitts NB, Longbottom C: Preventive Care Advised (PCA)/Operative Care Advised (OCA) – Categorising caries by the management option. Community Dent Oral Epidemiol 1995;23:55–59.
  32. Pitts NB, Renson CE: Monitoring the behaviour of posterior approximal carious lesions by image analysis of serial standardised bitewing radiographs. Br Dent J 1987;162:15–21.
  33. Pitts NB, Stamm JW: Proceedings of the International Consensus Workshop on Caries Clinical Trials ICW-CCT. J Dent Res, in press.
  34. Poulsen S, Heidman J, Vaeth M: Lorenz curves and their use in describing the distribution of ‘the total burden’ of dental caries in a population. Community Dent Health 2001;18:68–71.
  35. Scottish Intercollegiate Guidelines Network: SIGN guidelines: A Guideline Developer’s handbook. Edinburgh, Scottish Intercollegiate Guidelines Network, 2001, SIGN publication No 50.
  36. Scottish Intercollegiate Guidelines Network Guideline: Targeted Caries Prevention in 6- to 16-Year-Olds Attending for Dental Care. Edinburgh, Scottish Intercollegiate Guideline Network, 2000.
  37. Sheiham A, Fejerskov O: Caries control for populations; in Fejerskov O, Kidd EAM (eds): Dental Caries – The Disease and Its Clinical Management. London, Blackwell Munksgaard, 2003, pp 313–325.
  38. Silverstone LM: Structure of carious enamel including the early lesion. Oral Sci Rev 1973;3:100–160.
  39. Sjogren P, Ordell S, Halling A: Validation methodology in publication describing epidemiological registration methods of dental caries: A systematic review. Community Dent Health 2003;20:251–259.
  40. Swedish Council on Technology Assessment in Health Care: http://www.sbu.se.
  41. The Cochrane Library: CD ROM Update Software Ltd, Oxford, 2003. http://www.cochrane.co.uk.
  42. World Health Organization: A Guide to Oral Health Epidemiological Investigations. Geneva, World Health Organization, 1979.