Journal
JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
Volume 149, Issue 10, Pages 837-+Publisher
AMER DENTAL ASSOC
DOI: 10.1016/j.adaj.2018.07.002
Keywords
Carious lesion; American Dental Association; practice guidelines; evidence-based dentistry; decision making; general practice; clinical recommendations; nonrestorative treatments; caries
Categories
Funding
- National Institutes of Health (NIH) National Institute of Dental and Craniofacial Research (NIDCR)
- NIH-NIDCR
- Colgate-Palmolive
- GC America
- SDI
- Voco
- Oral Biotech
- Shofu
- Xlear
- Ivoclar
- NIH's NIDCR
- Health Resources and Services Administration
- Elevate Oral Care
- Johnson Johnson
- GlaxoSmithKline
- Novartis Pharmaceuticals
- Church Dwight
- Procter and Gamble
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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 non-cavitated 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. Results. The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate. Conclusions and Practical Implications. Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.
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