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

Schwendicke, Falk; Splieth, Christian H; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A; 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; ... (2020). How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement. Clinical oral investigations, 24(9), pp. 3315-3321. Springer-Verlag 10.1007/s00784-020-03431-0

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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 radiographically 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 the caries process in adults.

CLINICAL SIGNIFICANCE

Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.

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