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CariesCare practice guide: consensus on evidence into practice

A Correction to this article was published on 13 December 2019

This article has been updated


This CariesCare practice guide is derived from the International Caries Classification and Management System (ICCMS) and provides a structured update for dentists to help them deliver optimal caries care and outcomes for their patients. This '4D cycle' is a practice-building format, which both prevents and controls caries and can engage patients as long-term health partners with their practice. CariesCare International (CCI™) promotes a patient-centred, risk-based approach to caries management designed for dental practice. This comprises a health outcomes-focused system that aims to maintain oral health and preserve tooth structure in the long-term. It guides the dental team through a four-step process (4D system), leading to personalised interventions: 1st D: Determine Caries Risk; 2nd D: Detect lesions, stage their severity and assess their activity status; 3rd D: Decide on the most appropriate care plan for the specific patient at that time; and then, finally, 4th D: Do the preventive and tooth-preserving care which is needed (including risk-appropriate preventive care; control of initial non-cavitated lesions; and conservative restorative treatment of deep dentinal and cavitated caries lesions). CariesCare International has designed this practice-friendly consensus guide to summarise best practice as informed by the best available evidence. Following the guide should also increase patient satisfaction, involvement, wellbeing and value, by being less invasive and more health-focused. For the dentist it should also provide benefits at the professional and practice levels including improved medico-legal protection.

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Change history

  • 13 December 2019

    Author's correction note: Clinical article 2019; 353-362. When this article was initially published, one of the boxes in Figure 6 had been duplicated. The correct figure is shown below: Also, Matteo Basso's affiliation in the Acknowledgements section was incorrect. It should have read 'Matteo Bass...


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The Authors acknowledge the research conducted by many contributors that underpinned this CariesCare International Guide and are indebted to the contributions made by all of the internationally mixed groups who attended the launch meeting of the Global Collaboratory for Caries Management at Kings College London in 2013 and the many who have helped since at meetings in Liverpool, Seattle, Philadelphia, London, Capetown, Greifswald, Dubai, Delhi and Tokyo to drive the ICCMSä initiative forward. We are also exceedingly grateful to all the individuals who have helped shape the CariesCare International initiative at meetings in Athens, Oslo, Copenhagen, Buenos Aires and London as well as to the numerous organisations and companies who have helped support this work and enabled progress to date. Acknowledgement as consensus contributors: Ninoska Abreu-Placeres, Universidad Iberoamericana, Dominican Republic; University of Copenhagen, Denmark; Ben Amaechi, University of Texas Health Science Centre at San Antonio, USA; Matteo Basso, University of Torino, Italy; Mariana Braga, University of São Paulo, Brazil; Jeroen Van den Bulcke, Ghent University, Belgium; Iain L. C. Chapple, University of Birmingham, UK; Andrea Cortes, Universidad El Bosque, Colombia; Bhupinder Dawett, Hafren House Dental Practice at Derbyshire, UK; Bernadette K. Drummond, University of Leeds, UK; Kim Ekstrand, University of Copenhagen, Denmark; Margherita Fontana, University of Michigan, USA; Thomas Lamont, University of Dundee, UK; Adrian Lussi, University of Bern, Switzerland; David Manton, University of Melbourne, Australia; Paulo Melo, University of Oporto, Portugal; Michelle Muller-Bolla, Université Côte d' Azur, France; Mike McGrady, NHS Greater Glasgow and Clyde, UK; Marcelle Nascimento, University of Florida, USA; Hien Ngo, Kuwait University, Kuwait; Francisco Ramos-Gomez, UCLA School of Dentistry, USA; Eric Rooney, NHS Central Lancashire, UK; Susie Sanderson, British Dental Association (BDA), UK; Falk Schwendicke, Charité - Universitätsmedizin Berlin, Germany; Woosung Sohn, University of Sydney School of Dentistry, Australia; Christian Splieth, Greifswald University, Germany; Seiichi Sugiyama, Sugiyama Dental Clinic Chiba-ken, Japan; Angus Walls, University of Edinburgh, UK; David Wiliams, Bart's and The London School of Medicine and Dentistry, UK; Alix Young, University of Oslo, Norway; Andrea Zandona, Tufts University, USA; Olga Lucía Zarta, Universidad El Bosque, Colombia; Dom Zero, Indiana University, USA. Finally, we are grateful to Edgar O Beltrán, Universidad El Bosque, for his contribution with the manuscript.

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Correspondence to Stefania Martignon.

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Martignon, S., Pitts, N., Goffin, G. et al. CariesCare practice guide: consensus on evidence into practice. Br Dent J 227, 353–362 (2019).

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