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When to intervene in the caries process? A Delphi consensus statement


Objectives To define an expert Delphi consensus on when to intervene in the caries process and existing carious lesions.

Methods Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.

Results Lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations may be placed for form, function, aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated lesions which are cleansable. Cavitated lesions which are not cleansable usually require minimally invasive management. In specific circumstances, mixed interventions may be applicable. Occlusally, cavitated lesions confined to enamel/non-cavitated lesions extending radiographically into deep dentine may be exceptions. Proximally, cavitation is hard to assess tactile-visually. Most lesions extending radiographically into the middle/inner third of dentine are assumed to be cavitated. Those restricted to the enamel are not cavitated. For lesions extending radiographically into the outer third of dentine, cavitation is unlikely. These lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.

Conclusions Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions.

Key points

  • Provides much needed guidance for the primary care practitioner to help in their management of dental caries.

  • Considers the quality of the evidence available to provide pragmatic guidelines for caries management interventions.

  • Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions

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Correspondence to Avijit Banerjee.

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The corresponding author formally requested a declaration of possible conflicts of interest from each of the consensus panel members. No relevant conflicts of interest at the organisational and individual levels related to this consensus document were identified.


The conference was kindly sponsored by DMG (Hamburg, Germany). This included travel, accommodation and conference costs for panel members. The sponsor had no role in design or conduct of the conference or the content of this manuscript and were not present during the conference. No honoraria were given to any of the panel members.

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Banerjee, A., Splieth, C., Breschi, L. et al. When to intervene in the caries process? A Delphi consensus statement. Br Dent J 229, 474–482 (2020).

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