Managing carious lesions; consensus recommendations on terminology

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

If biofilm control is considered insufficient, the integrity of a fissure sealant should be monitored until more is known of the 'trampoline' effect (the sealant may not be able to resist occlusal forces when there is softened dentine beneath the weakened enamel).

Main

Innes NP, Frencken JE et al. Adv Dent Res 2016;28: 49–57

Managing carious lesions: consensus recommendations on carious tissue removal

Schwendicke F, Frencken JE et al. Adv Dent Res 2016;28: 58–67

This abstract summarises a consensus statement of 21 experts in the field of cariology. A pre-meeting was held as part of this rigorous process. At this, several contributors were asked to explore key areas; one was somewhat derisively entitled 'Why we've covered all this – Restoring excavated teeth'. In both the introductory and substantive paper (Adv Dent Res 2016;28: 46–48 and Adv Dent Res 2016;28: 49–57) it was argued that there is a disconnect between the research findings and clinical practice because of 'inconsistencies in clinical guidelines, dental education, national healthcare policies, and remuneration systems.' For example, 42 terms were identified and others were advanced to describe essentially the four following different strategies for managing carious lesions: 1) 'atraumatic restorative treatment', 2) 'no removal: no dentine carious tissue removal' (that include the use of a resin or glass ionomer sealant materials, the Hall Technique and non-restorative cavity control), 3) 'selective removal of carious tissue' including step-wise caries removal, and 4) 'nonselective removal to hard dentine'. Nonselective removal to hard dentine (formerly known as complete caries removal), often accompanied with 'extension for prevention', is unequivocally no longer recommended; the quest for 'cri dentinaire' (the scratchy sound when a straight probe is taken across the dentine) has been relegated to history.

It was highlighted that 'carious tissue is removed purely to create conditions for long-lasting restorations'. But the primary aim is to manage carious lesions before cavitation using a noninvasive approach. This involves 'biofilm removal (toothbrushing) and/or remineralisation'. And then it may be possible to transform noncleansible, into cleansable carious lesions (see Adv Dent Res 2016;28: 58–67).

The same first authors in an Invited Editorial (J Dent Res 2016;95: 485–486 – Advances in Dental Research publishes supplements to the Journal of Dental Research) offer reasons why such recommendations are not implemented. They argue practitioners can be categorised into 'don't know', 'can't do', or 'won't change'. But they also implicate effete education; 'in some countries and some schools, new dentists are still taught to remove all infected carious tissue, and it is actually not possible to pass professional examinations without demonstrating this'.