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Caries approach and management: Latin American Consensus

Date:February 2021

Author: Natalie Bradley BDS Dip SCD MFDS RCSEd

Understanding how dental caries develop and its risk factors are facts every dental student should know. Understanding the development and pathogenesis of this common dental disease allows dentists to educate their patients, help prevent cavities from developing and to implement techniques as part of minimally invasive dentistry to treat early lesions using biological techniques such as the use of topical fluorides (for example, Colgate Duraphat varnish).

Several international tools have been developed to assist dentists in preventing, diagnosing and treating dental caries. CariesCare International (CCI™) is a recent practice guide that promotes a patient-centred, risk-based approach to caries management. It is based a consensus on evidence into practice, and comprises ''a health outcomes-focused system that aims to maintain oral health and preserve tooth structure in the long-term.'' The system is a four-step guide for dental professionals (based on a ''4D'' system):

  1. D: Determine Caries Risk
  2. D: Detect lesions, stage their severity and assess their activity status
  3. D: Decide on the most appropriate care plan for the specific patient at that time
  4. D: Do the preventive and tooth-preserving care that is needed, e.g., preventive care, control of early non-cavitated lesions, restorative treatment of deep cavitated lesions

Preventing and managing caries risk is not just the responsibility of the dental team. A collective and community approach should be taken to ensure that preventive messages are delivered by other healthcare workers, as well as community professionals where messages can be delivered as a component of a multi-agency partnership. The Latin America Consensus concluded that ''prevention of oral diseases is crucial in terms of public health and should be concentrated not only on dentists, but also on interdisciplinary groups working together''.

Moreover, there are calls for a public policy approach to allow preventive messages to be circulated en masse, and for measures to be put in place to improve the oral health of large populations across countries. For example, the use of fluoridated water supplies, or other public health policies such as sugar taxes or banning or advertising of junk food. These public health messages will help to address some of the aetiological factors involved in dental caries, reducing the availability of free sugars which are metabolised by oral pathogens to produce acid that causes demineralization (and, eventually, cavitation if not halted/reversed); as well as increasing availability of fluoride which helps to prevent demineralization, promote remineralization, and at higher concentrations to inhibit cariogenic microorganisms.

Expert consensus has stated the importance of not only personalised clinical caries prevention methods for our patients, but also more collective approaches using other avenues to deliver prevention messages through the use of other team members and a public policy approach.