Detection, Diagnosis and Management of the Early Carious Lesion

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Abstract

The current evidenced-based caries understanding, based on biological concepts, involves new approaches in caries detection, assessment, and management that should include non-cavitated lesions.The purpose of the studies presented in this thesis was to investigate the current available evidence on methods to detect non-cavitated lesions (NCCls), the current evidence related to the efficacy of non-surgical caries preventive methods to arrest or reverse the progression of NCCls, the current evidence for the prediction of caries using four caries risk assessment systems/guidelines and a review of the literature related to alternative caries clinical trial methods for oral care products. The purpose of the in vitro studies was to study the performance of different caries detection methods (ICDAS, ICDAS photographs, FOTI, QLF, OCT, Soprolife) in detecting early caries lesions and in particular and to assess the QLF ability to detect changes after remineralisation/demineralisation cycles. The last study was a cross-sectional study aiming to investigate the caries management decisions for early caries lesions among dentists. The results of the systematic reviews (Paper I-IV) suggest a large variation of Sensitivity, Specificity and lack of consistence on the definition of disease among the detection methods assessed. The evidence on Caries Risk Assessment Systems is limited and the current systems seem not to predict future disease. In terms of Caries Management, according to the evidence fluorides continue to be the most effectiveness anti-caries agent. The evidence on abbreviated clinical trials showed excellent discrimination between anti-caries products in short clinical trials with fewer subjects using more sensitive caries detection methods. Paper V, showed that all the caries detection methods assessed in this study, except for OCT (0.65), were strongly correlated with Histology. In papers VI and VII, QLF showed the ability to detect differences between two NaF toothpastes (550 ppm F, 1100 ppm F) and a fluoride placebo treatment in two pH cycling models. Finally, the results of the questionnaire on Caries Related Treatment Decisions (Paper VIII) revealed that 60% of the dentists are practising prevention in occlusal early lesions. However, a large number of dentists are still oriented towards a restorative approach and do not base their treatment decisions on individual caries risk. The main conclusions from this thesis are that: 1) A comprehensive management system should include initial caries lesions; 2) Visual examinations is still the standard method of detection, other methods may be included for monitoring purposes; 3) QLF was able to detect remineralisation of artificial carious lesions and inhibition of demineralisation in sound enamel after two remineralisation/demineralisation pH cycling models; 4) The results of the cross-over study indicate that Colombian dentists have not yet fully adopted conservative treatment for early caries lesions.

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caries

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