Current Evidence for Caries Preventive Strategies

Partido, B.B.

Dental caries is an infectious, multi-factorial bacterial disease that involves the bacterial production of acids that leads to the breakdown of tooth structure. Previously, the main method to treat dental caries involved a reactionary approach with the removal of the carious lesion and the placement of a restoration. However, with the restoration, the risk for secondary carious lesion increased which led to cycles of larger and more invasive restorations. Now, the more current preventive approach involves the identification of risk factors and the recommendation of preventive interventions to reduce risk factors.

Caries Risk Assessment

Caries risk assessment (CRA) is an estimate of the likelihood of a carious lesion within a defined time span. There are four different caries risk assessment forms: 

• Caries Management by Risk Assessment (CAMBRA)- Interpretation of the assessment form
• Cariogram– This software allows the operator to input data and a visual representation is produced. Manual for directions and the interpretation.
• American Dental Association (ADA) for adults and children
• American Academy of Pediatric Dentistry (AAPD) – interpretation of the assessment form

Recall Intervals

The purpose of regular recall intervals was to identify caries, at its earliest clinical presentation, and to treat the carious lesion, with the most conservative approach. The 6-month interval has been the main recall interval recommended by dental professional. However, a systematic review of the literature determined that the evidence did not support a one-size-fit-all recall interval. The recall interval should be based on the risk assessment: children (3 months to 12 months) and adults (3 months to 24 months). With every visit, the caries risk should be reassessed at every visit and the recall interval should be adjusted to reflect any changes with the caries risk assessment.

Supplemental Therapy

Along with water fluoridation, supplemental products reduce caries risks by providing protection against protection. Using caries risk assessments, these products may be recommended using an individualized approach:

• Topical fluoride- adults and children
• Fluoride supplements
• Non-fluoride therapy
• Dental sealants

Mechanical Plaque Removal

A systematic review of literature showed toothbrushes with a rotation oscillation action removed more plaque than manual toothbrushes. However, it is generally believed that the fluoride component of the dentifrice provides the protection against caries. There is limited evidence that shows whether interproximal plaque control prevent interproximal caries.

Dietary Interventions 

The frequent consumption of carbohydrates allows the oral bacteria to metabolize the carbohydrates and release acids.  The intake of carbonated and sugary beverages may add to the acidic oral environment, which then leads to the development of carious lesions. A systematic review of the literature showed that one-on-one intervention are more effective at fruit/vegetable intake and alcohol consumption than sugar consumption.