A systematic review of selected caries prevention and management methods.
A systematic review of the periodic scientific literature was undertaken to determine the strength of the evidence for the efficacy of professional caries preventive methods applied to high risk individuals, and the efficacy of professionally applied methods to arrest or reverse non-cavitated carious lesions. An initial search identified 1435 articles, of which 27 were eventually included in the review. Among the 22 studies addressing the prevention of carious lesions in caries-active or high risk individuals, the strength of the evidence was judged to be fair for fluoride varnishes and insufficient for all other methods. Among the seven studies addressing the management of non-cavitated carious lesions, the strength of the evidence for efficacy was judged to be insufficient for all methods. The results do not indicate that the preventive and management methods reviewed are not efficacious; rather, they demonstrate that not enough is known to determine the efficacy of the methods. Suggestions for strengthening the limited evidence base involve the following: i) increasing the number of studies that examine prevention among high risk individuals and non-surgical management of non-cavitated lesions, ii) including a wider variety of subject ages, iii) targeting aspects of the efficacy questions not yet addressed, iv) strengthening research methods employed in the studies, and v) reporting methods and outcomes more completely.
Bader
J D
JD
Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599, USA. jim_bader@unc.edu
Shugars
D A
DA
Bonito
A J
AJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002327:Cariostatic Agents / Q000627:therapeutic use; D002648:Child; D002710:Chlorhexidine / Q000627:therapeutic use; D003731:Dental Caries / Q000517:prevention & control* / Q000628:therapy; D003733:Dental Caries Susceptibility; D018450:Disease Progression; D004338:Drug Combinations; D019317:Evidence-Based Medicine; D005460:Fluorides, Topical / Q000627:therapeutic use; D006801:Humans; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D010919:Placebos; D012107:Research Design; D012307:Risk Factors; D018401:Sample Size; D014089:Tooth Remineralization; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D002327:Cariostatic Agents; D004338:Drug Combinations; D005460:Fluorides, Topical; D010895:Pit and Fissure Sealants; D010919:Placebos; D002710:Chlorhexidine