The reliable and reproducible detection of dental caries by clinical examination has been recognized as a problem for decades with very variable approaches being taken to recognize and stage lesions along the continuum of caries--from very small initial lesions, just visible to the human eye, through more established white- and brown-spot lesions, to shadowing beneath the enamel and different extents of cavitation. Clinical caries lesion detection implies some objective method of determining whether or not disease is present, and many systems have been developed to improve the objectivity of examiners. The existence of a large number of different systems, using different definitions of caries detection thresholds, lesion staging and examination conditions has led to problems in comparing between studies and communicating across different dental domains. The International Caries Detection and Assessment System (ICDAS) has been developed from the best elements of previously published systems and is based upon the most robust evidence currently available to address the incompatibility of the systems currently used across the full breadth of cariology. The inherently visual ICDAS lesion detection codes are outlined for use with primary coronal caries, caries adjacent to restorations and sealants and for root surface caries. The ICDAS detection codes for primary coronal caries have been demonstrated to have the capability to record both enamel and dentinal caries in a reliable, valid and reproducible manner in both permanent and deciduous teeth and are being adopted increasingly in the domains of research, epidemiology, clinical practice and education.

Fluoride rinsing can be effectively targeted at children from deprived areas through school-based initiatives. There are some difficulties in recruiting all children from the more deprived backgrounds, but overall reductions in D(3)MFT were observed.

While socio-economic inequalities in prevalence of children with d3mft have decreased in recent years, socio-economic inequalities in the amount of d3mft for those with d3mft persist. This suggests that improvements are only seen for those children with the potential for low d3mft. High d3mft persists among children from more deprived areas. The national target conceals this apparent inconsistency.

Data sources Medline, Cochrane Library, reference lists of identified articles and selected textbooks were used to source studies. Study selection Selected studies were randomized or controlled clinical trials of at least 2 years' duration with caries increment in the permanent (DMFS/T) or primary (dmfs/t) dentition as the endpoint. Reports published in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were included. For multiply reported trials the one with the longest follow-up period was included. Data extraction and synthesis Inclusion decisions and grading of the studies was performed independently by two of the authors. The main outcome was prevented fraction (PF). A pooled estimate was calculated for included studies. Results Fifty-four studies were included. There was strong evidence for a caries-preventive effect of daily use of fluoride toothpaste compared with placebo in the young permanent dentition (PF, 24.9%; standard deviation, 711.5%). Toothpastes containing 1500 ppm of fluoride had a superior preventive effect (additional PF, 9.7%; range 0-22%) compared with standard dentifrices of 1000 ppm fluoride. There was also strong evidence for higher caries reductions with supervised toothbrushing compared with unsupervised brushing. There was incomplete evidence regarding the effect of fluoride toothpaste in the primary dentition. Conclusions This review reinforces the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long-term studies in age groups other than children and adolescents are still lacking.Commentary This is an important paper which highlights the strength of evidence supporting the daily use of fluoride toothpaste. Data were drawn from studies conducted in different geographical locations as well as in various age groups of children and adolescents. A clear benefit was observed, in terms of the preventive effect of fluoride, in studies that compared fluoride-toothpaste test groups with intervention controls that used a placebo or other fluoride-free toothpastes, with or without supervised brushing, in the young permanent dentition. In general, studies that used supervised brushing showed a higher preventive effect than those with unsupervised interventions.Brushing is an important measure in prevention of caries because it contributes to the disruption of the dental biofilm. Evidence is still lacking, however, to show the isolated effect of brushing in the prevention of dental caries. This is probably because studies would be considered unethical if they compared treatment with control groups that did not use any preventive method at all. Nevertheless, future research is needed to measure the real effect of brushing, supervised or unsupervised, as an isolated variable from the effect of fluoride.It has been suggested that the use of dentifrices with low fluoride concentrations (o1000 ppm) for children under 6 years of age may reduce fluoride ingestion and risk of dental fluorosis. The effectiveness of these is unclea...