Evidence-Based Caries Management for All Ages-Practical Guidelines

Abstract

Introduction: The purpose of the present paper is to provide step-by-step guidelines for dental healthcare providers to manage dental caries based upon caries risk assessment (CRA) for ages 0–6 years and 6 years through adult. The manuscript reviews and updates the CAMBRA (caries management by risk assessment) system which includes CRA and caries management recommendations that are guided by the assessed risk level.Caries Risk Assessment: CAMBRA CRA tools (CRAs) have been evaluated in several clinical outcomes studies and clinical trials. Updated CAMBRA CRAs for ages 0–6 years and 6 years through adult are provided. These CRAs have been refined by the addition of a quantitative method that will aid the health care provider in determining the caries risk of individuals.Caries Management Based Upon Risk Assessment: Guidelines for individualized patient care are provided based upon the caries risk status, results of clinical exams and responses of the patient to questions in the CRA. These guidelines are based upon successful outcomes documented in several clinical outcomes studies and clinical trials. The paper includes a review of successful caries management procedures for children and adults as previously published, with additional emphasis on correct use of silver diamine fluoride (SDF) for children. The caries management plan for each individual is based upon reducing the caries risk factors and enhancing the protective factors with the additional aid of behavior modification. Beneficially altering the caries balance is coupled with minimal intervention restorative dentistry, if appropriate. These methods are appropriate for the management of dental caries in all patients.

CAMBRA Protocol Efficacy: A Systematic Review and Critical Appraisal

“…The included articles were published in 2015 [ 7 ], 2018 [ 23 ], and 2021 [ 24 ]. No authors used the 2019/2021 update of the CAMBRA protocol [ 16 , 17 ].…”

“…In addition, Cheng et al [ 7 ] and Kriegler et al [ 24 ] did not mention the use of xylitol candies despite the fact that the original CAMBRA protocol indicated these for patients at moderate, high, and extreme risk for dental caries. Although the authors did not use the 2019/2021 CAMBRA protocol [ 16 , 17 ], in this update, xylitol is no longer listed as a protective factor as the evidence for its use is limited.…”

“…The fact that no results were reported for the 2019/2021 CAMBRA protocol [ 16 , 17 ] is justified by the fact that these are recent updates, a fact which has not yet allowed studies with adequate follow-up periods to be completed.…”

“…In the same year, a protocol aimed at children under 6 was developed [ 14 , 15 ], and it was later updated in 2010. To date, the last protocol updates were added in 2019 [ 16 ] and 2021 [ 17 ].…”

Clinical practice guideline adaptation for risk-based caries management in 18- 55 years old Iranian adults

“…In the rst round of scoring, each expert ranked scenarios individually, which was further discussed and rescored for the second round in a panel meeting. The median score was calculated for each scenario, and its appropriateness was determined as inappropriate (1-3), uncertain (4-6), or appropriate (7)(8)(9). In addition, agreement was assessed according to the RAM model based on the panel size (additional le 1) (33).…”