How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement

Abstract

<b><i>Aim:</i></b> To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. <b><i>Methods:</i></b> A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. <b><i>Results:</i></b> Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient’s individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.

Sobretratamento restaurador: relato de caso e discussão sobre a decisão do tratamento restaurador

“…No presente caso, observamos uma tendência do cirurgião-dentista em abordar a lesão inativa (sulco pigmentado) da paciente, enquanto a literatura científica claramente preconiza a não intervenção de lesões restritas ao esmalte. Além disso, a literatura, até pouco tempo, carecia de consenso em relação ao momento específico em que uma lesão necessita de intervenção restauradora, muitas vezes sendo contraditória em relação à referência/bibliografia utilizada 23 cárie 23,24 . Talvez este seja um dos fatos que ajude a explicar essa grande diferença de conduta clínica observada entre os profissionais [19][20][21] .…”

“…Além disso, foi explicado à paciente que ela apresentava boa saúde bucal e a realização de tratamento restaurador seria contraindicada. Após esclarecimento das dúvidas da paciente, a mesma foi instruída e alertada dos riscos de sobretratamento odontológico e que lesões inativas de cárie apresentam um baixo risco de reativarem e progredirem 23 .…”

Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control

“…Although most national dental societies have restrained from publishing SDF-specific protocols or guidelines, recently, clinical guidance and recommendation for caries management have been jointly published by the European Academy of Pediatric Dentistry, the Organization for Caries Research and the European Federation of Conservative Dentistry. This advice, using fluoride, in particular SDF (a high strength of recommendation and consensus), can be used to treat dentinal carious lesions without pulpal involvement in young children [18][19][20][21].…”

Mundgesundheitstrends im Kindesalter

“…Andere Maßnahmen sind eher additiv. Eine hohe Fluoridierungsquote wäre auch für eine zeitgemäße und wirksame Gruppenprophylaxe essenziell [ 40 ], wie erfolgreiche Pilotprogramme in Greifswald oder Osnabrück-Land belegen [ 41 , 42 ]. Die sich zurzeit in Überarbeitung befindende deutsche Leitlinie zu den Fluoridierungsmaßnahmen zur Kariesprophylaxe wird voraussichtlich auch Annäherungen an die internationalen Empfehlungen mit Verschiebungen zur Fluoridzahnpasta enthalten, da bei Fluoriden die lokale Applikation vorrangig genutzt werden sollte [ 40 ].…”