Management of dental caries lesions in patients with disabilities: Update of a systematic review

Abstract

The aim of this systematic review was to update an existing review on the management of dental caries lesions in patients with disabilities so as to provide an up-to-date summary of the evidence. Randomized clinical trials and cohort studies related to preventive and restorative programmes for dental caries among people requiring special care, published in English, Spanish, Portuguese, French and German languages from February 1st 2011 to April 1st 2022, were retrieved from three databases (“updated review”). From the 1,105 titles identified using the search topic “Caries AND Disability”, 17 papers informed in the analyses: 6 referring to caries preventive strategies and 11 related to restorative care strategies. Most of these studies targeted children and adults with intellectual/physical disability, although preventive and therapeutic strategies were also reported for frail older adults and onchohematological patients. Fluorides in tablets, gels or varnishes forms and the use of xylitol as a sugar substitute were reported as effective approach to prevent the onset of caries in high-risk groups. Minimally intervention treatment options such as the Hall technique, the ART approach and the use of SDF for arresting caries, were deemed suitable and effective strategies for treating existing lesions in-office. In conclusion, in the past decade (2011–2022) an increased number of articles reported strategies to prevent and manage caries among people requiring special care. Although an array of preventive and therapeutic strategies for dental caries exists, more and better-quality clinical evidence is needed to offer guidance to inform policy and practice for special care dentistry.

Retrospective Evaluation of 20 Years of Outpatient Dental Services to Adults with Disabilities at the Dental Hospitals of the Medical University of Innsbruck, Austria

“…Even dental students, who have little experience and currently receive no explicit training in the management of special needs patients, are able to cope with the task on condition of supervision and the accordance of enough time. However, insufficient compliance and defense (frequently resulting from problems coping with noise and vibration of the drill [ 23 ]) are limiting factors that may lead to treatment-break-off and assignment to dental general anesthesia as was the case in one third of the study population. Of these 74 (33%) individuals, two thirds underwent multiple treatment sessions under general anesthesia.…”

Therapeutic solutions for anterior restorations in disabled patients: Systematic review and case report

“…However, the boundary between functional and aesthetic is often difficult to determine in disabled patients, where the issues involved in managing a case of anterior rehabilitation are numerous. Rubber dam placement may not be possible 9,10 and prolonged or invasive procedures should be avoided as much as possible by shorter or preventive treatments 11 . The literature does not really provide answers to these problems, because the clinical studies conducted on the survival of anterior restorations are often carried out on able‐bodied patients and in compliance with very strict clinical protocols 12 .…”

“…The literature does not really provide answers to these problems, because the clinical studies conducted on the survival of anterior restorations are often carried out on able‐bodied patients and in compliance with very strict clinical protocols 12 . Most of the reports concerning handicapped patients also concern a low number of subjects, limiting the applicability of care recommendations 11 . The only way to increase the global level of evidence of these case reports or case series is to perform systematic reviews specifically dedicated to case reports 13 .…”

“…Rubber dam placement may not be possible 9,10 and prolonged or invasive procedures should be avoided as much as possible by shorter or preventive treatments. 11 The literature does not really provide answers to these problems, because the clinical studies conducted on the survival of anterior restorations are often carried out on able-bodied patients and in compliance with very strict clinical protocols. 12 Most of the reports concerning handicapped patients also concern a low number of subjects, limiting the applicability of care recommendations.…”

“…12 Most of the reports concerning handicapped patients also concern a low number of subjects, limiting the applicability of care recommendations. 11 The only way to increase the global level of evidence of these case reports or case series is to perform systematic reviews specifically dedicated to case reports. 13 Thus, knowing the variability in the care of handicapped patients, the aim of this study is, first, to report a clinical case of dental restoration in a patient with special needs and then to determine, through a systematic review, different therapeutic solutions that can be launched for anterior restorations in disabled people.…”