When to intervene in the caries process? An expert Delphi consensus statement

• Published in: Clinical oral investigations Vol. 23; no. 10; pp. 3691 - 3703
• Main Authors: Schwendicke, Falk, Splieth, Christian, Breschi, Lorenzo, Banerjee, Avijit, Fontana, Margherita, Paris, Sebastian, Burrow, Michael F., Crombie, Felicity, Page, Lyndie Foster, Gatón-Hernández, Patricia, Giacaman, Rodrigo, Gugnani, Neeraj, Hickel, Reinhard, Jordan, Rainer A., Leal, Soraya, Lo, Edward, Tassery, Hervé, Thomson, William Murray, Manton, David J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2019; Springer Nature B.V
• Subjects: Cavitation; Consensus; Decision making; Delphi Technique; Dental caries; Dental Caries - therapy; Dental enamel; Dental Enamel - pathology; Dentin - pathology; Dentistry; Discussion Paper; Esthetics, Dental; Humans; Medicine; Recovery of function; Decision-making; Dental caries; Restorations; Operative dentistry; Thresholds; Consensus
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-019-03058-w

Objectives
To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.
Methods
Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.
Results
Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.
Conclusions
Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions.
Clinical relevance
Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.