Management of Dental Caries Throughout Life – Part 1

The main premise behind the presentation was that our current system for treating dental caries is too expensive and not very effective, because it doesn’t appropriately address the underlying causes of the disease.

The presentation reviewed five vantage points (lens) for looking at the problem, namely, scientific, patient/parent, dental care providers, payers and society. Science has provided a deep understanding of the caries process and several conceptual frameworks for treating caries as a disease; however, much of the current treatment of caries only addresses its consequences and not the causes. Based on the patient’s needs, caries management must be integrated into comprehensive patient-centered care.

Dental caries is one of the few dental problems that can span from infancy to advanced aged, and caries risk assessment and management strategies need to be age-specific.

For the dental care provider, the main focus of caries management should be on detecting caries at an early (non-cavitated) stage and to determine appropriate risk-based level of caries preventive and control as well as recall frequency. Payers need to focus on promoting access to care, helping to assure high quality care and appropriate cost-containment, while eliminating un-reasonable incentives.

When considering the greater good of society both nationally and globally, the one overriding focus needs to be on addressing the increasing health crisis being cause by excessive consumption of sugars by taking a transdisciplinary approach with medicine and public health to develop upstream, midstream and downstream sugar restriction approaches to help prevent dental caries along with the other major sugar-related health problems – obesity, diabetes and cardiovascular disease.

The second half of the presentation briefly reviewed the newer methods of early caries detection, caries risk assessment, and strategies to prevent, arrest or reverse carious lesions with emphasis on the importance of using scientifically rounded approaches.

The International Caries Classification and Management System (ICCMS™) was briefly reviewed along with another scheme for precision caries management.

The presentation closed with a challenge to the dental profession that “dental caries never progresses beyond the moderate caries stage for patients who routinely seek dental care” and provided recommendations for the key innovations that are necessary to achieve this goal: highly accurate technology-based diagnostic tools to detect and stage lesion severity and to determine caries lesion activity status; practitioner-friendly caries risk assessment electronic aids that are valid across the life course; point-of-care diagnosis tests to determine biofilm cariogenic potential at the tooth surface level; algorithm-based computer clinical decision support systems that factor in all components of the caries diagnosis process; and new intervention strategies that target the main etiological factor –  dieto-microbial interaction.