Document Detail

The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries.
MedLine Citation:
PMID:  17138407     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the strength of the evidence describing the effectiveness of alternative strategies to the detection and management of early occlusal caries and suspected occlusal dentinal caries. METHODS: Nine detection and intervention decision points were identified as being central to the management of early occlusal caries and suspected occlusal dentinal caries, or suspicious areas. For each decision point, the evidence for effectiveness was assessed, using existing systematic reviews when available, and nonsystematic review methods when necessary. RESULTS: For the 2 detection decisions (early occlusal caries and suspicious areas) the strength of the evidence was weak. Accuracy in detecting early occlusal caries was extremely variable within and across detection methods. Approximately 50% of suspicious areas identified had dentinal caries. The strength of the evidence for effectiveness of nonsurgical approaches for the management of early occlusal caries was weak for all 3 management strategies examined (doing nothing, sealants, remineralization). This evidence suggested that sealants were highly effective, with remineralization reflecting moderate effectiveness. For the management of suspicious areas, the strength of the evidence was still weaker and reflected the same relative effectiveness. For the surgical management strategy for suspicious areas, operative treatment, the evidence was strong and reflected high effectiveness for preventive resin restorations, but no evidence was available for minimally invasive techniques. CONCLUSION: Identification methods for early occlusal caries are not accurate. The strength of the evidence for effectiveness of nonsurgical management strategies for early occlusal caries is at best, weak. The available evidence suggests that sealing both enamel caries and suspected occlusal dentinal caries is the most effective management approach if subsequent maintenance of the sealed surfaces can be assured.
James D Bader; Daniel A Shugars
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The journal of evidence-based dental practice     Volume:  6     ISSN:  1532-3390     ISO Abbreviation:  J Evid Based Dent Pract     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-12-01     Completed Date:  2006-12-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101083101     Medline TA:  J Evid Based Dent Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  91-100     Citation Subset:  D; IM    
Operative Dentistry, University of North Carolina, Chapel Hill, NC, USA.
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MeSH Terms
Age Factors
Cariostatic Agents / therapeutic use
Child, Preschool
Dental Caries / diagnosis*,  therapy*
Dental Restoration, Permanent / methods*
Dentin / pathology
Dentist's Practice Patterns
Evidence-Based Medicine
Pit and Fissure Sealants*
Review Literature as Topic
Surgical Procedures, Minimally Invasive
Tooth Remineralization*
Treatment Outcome
Reg. No./Substance:
0/Cariostatic Agents; 0/Pit and Fissure Sealants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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