This July, a panel of experts published new recommendations for dental treatment of caries lesions in the Journal of the American Dental Association (JADA). Dentists should take some time to review these recent guidelines and modify current practices as needed to reflect the updated recommendations. 

The experts, convened by the American Dental Association (ADA) Council on Scientific Affairs and the ADA Science and Research Institute’s program for Clinical and Translational Research, came together to review and develop recommendations for treating “moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated permanent teeth.” The panel conducted a robust review of carious tissue removal (CTR) approaches from a variety of databases and analyzed randomized controlled trials comparing direct restorative materials.  

The evidence suggests a more conservative CTR approach to decrease the risk of adverse effects. Findings also showed that direct restorative materials may be effective at treating moderate or advanced lesions.  

After their review, the panel came up with 16 recommendations and good practice statements: four on CTR approaches and 12 on direct restorative materials specific to tooth location and the surfaces involved. The panel grouped their recommendations based on their certainty of available evidence from high confidence to very low confidence, which is a hallmark of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. 

All these recommendations are geared toward helping dentists make surgical, evidence-based decisions. With each clinical question answered in terms of moderate to severe caries lesions, dentists who read the review can better make choices for each patient’s unique situation.  

In general, the study found that most clinical scenarios didn’t show an important difference between CTR approaches and direct restorative materials in terms of patient outcomes. This means that there isn’t evidence of one treatment option being more effective than another. The most important thing a dentist can do is prioritize intervention and work with their patients and patients’ caregivers in a shared decision-making process to decide which treatment path is best for them.  

The main recommendation that dentists should take away from this study is the prioritization of conservative CTR to treat advanced caries lesions. Notably, dental teams should avoid exposing the pulp of the teeth when caries are removed because it can lead to worse clinical outcomes. The ADA recommends more conservative approaches that both preserve the teeth and protect the pulp. Note that the ADA’s recommendations are consistent with prior guidance in some cases.  

This is the first set of guidelines and recommendations for CTR approaches and direct restorative materials for primary and permanent teeth using the GRADE framework. Although not all the guidance is new, it’s still important for everyone performing CTR procedures to read the ADA panel’s review of evidence to inform their clinical decisions.  

If you’d like to read more about the recommendations in this study, you can find it here.  

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