Practical approach to evidence-based management of caries

This paper discusses evidence-based management of dental caries with regard to: (1) need to adopt new office methods, (2) potential barriers to change, and (3) possible practical solutions to aid change. The need for classifying individual patients into low-, medium-, and high-risk caries groups is justified from a review of the epidemiological characteristics of caries. In addition, a deficiency is identified in traditional caries recording methods since they are unable to grade the severity and activity of individual lesions. The traditional basis of six-monthly recall examinations for all patients is shown from the literature to have no scientific support. It is suggested a three-twelve month recall interval be used, depending on a patient's risk group classification. Some barriers to change are identified as: (1) the collection of more comprehensive history and clinical caries data, (2) the complexity of evidence-based decision-making, and (3) dentists' difficulty in standardizing decision-making. A new pictorial classification for caries severity and activity is described. A demonstration decision-support system is presented in terms of assisting collection of data, automatic identification of risk factors, patient risk classification, and generation of a suggested treatment plan. Evidence-based management may result in change of professional manpower levels.