Evidence concerning the medical management of caries

Caries is an infectious, chronic and cumulative disease. It seriously affects quality of life and creates considerable expense for individuals and communities. The disease can be managed by acting on biofilm formation and maturation, by modifying the kinetics of apatite solution or with a combination of the two processes. This can be achieved by mechanical and chemical control of plaque, appropriate use of fluorides, controlling diet and salivary flow, when possible. Many of these factors depend on the patient's co-operation. Decisions concerning treatment are influenced by two questions: the scientific evidence for the different alternatives available and each patient's individual caries risk. The use of different fluoride regimes, depending on the individual risk, remains the most scientifically proven method for avoiding the appearance of new lesions and curbing the speed at which existing ones progress. Chemical control of plaque using chlorhexidine is indicated for patients at high microbiological risk; it is more effective at controlling caries when used in combination with fluorides. Fissure sealing is an effective means of controlling occlusal caries of the molars when the patient's caries risk and the eruptive age of the tooth are taken into account.