When to intervene in the caries process? An expert Delphi consensus statement.

Area of Science:

• Dental science
• Cariology
• Restorative dentistry

Background:

• Dental caries is a complex disease requiring timely and appropriate intervention.
• Current guidelines for managing carious lesions vary, necessitating expert consensus.

Purpose of the Study:

• To establish an expert Delphi consensus on intervention timing and strategies for the caries process and existing carious lesions.
• To define criteria for using non- or micro-invasive, invasive/restorative, or mixed interventions.

Main Methods:

• Non-systematic literature synthesis.
• Expert Delphi consensus process.
• Expert panel conference.

Main Results:

• Intervention thresholds are determined by carious lesion activity, cavitation, and cleansability.
• Inactive lesions generally do not require treatment unless for aesthetic or functional reasons.
• Non-cavitated lesions and most cleansable cavitated lesions are managed non- or micro-invasively.
• Non-cleansable cavitated lesions typically require invasive/restorative management.
• Radiographic depth is crucial for assessing proximal lesion cavitation, with D2/3 lesions presumed cavitated and E1/2 lesions non-cavitated.
• Lesions in the outer dentine (D1) are unlikely to be cavitated and managed as such unless indicated otherwise.

Conclusions:

• Comprehensive diagnostics are fundamental for systematic decision-making in caries management.
• Intervention decisions must prioritize lesion activity, cavitation, and cleansability.
• Invasive treatments should be used restrictively based on these clinical factors.