Non-restorative Treatments for Cavities
An expert panel convened by the ADA provides an evidence-based clinical practice guideline aimed to help dentists decide which nonrestorative treatments could be used to stop or reverse existing cavities.
A carious lesion, or cavity, is caused by acid dissolving tooth minerals. The acid is produced by bacteria breaking down dietary sugars on the tooth surface.
A noncavitated carious lesion is a demineralized lesion that is not covitated. While a cavitated carious lesion is a more advanced lesion in which the surface has collapsed, creating a break in the enamel which may expose the dentin.
To arrest cavitated coronal carious lesions, the expert panel recommends the use of 38% silver diamine fluoride (SDF) solution applied biannually over the use of 5% sodium fluoride (NaF) varnish applied once per week for 3 weeks. To arrest or reverse noncavitated carious lesions on occlusal surfaces, the expert panel recommends the use of sealants with 5% NaF varnish applied every 3 to 4 months or just sealants alone. To arrest or reverse noncavitated carious lesions on the facial or lingual surfaces, the panel suggests the use of 1.23% acidulated phosphate fluoride (APF) gel or 5% NaF varnish applied every 3 to 6 months. To arrest or reverse noncavitated carious lesions on the coronal surfaces of teeth, the panel suggests to not use 10% casein phosphopeptide – amorphous calcium phosphate (CPP– ACP) paste if other fluoride interventions, sealants, or resin infiltration is available.
To arrest or reverse noncavitated and cavitated carious lesions on root surfaces, the panel suggests the use of 1.1% NaF toothpaste or gel at least once per day.
In addition to the recommended nonrestorative treatments, the expert panel also emphasize actively monitoring the carious lesions, observing signs of hardness by probing or X-ray evidence of arrest or reversal. The panel also emphasizes that these treatments should be accompanied by a low sugar diet, and will consider dietary modifications for caries prevention.
R.L. Slayton, O. Urquhart, M.W.B. Araujo, M. Fontana, S. Guzmán-Armstrong, M.M. Nascimento, B.B. Nový, N. Tinanoff, R.J. Weyant, M.S. Wolff, D.A. Young, D.T. Zero, M.P. Tampi, L. Pilcher, L. Banfield, A. Carrasco-Labra. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions. JADA 2018: 149(10): 837-849.