IN THE PERMANENT DENTITION

Key words: dental caries, caries susceptibility, dental sealants, chemotherapeutic agents, decision trees, tooth remineralization, fluoride varnishes, fluorides, chlorhexidine, decision analysis Optimal conservative treatment decisions to prevent, arrest, and reverse tooth demineralization caused by caries require probability data on caries risk, patient compliance with prescribed chemotherapeutic, oral hygiene and dietary regimens, and treatment outcomes. This article is focused on the use of the best scientific evidence to recommend treatment strategies for management of coronal caries in permanent teeth as a function of caries risk. Evidence suggests that assigning therapeutic regimens to individuals according to their risk levels should yield a significantly greater probability of success and improved cost effectiveness than applying the identical treatments to all patients independent of risk. One of the obstacles to improvement of treatment outcomes is poor sensitivity of caries detection tests to identify all true lesions. This is especially true for studies in which only a mirror and explorer are used for visual examinations. Another is the lack of scientific studies that correlate individual risk levels with individual treatment outcomes. Nevertheless, population-based studies offer some evidence to support specific treatments as a function of risk. Depending on oral conditions and caries risk levels, treatment decisions can reduce the risk of unnecessary surgical intervention by incorporating the best evidence regarding the use of fluorine-releasing agents, sealant, chlorhexidine or combinations of these products