Dental caries is a chronic disease that usually progresses slowly. The demineralisation of the tooth seen in the early stages of dental decay are reversible so progression to cavitation can be prevented.  The aim of this review was to appraise the evidence for the efficacy of  nonsurgical caries preventive methods to arrest or reverse the progression of  these non-cavitated carious lesions (NCCls).

The Medline, Cochrane Collaboration, SCIELO, and Embase databases were searched together with the reference lists of identified reviews. The Caries Research journal was handsearched. Randomised controlled trials in humans where Analysis of data was conducted at the non-cavitated level. Study quality was assessed using the American Dental Association Criteria, Cochrane criteria and by author consensus.

•  29 studies were included, 13 evaluated fluorides, 1 chlorhexidine, 1 xylitol, 6 Casein phosphopeptide amorphous calcium phosphate (CPP-ACP) 6 sealant /resin infiltration and 2 studies used a combination of interventions.
• The trials ranged in size between 15 and 3903 participants, and between 2 weeks and 4.02 years duration.
• More than half of the trials assessed had moderate to high risk of bias or may be categorized as ‘poor’.The great majority (65.5%) did not use intention to treat analysis, 21% did not use any blinding techniques, and 41% reported concealment allocation procedures. Slightly more than half of the trials (55%) factored in background exposure to other fluoride sources, and only 41% properly adjusted for potential confounders.

The authors concluded

Fluoride interventions (varnishes, gels, and toothpaste) seem to have the most consistent benefit in decreasing the progression and incidence of NCCls. Studies using xylitol, CHX, and CPP-ACP vehicles alone or in combination with fluoride therapy are very limited in number and in the majority of the cases did not show a statistically significant reduction. Sealants and resin infiltration studies point to a potential consistent benefit in slowing the progression or reversing NCCls.

Comment

There have already been a large number of systematic reviews, including several Cochrane reviews that have looked at the prevention of caries. The usual outcome in these reviews has been caries measured at the decayed, missing and filled level rather than at the pre-cavitation level employed in this review.

Links

Tellez M, Gomez J, Kaur S, Pretty IA, Ellwood R, Ismail AI. Non-surgical management methods of noncavitated carious lesions. Community Dent Oral Epidemiol. 2012 Dec 18. doi: 10.1111/cdoe.12028. [Epub ahead of print] PubMed PMID: 23253076.

 

Tubert-Jeannin S, Auclair C, Amsallem E, Tramini P, Gerbaud L, Ruffieux C, Schulte AG, Koch MJ, Rège-Walther M, Ismail A. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD007592. DOI: 10.1002/14651858.CD007592.pub2.

Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VCC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007868. DOI: 10.1002/14651858.CD007868.pub2.

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD002284. DOI: 10.1002/14651858.CD002284.

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002278. DOI: 10.1002/14651858.CD002278.

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002280. DOI: 10.1002/14651858.CD002280.

Marinho VCC, Higgins JPT, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002780. DOI: 10.1002/14651858.CD002780.pub2.

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279.