More Rigorous Studies Needed to Advance Emerging Dental Caries (tooth decay) Diagnostic and Management Strategies, says National Institutes of Health (NIH) Consensus Panel

The development of new diagnostic techniques to detect early stages of dental caries (tooth decay) may give dentists more options than ever before to stop or reverse decay using noninvasive techniques. This and other findings emerged from a Consensus Development Conference on the Diagnosis and Management of Dental Caries Throughout Life, convened by the National Institutes of Health on March 26-28, 2001 in Bethesda, MD.
The conference examined the current state of dental caries research to help health care providers and the general public make informed decisions about this important health issue.

Panel members reviewed an extensive collection of literature related to dental caries, including a systematic review of the dental research literature provided by the Agency for Healthcare Research and Quality (AHRQ). The panel also heard presentations by experts in the field, as well as public comment.

While water fluoridation, the use of fluoride products, dietary modification including sugar restriction, improved oral hygiene, and regular professional care have led to dramatic reductions in dental caries over the past 30 years, the disease remains a major public health problem.

Nearly 20 percent of children between the ages of 2 and 4 have experienced dental caries, and by the age of 17 almost 80 percent of young people have had at least one cavity – a late manifestation of dental caries infection. More than two-thirds of adults between the ages of 35 to 44 have lost at least one permanent tooth due to dental caries, and one-fourth of those aged 65 to 74 have lost all of their natural teeth.

Although the panel did not evaluate the evidence for the effectiveness of community water fluoridation, they acknowledged that water fluoridation and the use of fluoridated toothpastes are highly successful in preventing dental caries. They also determined that there is evidence to support the use of fluoride varnishes in permanent teeth, as well as fluoride gels, chlorhexidine gels, sealants, and chewing gum containing xylitol, a sugar substitute. Combined interventions may be more effective in preventing caries in children.

The panel also noted that effective dentistry requires early identification of children at high risk for extensive caries so that they may receive early and intense preventive intervention. Children at low risk also need to be identified to reduce unnecessary care and expenditures.

According to the evidence presented, the most consistent predictor of caries risk in children is past caries experience. Low socioeconomic status (SES) is also associated with higher caries rates. While some risk factors may be applicable across all ages, others are distinctive for adult and elderly populations, such as the inability to maintain good oral hygiene, lack of adequate salivary flow, and gum recession.

The panel called for a major investment of research and training funds to "seize the opportunities presented… When solid confirmation of the effectiveness of promising new diagnostic techniques, non-surgical treatments of non-cavitated lesions, and conservative surgical interventions for cavitated lesions are obtained, dental health professionals and the public should embrace them rapidly in anticipation of attaining still higher levels of oral health."
The full NIH Consensus Statement on Diagnosis and Management of Dental Caries Throughout Life is available by calling 1-888-NIH-CONSENSUS (1-888-644-2667) or by visiting the NIH Consensus Development Program Web site at http://consensus.nih.gov.

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