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Operative Dentistry - Best Practices

Caries Management - Guiding Principles

(last modified April 29. 2016)

  • Dental caries is a disease that is not caused by a single factor but the interaction of several factors (Selwitz et al, Lancet 2007) and is one of the most prevalent diseases throughout history
  • Dental caries is a complex multifactorial disease that is not easily prevented, diagnosed or treated
  • "In 2010, untreated caries in permanent teeth was the most prevalent condition worldwide, affecting 2.4 billion people, and untreated caries in deciduous teeth was the 10th-most prevalent condition, affecting 621 million children worldwide." (Kassebaum et al. JDR 2015)
  • In the US alone, the total annual cost of treating dental caries and its sequelae is estimated to be around $60 billion out of ~ $100B total annual expense (Ismail et al, Comm Dent Oral Epi 2013)
  • 500 million direct restorations are placed globally per year making direct restorations one of the most prevalent medical interventions worldwide (2010 Ivoclar market data)

We are in general agreement with the ICDAS Foundation Coordinating Committee philosophy and recommendations, a guiding principle of which is that the quality of caries management is not solely assessed by the quality of restorations but rather by the preservation and promotion of oral health which may be measured by the prevention and arrestment of any caries activity in an individual over a period of time:

  • Manage dental caries as a disease process
  • The detection of a lesion is not a diagnosis nor a treatment plan
  • The detection of a caries lesion by itself must not automatically lead to a decision to restore it
  • Preserve dental tissues first and restore only when indicated
  • Achieve and maintain dental health, prevent progression of existing initial lesions and restore moderate or extensive lesions by use of risk-based clinical decision making
  • Follow the principles of minimally invasive surgical techniques
  • Restore to form and function with the highest quality esthetic outcome
  • Engage patients with activities focused on understanding the caries disease process and creating caries preventive and behavioral norms at home.

The  International Caries Classification and Management System  "ICCMS™ Guide for Practitioners and Educators" can be found at