Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association.
Level 1 - systematic review of randomized trials
Clinical practice guideline based on a systematic review of randomized controlled trials
PubMed 30261951 · doi:10.1016/j.adaj.2018.07.002
What was done
An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review searching MEDLINE, Embase, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews. The authors identified randomized controlled trials assessing nonrestorative treatments for arresting or reversing noncavitated and cavitated carious lesions in children and adults, using the GRADE approach to evaluate certainty of evidence.
What was found
The abstract reports no numerical values, effect sizes, or confidence intervals. The panel issued 11 clinical recommendations stratified by lesion type, tooth surface, and dentition. Interventions recommended for caries arrest or reversal included 38% silver diamine fluoride, dental sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 ppm fluoride (1.1% sodium fluoride) toothpaste or gel. The panel recommended against using 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP).
Why it matters
This guideline provides clinicians with evidence-based, non-invasive alternatives to traditional restorative surgery for managing active coronal and root caries in primary and permanent teeth.
Limits
The abstract does not disclose the total number of included randomized trials or patient sample sizes. Quantitative outcome measures, comparative effect sizes, adverse events (such as staining from silver diamine fluoride), and cost-effectiveness data are not reported in the abstract.
Cited by
- supports Dental caries that has penetrated into dentin can reverse.