Skip to main content

Table 2 Characteristics of selected studies and recommended procedures for ECC management

From: Recommended procedures for the management of early childhood caries lesions – a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

Author, year

Country and/or Association

Recommended procedures management

Policies

 Asociación Argentina de Odontología para Niños [19]

Argentina

Remineralization with fluorides: systemic fluoride, topical fluoride- including fluoride toothpaste [6 months to 2 years: do not use; < 500 ppm for young children; 1000–1450 for children> 6 years]).

Management of cavitated lesions: atraumatic restorative treatment, restoration with glass ionomer cement, composite resins and amalgam, steel crowns on primary molars

 Kandiah et al., 2010

(replace Rayner et al., 2003 [20]; Fayle et al., 2001 [21]) [22]

British Society of Paediatric Dentistry (United Kingdom)

Management of active dental caries requires a combination of:

- Prevention: water fluoridation, use of fluoride toothpaste and professional topical fluoride application, diet counselling, and provision of fissure sealants;

-Restoration: use of stainless-steel crowns, and plastic restorations on small one and two surface cavities;

- Pulp management, if necessary;

-extraction.

* Inhalation sedation and general anesthesia (GA) should be available for anxious children. GA can be used in cases of extensive disease.

 American Academy of Pediatric Dentistry, 2016 [23] (replace AAPD, 2008 [24])

American Academy of Pediatric Dentistry (United States)

Anticariogenic agents (fluoride toothpaste and fluoride varnish)

Definitive restorative

Interim therapeutic restorations (ITR) or silver diamine fluoride (young children)

Stainless steel crowns (advanced cases)

*The selection of treatment is determined by the extend of the disease process, the patient’s developmental level and the comprehension skills.

*More emphasis on prevention and arrestment to minimize the necessity of use of sedation and general anesthesia.

 Kuhnisch et al., 2016 [25]

European Academy of Paediatric Dentistry

Arrest caries: fluorides

Non-cavitated caries lesions: non-invasively management in the majority of cases (diet, oral hygiene, fluoride use and sealing techniques).

Persistent active lesions: non-cavitated lesions may be sealed;

Cavitated lesions should be restored after excavate soft and wet dentine

Pulp management or extraction, if necessary

* Minimally invasive methods and procedures to reduce the need of extensive operative measures with sedation or general anesthesia, especially in young children.

Guidance

 Scottish Dental Clinical Effectiveness Programme, 2018 [26]

Scottish Dental Clinical Effectiveness Programme (Scotland)

Site-specific prevention (fluoride varnish, dietary advice, brush lesion) for initial lesion (outer third dentine) or arrested caries in all teeth, and for tooth near to exfoliation.

Fissure sealants/infiltration for initial lesion in molar.

Caries removal and restoration using Atraumatic Restorative Treatment (ART) approach, composite, resin modified glass ionomer, compomer or glass ionomer for advanced lesion in all teeth.

Hall technique for advanced lesion in molar (specially for proximal lesions, but either for occlusal lesion if child is not cooperative enough for a good adhesive restoration).

Non-restorative cavity control for tooth near to exfoliation, any tooth with arrested caries, advanced lesion in anterior tooth, advanced lesion in molars with extensive cavitation, and for unrestorable tooth (pain/infection free).

Teeth pulpally involved: extraction or endodontic treatment.

* Sedation and general anaesthesia can be considered for child who is pre-cooperative or unable to co-operate or who has multiple affected teeth.

Guidelines

 American Academy of Pediatric Dentistry, 2017 [27]

American Academy of Pediatric Dentistry (United States)

Use of 38% SDF for the arrest of cavitated caries lesions

 American Academy of Pediatric Dentistry, 2016 [28]

American Academy of Pediatric Dentistry (United States)

Active surveillance in cases of incipient lesions

ITR - until a time when traditional cavity preparation and restoration is possible

*More emphasis on prevention and arrestment to minimize the necessity of use of sedation and general anesthesia.

 American Academy of Pediatric Dentistry, 2016 [29] (replace AAPD, 2008 [30] and AAPD, 2004 [31])

American Academy of Pediatric Dentistry (United States)

Active surveillance

Sealants for already exhibit incipient, non-cavitated carious lesions

Restoration with glass ionomer cement or resin-based composites or amalgam

ITR

ART

Preformed metal crowns – Hall technique

Pre-veneered stainless steel crowns

 American Academy of Pediatric Dentistry, 2014 [32] (replace AAPD, 2013 [33] and AAPD, 2010 [34])

American Academy of Pediatric Dentistry (United States)

1–2 years old: Restore cavitated lesions with ITR or definitive restorations; active surveillance for incipient lesions;

> 3 years: Restoration of cavitated or enlarging lesions; incipient lesions - active surveillance, except for children with high risk and parent not engaged, in which cases incipient lesions should be restored.

* Fluoridated toothpaste was recommended for all children

 Brazilian Association of Pediatric Dentistry, 2014 [35] (replaced Reference Manual, 2009 [36])

Brazilian Association of Pediatric Dentistry (Brazil)

Non-invasive approach (fluoride, dietary advice, biofilm control) for active enamel lesions.

Sealants for incipient lesions

Dentin lesions: ART, restoration with resin, glass ionomer cement or modified resin glass ionomer

 Ministerio de Salud, Gobierno de Chile [37] (replaced Ministerio de Salud, Gobierno de Chile, 2008 [38])

Ministerio de Salud, Gobierno de Chile (Chile)

Application of fluorides (varnish, gel, mouthwash, fluoridated toothpaste)

Sealants for non-cavitated lesions

Dentin lesions: ART, restoration with resin or glass ionomer cement, preformed crowns.

Pulpal therapy

 Uribe, 2006 [39]

Scottish Intercollegiate Guideline Network (Scotland)

Caries progressing into dentine: managed with a preventive (not specified), or a preventive and restorative approach.

Indirect pulp capping: if complete caries removal is not possible

Cavitated lesions- ART, restoration with amalgam, composite, resin-modified glass-ionomers, compomer or preformed metal crowns

 Peariasamy et al., 2012 [40]

Malaysia

Non-cavitated proximal enamel lesions: resin infiltration system used in conjunction with fluoride.

Teeth that require temporization: use of spoon excavators followed by sealing the teeth with glass ionomer cement.

Restorative treatment with amalgam, composite, glass ionomer cement, resin modified glass ionomer, high-viscosity glass ionomer, polyacid modified composite resin, stainless steel crown.

Teeth pulpally involved: extraction or endodontic treatment, based on patient’s cooperation, medical condition, infection, restorability, extent of caries, potential for malocclusion.

* The use of general anesthesia may be considered for uncooperative children or children that require extensive treatment.