Non-Invasive Management of Carious Lesions: Behaviour Modification and Fluoride Application

Objectives: The Caries Management System (CMS) is a non-invasive risk-stratification protocol that aims to halt active caries and educate patients about dental decay, oral hygiene and diet. The CMS has been successfully trialled in private general dental clinics showing that it lowers caries incidence for patients 4 years post-treatment compared to patients in control clinics not using the CMS. However, at public dental hospitals evidence has yet to be collected on the effect of the CMS. The aim of this study is to investigate or evaluate the success of the CMS in treating carious lesions and lowering caries risk for patients attending public hospitals.
Methods: This study collected CMS data from 152 patient files stored at the WCOH records room and from their respective bitewing radiographs. The data collected were from patients who were deemed as high or medium caries-risk at their baseline appointments and at a recall appointment after 6 months with student clinicians. In accordance with the CMS guidelines, high-risk patients had frank cavitation into dentine or an inner third of dentine. Medium risk patients had no frank cavitation but extensive white spot lesions and/or bitewing radiolucency’s no greater than C4 (an outer third of dentine).
Results: 84% (152) of ICDAS 1, 2 and 3 lesions were arrested without need for restorative intervention.85 patients did not develop new lesions between baseline and recall appointments.16 new lesions were found at recall. 5 existing lesions progressed to cavitation. 70% of high and medium risk patients at baseline achieved a risk reduction to either medium or low risk at recall. Furthermore, 84% of carious lesions ICDAS 1-3 were arrested without need for restoration.
Conclusions: This study showed the effectiveness of the CMS in lowering caries risk and modifying oral health behaviours in WCOH patients, reinforcing the place of non-invasive dentistry at WCOH.