FDI policy statement on classification of caries lesions of tooth surfaces and caries management...
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ORIGINAL ARTICLE FDI policy statement on Classification of caries lesions of tooth surfaces and caries management systems Adopted by the FDI General Assembly: 17 September 2011, Mexico City, Mexico FDI World Dental Federation FDI World Dental Federation, Geneva, Switzerland. INTRODUCTION Caries is a major global oral disease and its manage- ment should be based on our current knowledge of the disease process; its aetiology, prevention and control. Health promotion and wellbeing across all communities are linked to caries control. BACKGROUND The original classification of carious cavities in exposed tooth surfaces was proposed by G. V. Black in the early 1900s for use in operative procedures 1 .A century later, this system is still in widespread use by the majority of dentists. Over the last 30 years there have been marked improvements in the understanding of the aetio- pathology and the nature of caries and the caries process. Dental caries is the localized destruction of susceptible dental hard tissue by acidic byproducts from bacterial fermentation of carbohydrates. The caries process is the dynamic sequence of biofilm– tooth interactions which can occur over time on and within a tooth surface. Improvements in understand- ing also extend to the role of bacterial transmission in young children, the importance of common risk factors and the potential impact of caries on general health. Scientists and clinicians now also recognize the need for a minimal intervention approach to surgical caries management, including the potential for arrest and remineralisation of early lesions. At the other end of the disease spectrum there is a need to recognize the consequences of untreated car- ies, both to the individual and society, as the evidence for the close interrelation between oral health, general health and quality of life is growing. CURRENT SITUATION • Caries is a multifactorial disease, which is largely preventable • The disease process results in loss of mineral ions from the tooth surface and subsurface, which may lead to surface cavitation • The disease becomes established before cavitation of the tooth surface • The disease process can be treated and reversed in its earliest stages; early recognition and arrest or reversal is therefore highly desirable and possible in most cases, without restoration (‘surgical treat- ment’) of the tooth • Failure to intervene early may result in lesion pro- gression, leading to irreversible damage to the tooth structure (i.e. cavitation) and an increasing burden to the patient throughout life • Modifiable and non-modifiable risk factors are important contributory factors • Social determinants of health play an important role in the risk assessment, prevention, surgical treatment and continuing management of a caries lesion. • The Black caries classification, as commonly imple- mented, is based on five standardized cavity designs, regardless of the stage or size of the lesion • Any revised classification should recognize the site, the stage, activity and size of lesions, for both pri- mary caries and recurrent caries, associated with both restorations and sealants • Any new classification would ideally be relevant for deciduous and permanent teeth and take into account the systemic consequences of untreated caries • Any new classification should enable decision makers to understand the oral health status of the 4 © 2013 FDI World Dental Federation International Dental Journal 2013; 63: 4–5 doi: 10.1111/idj.12014
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Transcript of FDI policy statement on classification of caries lesions of tooth surfaces and caries management...
ORIG INAL ART ICLE
FDI policy statement on Classification of caries lesionsof tooth surfaces and caries management systemsAdopted by the FDI General Assembly: 17 September 2011,Mexico City, Mexico
FDI World Dental Federation
FDI World Dental Federation, Geneva, Switzerland.
INTRODUCTION
Caries is a major global oral disease and its manage-ment should be based on our current knowledge ofthe disease process; its aetiology, prevention andcontrol. Health promotion and wellbeing across allcommunities are linked to caries control.
BACKGROUND
The original classification of carious cavities inexposed tooth surfaces was proposed by G. V. Blackin the early 1900s for use in operative procedures1. Acentury later, this system is still in widespread use bythe majority of dentists.Over the last 30 years there have been marked
improvements in the understanding of the aetio-pathology and the nature of caries and the cariesprocess. Dental caries is the localized destruction ofsusceptible dental hard tissue by acidic byproductsfrom bacterial fermentation of carbohydrates. Thecaries process is the dynamic sequence of biofilm–tooth interactions which can occur over time on andwithin a tooth surface. Improvements in understand-ing also extend to the role of bacterial transmissionin young children, the importance of common riskfactors and the potential impact of caries on generalhealth.Scientists and clinicians now also recognize the need
for a minimal intervention approach to surgical cariesmanagement, including the potential for arrest andremineralisation of early lesions.At the other end of the disease spectrum there is a
need to recognize the consequences of untreated car-ies, both to the individual and society, as the evidencefor the close interrelation between oral health, generalhealth and quality of life is growing.
CURRENT SITUATION
• Caries is a multifactorial disease, which is largelypreventable
• The disease process results in loss of mineral ionsfrom the tooth surface and subsurface, which maylead to surface cavitation
• The disease becomes established before cavitationof the tooth surface
• The disease process can be treated and reversed inits earliest stages; early recognition and arrest orreversal is therefore highly desirable and possible inmost cases, without restoration (‘surgical treat-ment’) of the tooth
• Failure to intervene early may result in lesion pro-gression, leading to irreversible damage to the toothstructure (i.e. cavitation) and an increasing burdento the patient throughout life
• Modifiable and non-modifiable risk factors areimportant contributory factors
• Social determinants of health play an importantrole in the risk assessment, prevention, surgicaltreatment and continuing management of a carieslesion.
• The Black caries classification, as commonly imple-mented, is based on five standardized cavitydesigns, regardless of the stage or size of the lesion
• Any revised classification should recognize the site,the stage, activity and size of lesions, for both pri-mary caries and recurrent caries, associated withboth restorations and sealants
• Any new classification would ideally be relevant fordeciduous and permanent teeth and take intoaccount the systemic consequences of untreatedcaries
• Any new classification should enable decisionmakers to understand the oral health status of the
4 © 2013 FDI World Dental Federation
International Dental Journal 2013; 63: 4–5
doi: 10.1111/idj.12014
population, to identify needs and priorities in den-tal care and reflect the care that has been provided
• Any new classification should be designed to give rel-evant and high-quality information to clinical prac-tice, for educational purposes and for researchers
• Any new classification should relate to the need forearly arrest of lesions and their reversal to the abilityto monitor preventive treatment, and to the complex-ity of a restoration, if a restoration is required
• Caries management and monitoring of the diseaseprogress should take into account local oral factors,and the general health status and environment ofthe individual patient.
THE FDI WORLD DENTAL FEDERATIONRECOMMENDS
• The continued development and adoption of a car-ies lesion classification and a separate caries man-agement system, including risk assessment andprevention, that are able to describe and documentthe total caries (clinical) experience at both a popu-lation and an individual level
• That this caries classification and caries manage-ment system be used as the basis for communicat-ing and educating patients, health professions and
governments about caries, its prevention, controland management
• That the caries classification and caries manage-ment system should provide a framework for designof appropriate health policy and planning decisions,and relevant and cost-effective implementation ofcaries management planning
• That adequate and appropriate surveillance, recordkeeping and information technology supportsystems be developed
• That implementation of existing, continuing andfuture research activities to improve the systemsand their delivery be a priority.
REFERENCE
1. Black GV. A work on operative dentistry, vol 2. Chicago: TheMedico-Dental Publ Co, 1908.
Correspondence to:FDI World Dental Federation,
Avenue Louis Casai 84,Case Postale 3,
CH–1216 Geneva,Switzerland.
Email: [email protected]
© 2013 FDI World Dental Federation 5
Classification of caries lesions
