NMDA Journal Spring 2020

22 New Mexico Dental Journal, Spring 2020 Update Summary: Evidence-Based Clinical Practice Guideline on Nonrestorative Treatments for Carious Lesions, JADA October 2018, Vol. 149, Issue 10, Pages 837–849 This is a summary of the report convened by the ADA council on Scientific Affairs written by a panel of 16 professors, staff members, and institute leaders who know these things better than we do because they reviewed all the research as in 69 papers. These experts give us eight clinical recom- mendations discussing lesion types, tooth surface and dentition. These recommendations assist clinicians, patients, and stakeholders inmaking evidence-based decisions (EBD’s). They note that the lesions should be monitored for hardness, texture, and color. Radiographs should be taken (as you normally do in a recall appointment). The questions and recom- mendations are directly quoted. At the end of the recommendations is a caveat of the certainty of the evidence and strength of the recommenda- tion. (You can go to EBD literature to see what the certainty and recom- mendations terms mean.) There is an online continuing education activity at http://jada.ada.org/ce/home. Question 1 To arrest cavitated coronal carious lesions on primary or permanent teeth, should we recommend silver diamine fluoride, silver nitrate, or sealants? • To arrest advanced cavitated carious lesions on any coronal surface of primary teeth, the expert panel recommends clinicians prioritize the use of 38% SDF solution (biannual application) over 5% NaF varnish (application once per week for 3 weeks). (Moderate certainty evidence, strong recommendation.) • To arrest advanced cavitated carious lesions on any coronal surface of permanent teeth, the expert panel recommends clinicians prioritize the use of 38% SDF solution (biannual application) over 5% NaF varnish (application once per week for 3 weeks). (Low certainty evidence, conditional recommendation.) Question 2 To arrest or reverse noncavitated coronal carious lesions on primary or permanent teeth, shouldwe recommend NaF, stannous fluoride, polyols, chlorhexidine, calcium phosphate, amorphous calcium phosphate (ACP), casein phosphopeptide (CCP) –ACP, nano-hydroxyapatite, trical- cium phosphate, or prebiotics with or without 1.5% arginine, probiotics, SDF, silver nitrate, lasers, resin infiltration, sealants, sodium bicarbon- ate, calcium hydroxide, or carbamide peroxide? • To arrest or reverse noncavitated carious lesions on occlusal surfaces of primary teeth. The expert panel recommends clinicians prioritize the use of sealants plus 5% NaF varnish (application every 3–6 months), or sealants alone over 5% NaF varnish alone (application every 3–6 months), 1.23 APF gel (application every 3–6 months), resin infiltration plus 5% NaF varnish (application every 3–6 months), or 0.2% NaF mouth rinse (once per week). (Moderate certainty evidence, strong recommendation.) • To arrest or reverse noncavitated carious lesions on occlusal surfaces of permanent teeth. The expert panel recommends clinicians prioritize the use of sealants plus 5% NaF varnish (application every 3–6 months), or sealants alone over 5% NaF varnish alone (application every 3–6 months), 1.23 APF gel (application every 3–6 months), or 0.2% NaF mouth rinse (once per week). (Moderate certainty evidence, strong recommendation.) • To arrest or reverse noncavitated carious lesions on approximal surfaces of primary and permanent teeth, the expert panel suggests clinicians use 5% NaF varnish (application every 3–6 months), resin infiltration alone, resin infiltration plus 5% NaF varnish (application every 3–6 months), resin infiltration or sealants alone over 5% NaF varnish alone (application every 3–6 months) or sealants alone. (Low- to very low-certainty evidence, conditional recommendation.) • To arrest or reverse noncavitated carious lesions on facial and lingual surfaces of primary and permanent teeth, the expert panel suggests clinicians use 1.23% APF gel (application