Clinical interventions for caries management through minimal intervention procedures in young children: an updated evidence-based review
1Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, 78290 San Luis Potosí, SLP, Mexico
DOI: 10.22514/jocpd.2023.076 Vol.47,Issue 6,November 2023 pp.1-10
Submitted: 27 February 2023 Accepted: 06 March 2023
Published: 03 November 2023
This review aimed to summarize the preventive, non-restorative and restorative minimal intervention dentistry (MID) interventions for managing dental caries during the primary dentition stage, after selecting the highest quality evidence. A comprehensive literature search for relevant studies was performed in PubMed (MEDLINE), Embase, Cochrane Library and Google Scholar, published between 2007 and 2022. Only clinical randomized controlled trials, clinical guidelines with literature review, systematic reviews and meta-analyses conducted in the primary dentition were included. One hundred fifty-three MID-associated references were found, and 63 of them were considered for the present review. Of these, 24 were clinical randomized controlled trials, 21 were systematic reviews, 3 umbrella reviews and 11 practice guidelines with a literature review. The retrieved evidence was divided into (and discussed) three general caries management strategies: (i) carious lesion diagnosis and individual risk assessment; (ii) preventive measurements and non-cavitated lesions management; and (iii) cavitated lesions management. MID is an attractive alternative management that promotes prevention rather than intervention to achieve a long-lasting oral health in young children through easy and cost-benefit preventive, non-invasive, minimally invasive or conservative invasive restorative measures. This philosophy of management is suitable for treating young children, considered friendlier and less anxiety-provoking than traditional methods.
Minimally intervention dentistry; Young children; Conservative caries management
Arturo Garrocho-Rangel,Paola Navarro-Padilla,Daniela Guzmán-Uribe,Gabriela Torre-Delgadillo,Socorro Ruiz-Rodríguez,Amaury Pozos-Guillén. Clinical interventions for caries management through minimal intervention procedures in young children: an updated evidence-based review. Journal of Clinical Pediatric Dentistry. 2023. 47(6);1-10.
 Maguire A, Clarkson JE, Douglas GVA, Ryan V, Homer T, Marshman Z, et al. Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FICTION three-arm RCT. Health Technology Assessment. 2020; 24: 29–34.
 Anil S, Anand PS. Early childhood caries: prevalence, risk factors, and prevention. Frontiers in Pediatrics. 2017; 5: 157.
 Meyer F, Enax J. Early childhood caries: epidemiology, aetiology, and prevention. International Journal of Dentistry. 2018; 2018: 1415873.
 Ramos-Gomez FJ, Crystal YO, Domejean S, Featherstone JDB. Minimal intervention dentistry: part 3. Paediatric dental care—prevention and management protocols using caries risk assessment for infants and young children. British Dental Journal. 2012; 213: 501–508.
 BaniHani A, Duggal M, Toumba J, Deery C. Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition. International Journal of Paediatric Dentistry. 2018; 28: 12–22.
 Tickle M, Milsom K, King D, Kearney-Mitchell P, Blinkhorn A. The fate of the carious primary teeth of children who regularly attend the general dental service. British Dental Journal. 2002; 192: 219–223.
 Levine RS, Pitts NB, Nugent ZJ. The fate of 1587 unrestored carious deciduous teeth: a retrospective general dental practice based study from northern England. British Dental Journal. 2002; 193: 99–103.
 Innes NPT, Evans DJP, Stirrups DR. Sealing caries in primary molars. Journal of Dental Research. 2011; 90: 1405–1410.
 Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries—a review: report of a FDI task group. International Dental Journal. 2012; 62: 223–243.
 Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database of Systematic Reviews. 2013; CD003808.
 Jingarwar MM, Bajwa NK, Pathak A. Minimal intervention dentistry—a new frontier in clinical dentistry. Journal of Clinical and Diagnostic Research. 2014; 8: ZE04–ZE08.
 Leal SC. Minimal intervention dentistry in the management of the paediatric patient. British Dental Journal. 2014; 216: 623–627.
 Chaffee BW, Featherstone JDB, Zhan L. Pediatric caries risk assessment as a predictor of caries outcomes. Pediatric Dentistry. 2017; 39: 219–232.
 Schwendicke F, Splieth C, Breschi L, Banerjee A, Fontana M, Paris S, et al. When to intervene in the caries process? An expert Delphi consensus statement. Clinical Oral Investigations. 2019; 23: 3691–3703.
 Giacaman R, Muñoz-Sandoval C, Neuhaus K, Fontana M, Chałas R. Evidence-based strategies for the minimally invasive treatment of carious lesions: review of the literature. Advances in Clinical and Experimental Medicine. 2018; 27: 1009–1016.
 Altoukhi DH, El-Housseiny AA. Hall technique for carious primary molars: a review of the literature. Dentistry Journal. 2020; 8: 11.
 Al-Halabi M, Salami A, Alnuaimi E, Kowash M, Hussein I. Assessment of paediatric dental guidelines and caries management alternatives in the post COVID-19 period. A critical review and clinical recommendations. European Archives of Paediatric Dentistry. 2020; 21: 543–556.
 Santos PSD, Pedrotti D, Braga MM, Rocha RO, Lenzi TL. Materials used for indirect pulp treatment in primary teeth: a mixed treatment comparisons meta-analysis. Brazilian Oral Research. 2017; 31: e101.
 Pedrotti D, Cavalheiro CP, Casagrande L, de Araújo FB, Pettorossi Imparato JC, de Oliveira Rocha R, et al. Does selective carious tissue removal of soft dentin increase the restorative failure risk in primary teeth?: Systematic review and meta-analysis. The Journal of the American Dental Association. 2019; 150: 582–590.e1.
 Santamaría RM, Abudrya MH, Gül G, Mourad MS, Gomez GF, Zandona AGF. How to intervene in the caries process: dentin caries in primary teeth. Caries Research. 2020; 54: 306–323.
 BaniHani A, Santamaría RM, Hu S, Maden M, Albadri S. Minimal intervention dentistry for managing carious lesions into dentin in primary teeth: an umbrella review. European Archives of Paediatric Dentistry. 2022; 23: 667–693.
 Oliveira B, Rajendra A, Veitz-Keenan A, Niederman R. The effect of silver diamine fluoride in preventing caries in the primary dentition: a systematic review and meta-analysis. Caries Research. 2019; 53: 24–32.
 Seifo N, Cassie H, Radford JR, Innes NPT. Silver diamine fluoride for managing carious lesions: an umbrella review. BMC Oral Health. 2019; 19: 145.
 Wakhloo T, Reddy SG, Sharma SK, Chug A, Dixit A, Thakur K. Silver diamine fluoride versus atraumatic restorative treatment in pediatric dental caries management: a systematic review and meta-analysis. Journal of International Society of Preventive & Community Dentistry. 2021; 11: 367–375.
 Wong MC, Clarkson J, Glenny AM, Lo EC, Marinho VC, Tsang BW, et al. Cochrane reviews on the benefits/risks of fluoride toothpastes. Journal of Dental Research. 2011; 90: 573–579.
 Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2010; CD007868.
 Wong MC, Glenny AM, Tsang BW, Lo EC, Worthington HV, Marinho VC. Topical fluoride as a cause of dental fluorosis in children. Cochrane Database of Systematic Reviews. 2010; 2010: CD007693.
 Wright JT, Hanson N, Ristic H, Whall CW, Estrich CG, Zentz RR. Fluoride toothpaste efficacy and safety in children younger than 6 years. The Journal of the American Dental Association. 2014; 145: 182–189.
 Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database of Systematic Reviews. 2019; 3: CD007868.
 Santos GM, Pacheco RL, Bussadori SK, Santos EM, Riera R, de Oliveira Cruz Latorraca C, et al. Effectiveness and safety of ozone therapy in dental caries treatment: systematic review and meta-analysis. Journal of Evidence Based Dental Practice. 2020; 20: 101472.
 Duangthip D, Jiang M, Chu CH, Lo EC. Non-surgical treatment of dentin caries in preschool children—systematic review. BMC Oral Health. 2015; 15: 44.
 Hu S, BaniHani A, Nevitt S, Maden M, Santamaria RM, Albadri S. Hall technique for primary teeth: a systematic review and meta-analysis. Japanese Dental Science Review. 2022; 58: 286–297.
 Frencken JE, Liang S, Zhang Q. Survival estimates of atraumatic restorative treatment versus traditional restorative treatment: a systematic review with meta-analyses. British Dental Journal. 2021. [Preprint].
 Chaudhari HG, Patil RU, Jathar PN, Jain CA. A systematic review of randomized controlled trials on survival rate of atraumatic restorative treatment compared with conventional treatment on primary dentition. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2022; 40: 112–117.
 Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American dental association and the American academy of pediatric dentistry. The Journal of the American Dental Association. 2016; 147: 672–682.e12.
 Papageorgiou SN, Dimitraki D, Kotsanos N, Bekes K, van Waes H. Performance of pit and fissure sealants according to tooth characteristics: a systematic review and meta-analysis. Journal of Dentistry. 2017; 66: 8–17.
 Singal K, Sharda S, Gupta A, Malik VS, Singh M, Chauhan A, et al. Effectiveness-of calcium phosphate derivative agents on the prevention and remineralization of caries among children—a systematic review & meta-analysis of randomized controlled trials. Journal of Evidence-Based Dental Practice. 2022; 22: 101746.
 Chen Y, Chen D, Lin H. Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis. BMC Oral Health. 2021; 21: 13.
 Deng Y, Feng G, Hu B, Kuang Y, Song J. Effects of Papacarie on children with dental caries in primary teeth: a systematic review and meta-analysis. International Journal of Paediatric Dentistry. 2018; 28: 361–372.
 Kirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk factors for early childhood caries: a systematic review and meta-analysis of case-control and cohort studies. Pediatric Dentistry. 2019; 41: 95–112.
 Thang Le VN, Kim JG, Yang YM, Lee DW. Risk factors for early childhood caries: an umbrella review. Pediatric Dentistry. 2021; 43: 176–194.
 Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. International Journal of Paediatric Dentistry. 2019; 29: 238–248.
 Ekstrand KR, Gimenez T, Ferreira FR, Mendes FM, Braga MM. The international caries detection and assessment system—ICDAS: a systematic review. Caries Research. 2018; 52: 406–419.
 Campus G, Cocco F, Ottolenghi L, Cagetti MG. Comparison of ICDAS, CAST, Nyvad’s Criteria, and WHO-DMFT for caries detection in a sample of Italian schoolchildren. International Journal of Environmental Research and Public Health. 2019; 16: 4120.
 Gudipaneni RK, Alkuwaykibi AS, Ganji KK, Bandela V, Karobari MI, Hsiao C, et al. Assessment of caries diagnostic thresholds of DMFT, ICDAS II and CAST in the estimation of caries prevalence rate in first permanent molars in early permanent dentition—a cross-sectional study. BMC Oral Health. 2022; 22: 133.
 Featherstone JDB, Crystal YO, Alston P, Chaffee BW, Doméjean S, Rechmann P, et al. Evidence-based caries management for all ages—practical guidelines. Frontiers in Oral Health. 2021; 2: 657518.
 Innes NPT, Chu CH, Fontana M, Lo ECM, Thomson WM, Uribe S, Heiland M, et al. A century of change towards prevention minimal intervention in cariology. Journal of Dental Research. 2019; 98: 611–617.
 Wolff MS, Schenkel AB. The Anticaries efficacy of a 1.5% arginine and fluoride toothpaste. Advances in Dental Research. 2018; 29: 93–97.
 Toumba KJ, Twetman S, Splieth C, Parnell C, van Loveren C, Lygidakis NΑ. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. European Archives of Paediatric Dentistry. 2019; 20: 507–516.
 Kade KK, Chaudhary S, Shah R, Patil S, Patel A, Kamble A. Comparative evaluation of the remineralization potential of fluoride-containing toothpaste, honey ginger paste and ozone. An in vitro study. International Journal of Clinical Pediatric Dentistry. 2023; 15: 541–548.
 Pozos-Guillén A, Molina G, Soviero V, Arthur RA, Chavarria-Bolaños D, Acevedo AM. Management of dental caries lesions in Latin American and Caribbean countries. Brazilian Oral Research. 2021; 35: e055.
 Ricomini Filho AP, Chávez BA, Giacaman RA, Frazão P, Cury JA. Community interventions and strategies for caries control in Latin American and Caribbean countries. Brazilian Oral Research. 2021; 35: e054.
 Pretty IA. High fluoride concentration toothpastes for children and adolescents. Caries Research. 2016; 50: 9–14.
 Mekky AI, Dowidar KML, Talaat DM. Casein phosphopeptide amorphous calcium phosphate fluoride varnish in remineralization of early carious lesions in primary dentition: randomized clinical trial. Pediatric dentistry. 2021; 43: 17–23.
 Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions. The Journal of the American Dental Association. 2018; 149: 837–849.e19.
 Chabadel O, Véronneau J, Montal S, Tramini P, Moulis E. Effectiveness of pit and fissure sealants on primary molars: a 2-yr split-mouth randomized clinical trial. European Journal of Oral Sciences. 2021; 129: e12758.
 Dias KR, de Andrade CB, Wait TT, Chamon R, Ammari MM, Soviero VM, et al. Efficacy of sealing occlusal caries with a flowable composite in primary molars: a 2-year randomized controlled clinical trial. Journal of Dentistry. 2018; 74: 49–55.
 Ammari MM, Jorge RC, Souza IPR, Soviero VM. Efficacy of resin infiltration of proximal caries in primary molars: 1-year follow-up of a split-mouth randomized controlled clinical trial. Clinical Oral Investigations. 2018; 22: 1355–1362.
 Jorge RC, Ammari MM, Soviero VM, Souza IPR. Randomized controlled clinical trial of resin infiltration in primary molars: 2 years follow-up. Journal of Dentistry. 2019; 90: 103184.
 Rickard GD, Richardson RJ, Johnson TM, McColl DC, Hooper L. Ozone therapy for the treatment of dental caries. Cochrane Database of Systematic Reviews. 2019; 2: CD004153.
 Luppieri V, Manfra A, Ronfani L, Chermetz M, Cadenaro M. Ozone therapy for early childhood caries (ECC) treatment: an in vivo prospective study. Applied Sciences. 2022; 12: 1964.
 XIMENES M, CARDOSO M, ASTORGA F, ARNOLD R, PIMENTA LA, VIERA RDS. Antimicrobial activity of ozone and NaF-chlorhexidine on early childhood caries. Brazilian Oral Research. 2017; 31: e2
 Mese M, Tok YT, Kaya S, Akcay M. Influence of ozone application in the stepwise excavation of primary molars: a randomized clinical trial. Clinical Oral Investigations. 2020; 24: 3529–3538.
 Alkhouli MM, Al Nesser SF, Bshara NG, AlMidani AN, Comisi JC. Comparing the efficacies of two chemo-mechanical caries removal agents (2.25% sodium hypochlorite gel and brix 3000), in caries removal and patient cooperation: a randomized controlled clinical trial. Journal of Dentistry. 2020; 93: 103280.
 Aswathi K, Rani S, Athimuthu A, Prasanna P, Patil P, Deepali K. Comparison of efficacy of caries removal using polymer bur and chemomechanical caries removal agent: a clinical and microbiological assessment—an in vivo study. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2017; 35: 6–13.
 Asal MA, Abdellatif AM, Hammouda HE. Clinical and microbiological assessment of Carisolv and polymer bur for selective caries removal in primary molars. International Journal of Clinical Pediatric Dentistry. 2021; 14: 357–363.
 Schwendicke F. Caries removal in primary teeth using Papacarie. Evidence-Based Dentistry. 2018; 19: 74.
 Bottega F, Bussadori SK, Battisti IDE, Vieira EP, Pompeo TS, Winkelmann ER. Costs and benefits of Papacarie in pediatric dentistry: a randomized clinical trial. Scientific Reports. 2018; 8: 17908.
 Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. Journal of the California Dental Association. 2016; 44: 17–28.
 Crystal YO, Chaffee BW. Silver diamine fluoride is effective in arresting caries lesions in primary teeth. Journal of Evidence Based Dental Practice. 2018; 18: 178–180.
 Vollú AL, Rodrigues GF, Rougemount Teixeira RV, Cruz LR, Dos Santos Massa G, de Lima Moreira JP, et al. Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: a 12-month parallel randomized controlled clinical trial. Journal of Dentistry. 2019; 88: 103165.
 Jiang M, Wong MCM, Chu CH, Dai L, Lo ECM. A 24-month randomized controlled trial on the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with the ART approach. Journal of Dentistry. 2020; 100: 103435.
 Gruythuysen RJM. Non-restorative cavity treatment. Managing rather than masking caries activity. Nederlands Tijdschrift Voor Tandheelkunde. 2010; 117: 173–180. (In Dutch)
 Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Splieth CH. Caries management strategies for primary molars: 1-yr randomized control trial results. Journal of Dental Research. 2014; 93: 1062–1069.
 van Strijp G, van Loveren C. No removal and inactivation of carious tissue: non-restorative cavity control. Monographs in Oral Science. 2018; 27: 124–136.
 Santamaría RM, Innes NPT, Machiulskiene V, Schmoeckel J, Alkilzy M, Splieth CH. Alternative caries management options for primary molars: 2.5-year outcomes of a randomised clinical trial. Caries Research. 2017; 51: 605–614.
 Hesse D, Bonifácio CC, Bönecker M, Guglielmi Cde A, da Franca C, van Amerongen WE, et al. Survival rate of atraumatic restorative treatment (ART) restorations using a glass ionomer bilayer technique with a nanofilled coating: a bi-center randomized clinical trial. Pediatric Dentistry. 2016; 38: 18–24.
 Araujo MP, Innes NP, Bonifácio CC, Hesse D, Olegário IC, Mendes FM, et al. Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting. BMC Oral Health. 2020; 20: 318.
 American Academy of Pediatric Dentistry. Pediatric restorative dentistry. The reference manual of pediatric dentistry. Pediatric Dentistry. 2021; 43: 386–398.
 Ayedun OS, Oredugba FA, Sote EO. Comparison of the treatment outcomes of the conventional stainless-steel crown restorations and the hall technique in the treatment of carious primary molars. Nigerian Journal of Clinical Practice. 2021; 24: 584–594.
 Stafuzza TC, Vitor LLR, Rios D, Cruvinel T, Loureço Neto N, Sakai VT, et al. A randomized clinical trial of cavity liners after selective caries removal: one-year follow-up. Journal of Applied Oral Science. 2019; 27: e20180700.
 Machiulskiene V, Campus G, Carvalho JC, Dige I, Ekstrand KR, Jablonski-Momeni A, et al. Terminology of dental caries and dental caries management: consensus report of a workshop organized by ORCA and cariology research group of IADR. Caries Research. 2020; 54: 7–14.
 Elhennawy K, Finke C, Paris S, Reda S, Jost-Brinkmann P, Schwendicke F. Selective vs stepwise removal of deep carious lesions in primary molars: 24 months follow-up from a randomized controlled trial. Clinical Oral Investigations. 2021; 25: 645–652.
 Schwendicke F, Walsh T, Lamont T, Al-Yaseen W, Bjørndal L, Clarkson JE, et al. Interventions for treating cavitated or dentine carious lesions. Cochrane Database of Systematic Reviews. 2021; 7: CD013039.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.
Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.
Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.
JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.