New ADA Guideline Recommends Conservative Treatment Methods for Tooth Decay

US: The American Dental Association (ADA) has released a new clinical practice guideline that suggests conservative methods for treating tooth decay in primary and permanent teeth. The guideline, titled “Evidence-based clinical practice guideline on restorative treatments for caries lesions,” was developed by an expert panel of dentists after an extensive review of approximately 300 published studies. 

It aims to provide dentists with evidence-based recommendations for the treatment of moderate and advanced tooth decay in patients with vital, nonendodontically treated teeth.

Preserving Tooth with CTR

The ADA guideline recommends conservative carious tissue removal (CTR) as a preferred method for treating tooth decay. This approach involves removing the infected tissue while preserving as much of the original tooth structure as possible. 

According to the guideline, conservative CTR is less likely to result in adverse outcomes such as nerve exposure or a failed filling. The recommendations also highlight the effectiveness of selective CTR, which involves removing most, but not all, of the decayed tissue before sealing the tooth with a filling or cap. This method prevents the remaining bacteria from multiplying, thus halting further tooth decay.

The ADA guideline affirms the efficacy of various restorative materials commonly used in dental treatments. These materials, including tooth-colored fillings, silver-colored fillings (amalgam), and preformed caps, are considered effective for treating moderate and advanced tooth decay in both primary and permanent teeth. The guideline provides specific recommendations for the choice of materials depending on the extent of the decay.

Expert Opinions and Evidence-Based Guidelines

Lead author Dr Vineet Dhar, B.D.S., M.D.S., Ph.D., who is a clinical professor and chair of orthodontics and pediatric dentistry at the University of Maryland School of Dentistry and a member of the ADA Council on Scientific Affairs, emphasizes that the guideline aims to address how to maintain healthy tooth structure and protect the soft tissue inside the tooth. 

“While research had already confirmed that selectively removing decayed tissue is an effective approach to treating early tooth decay, dentists needed an evidence-based guideline to provide them with a range of treatment choices for patients with moderate to advanced tooth decay,” said Dr Dhar.

This new guideline is the ADA’s second clinical practice guideline in a series focused on caries treatment. It was developed by the ADA Council on Scientific Affairs and the Clinical and Translation Research team within the ADA Science and Research Institute. The panel of experts convened by the ADA reportedly reviewed the best-available scientific evidence to ensure the recommendations were grounded in reliable research.

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