Browsing by Author "Machiulskiene, Vita"

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    How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement
    (Springer, 2020) Schwendicke, Falk; Splieth, Christian H.; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A.; Haak, Rainer; Hannig, Matthias; Hickel, Reinhard; Juric, Hrvoje; Lussi, Adrian; Machiulskiene, Vita; Manton, David; Jablonski-Momeni, Anahita; Opdam, Niek; Paris, Sebastian; Santamaria, Ruth; Tassery, Hervé; Zandona, Andrea; Zero, Domenick; Zimmer, Stefan; Banerjee, Avijit; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual’s caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual’s caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the caries process in adults.
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    How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement
    (Karger, 2020) Paris, Sebastian; Banerjee, Avijit; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A.; Haak, Rainer; Hannig, Matthias; Hickel, Reinhard; Juric, Hrvoje; Lussi, Adrian; Machiulskiene, Vita; Manton, David; Jablonski-Momeni, Anahita; Santamaria, Ruth; Schwendicke, Falk; Splieth, Christian H.; Tassery, Hervé; Zandona, Andrea; Zero, Domenick; Zimmer, Stefan; Opdam, Niek; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient’s individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.