Traditional preventive treatment options.

Preventive treatment options can be divided into primary, secondary and tertiary prevention techniques, which can involve patient- or professionally applied methods. These include: oral hygiene (instruction), pit and fissure sealants ('temporary' or 'permanent'), fluoride applications (patient- or professionally applied), dietary assessment and advice (modification), other measures to help remineralize demineralized tissue and other measures to help modify the biofilm to reduce the cariogenic challenge. There is a considerable body of strong evidence supporting the use of specific techniques for primary prevention of caries in children, e.g. pit and fissure sealants and topically applied fluorides (including patient-applied fluoride toothpastes and professionally applied fluoride varnishes), but limited strong evidence for these techniques for secondary prevention--i.e. where early to established lesions with ICDAS codes 1-4 (and also the severer lesions coded 5 or 6) are involved--and in relation to adults. This lack of evidence reflects a shortage of high-quality trials in the area, as opposed to a series of good studies showing no effect. Since there is also limited longitudinal evidence supporting conventional operative care, and since controlling the caries process prior to first restoration is the key to breaking the repair cycle and improving care for patients, future research should address the shortcomings in the current level of supporting evidence for the various traditional preventive treatment options. Copyright 2009 S. Karger AG, Basel