The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for children and adolescents.

The application of the Caries Management System (CMS) for children and adolescents follows the rationale underlying the application of the CMS for adults. Briefly, the CMS is a 10-step, risk-based, non-invasive strategy to arrest and remineralize early lesions and to enhance caries primary prevention. The method for assessing each patient's diet, plaque distribution, and signs of caries as shown in bitewing radiograph images, follows the protocols for adults. Protocols presented here relating to caries risk assessment, lesion diagnosis and management, and patient recall are specific for children and adolescents. Fundamentally, non-cavitated lesions in primary and especially permanent teeth are managed: (1) professionally by preservative non-invasive means, including fluoride varnish and sealants; and (2) daily home toothbrushing using fluoride toothpaste where the aim is to arrest lesion progression so that restorations will not be necessary. Monitoring of lesions through the review of clinical signs and bitewing images is the means for assessing caries activity. For those who fail to respond to advice to reduce cariogenic exposures and continue to develop new lesions at a steady or increased rate, a more intensified programme is required; their higher risk status is confirmed and treatment follows the corresponding protocol.