Diagnosis and treatment of dental caries: the clinicians' dilemma. Scope for change in clinical practice.

The prevalence of dental caries is decreasing, yet the proportion of General Dental Service expenditure devoted to restoring teeth continues to rise. This appears to reflect a deep-seated restorative philosophy, yet some carious lesions can be arrested. New restorations often contain characteristics consistent with in-built obsolescence, which explains why restorations are often not very durable and why two-thirds of all restorative treatment involves replacing them. The problem is compounded by the fact that disagreement among dentists as to which restorations should be replaced and why, is of alarming proportions. The universal adoption of a preventive approach to making treatment decisions, especially with respect to early carious lesions and mechanically imperfect restorations, could be a major factor in reducing the restorative burden of the dental service.