No Removal and Inactivation of Carious Tissue: Non-Restorative Cavity Control.

Abstract

Non-restorative cavity control (NRCC) is a 3-part treatment option for dentine cavities in the primary dentition, for root carious lesions and cavitated coronal smooth surface lesions. The first part is that the patient's oral hygiene procedure/habits improve and involve the exposed dentine. For this, it may be necessary to expose the cavity (second part) so that it is accessible for the toothbrush (the lesion exposure method). As long as the dentine carious lesion is diagnosed as active or there is increased risk that carious lesion activity will recur, it is advisable to support the treatment with a 38% silver diamine fluoride (SDF) or a 5% sodium fluoride (NaF) varnish therapy (third part). NRCC has advantages over traditional restorative therapy as it avoids the stress and fear initiation that often results from invasive restorative therapy. It avoids a futile or detrimental repeat restorative cycle when cavity outlines have to be designed in caries active areas and it increases awareness of people's own responsibility for oral health and the quality of the oral hygiene procedure. NRCC has been advocated, particularly in primary dentitions, for patients or parents/carers who are able to accept responsibility for the disease and commit to remedial action including diet modification and regular, frequent toothbrushing with a fluoride toothpaste. It should not be used when immediate invasive action is required such as in the case of pain, infection, or sepsis, or where there is no readiness to change behaviours that have led to the development of the disease in the first place. Professionals who choose NRCC commit themselves to being critical regarding their educational qualities and to commence a cycle of quality improvement.