Background level care.

The framework enabled by the International Caries Detection and Assessment System to allow appropriate, patient-centred caries management includes a frequently encountered scenario in which a comprehensive assessment of the teeth and the patient reveals no lesions in need of active preventive or operative care. The issue addressed here is: what background care is appropriate for patients attending a dental practice for routine caries care who, at present, appear to have no active or progressing caries lesions? It is proposed that, in addition to the use of criteria for lesion extent, treatment planning systems should also express the results of lesion assessments in terms of background level care (BLC), preventive treatment options and operative treatment options. The specific treatment options recommended for specific lesions and patients will depend upon a variety of other factors, including lesion activity, monitoring lesion behaviour over time and a range of other prognostic factors. Over recent decades, there has been comparatively little focus on appropriate BLC in a general practice setting. There are a range of issues around the need to support caries prevention and health maintenance from a behavioural and patient-focussed perspective. Even if a patient is deemed to be at low risk of future caries at a particular examination, there is a need for maintenance care. Intrinsic issues which need to be managed for both patients and their caries lesions in this patient group are: (1) the possibility of a change in caries risk status and (2) the impact of incorrect lesion assessments/diagnoses.