Removing or Controlling? How Caries Management Impacts on the Lifetime of Teeth.

Historically, traditional carious lesion management focused on the importance of removal of all carious tissue, with little thought to the lesion origins. The surgical removal of any sign of a carious lesion was prioritised with little, or no, consideration to pulp vitality, loss of tooth structure, or caries disease management. This symptomatic approach concentrating on lesions rather than on the cause of the disease, focused on preventing secondary carious lesion development. Early detection and improved understanding of the caries process - that lesion progress can be arrested or slowed - has led to preventive measures and less destructive management as a focus. The choice of lesion management depends on: whether a primary or permanent tooth is involved; which tooth surface(s) is/are involved; whether the lesion is confined to enamel or extends into dentine; the lesion depth, and lesion cleansability. Use of preventive and minimally invasive operative strategies is complicated by the lack of predictable ways of recording lesions' status to allow early detection of failed strategies and early intervention. Because re-restoration usually makes the cavity larger and, consequently, the tooth weaker, the clinician should be certain about initiating the repeat restoration cycle, delaying the first restoration as much as possible. The 3 main principles that support preventing or slowing the repeat restoration cycle are: (1) avoid restoration placement until there is no other option; (2) place them for maximum longevity; (3) if re-restoration is necessary, repair or refurbishment is preferable to replacement of a defective restoration.