The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries.

OBJECTIVE To assess the strength of the evidence describing the effectiveness of alternative strategies to the detection and management of early occlusal caries and suspected occlusal dentinal caries. METHODS Nine detection and intervention decision points were identified as being central to the management of early occlusal caries and suspected occlusal dentinal caries, or suspicious areas. For each decision point, the evidence for effectiveness was assessed, using existing systematic reviews when available, and nonsystematic review methods when necessary. RESULTS For the 2 detection decisions (early occlusal caries and suspicious areas) the strength of the evidence was weak. Accuracy in detecting early occlusal caries was extremely variable within and across detection methods. Approximately 50% of suspicious areas identified had dentinal caries. The strength of the evidence for effectiveness of nonsurgical approaches for the management of early occlusal caries was weak for all 3 management strategies examined (doing nothing, sealants, remineralization). This evidence suggested that sealants were highly effective, with remineralization reflecting moderate effectiveness. For the management of suspicious areas, the strength of the evidence was still weaker and reflected the same relative effectiveness. For the surgical management strategy for suspicious areas, operative treatment, the evidence was strong and reflected high effectiveness for preventive resin restorations, but no evidence was available for minimally invasive techniques. CONCLUSION Identification methods for early occlusal caries are not accurate. The strength of the evidence for effectiveness of nonsurgical management strategies for early occlusal caries is at best, weak. The available evidence suggests that sealing both enamel caries and suspected occlusal dentinal caries is the most effective management approach if subsequent maintenance of the sealed surfaces can be assured.