Table 4 Reasons given in “Other” response for radiographic threshold for operative intervention

Radiographic Threshold for Operative Intervention – Other reasons specified

We have an adjustment of the ICDAS classification as follows:

For C3 lesions: Radiolucency extending beyond ADJ just into dentine (0.5 mm). At this point we teach the students that for a low risk patient with a C3 lesion is recommended to remineralise it by applying fluoride varnish.

Our C4 classification is: Radiolucency with obvious spread in the outer 1/3 of dentine. If a patient is medium or high risk then intervention is recommended based on risk assessment (existing restorations, carious lesions).

For Medium risk in the permanent dentition – clinical judgement should be considered. Since we are talking about adults maybe preventative treatment should be considered as the patient might change the diet and hygiene practices

Our definition of low caries risk is no active primary or secondary caries lesions. Therefore, a low caries risk patient would not require operative treatment.

For Low and Medium risk in the primary dentition - due to unreliable clinic visits in country clinic, outer 1/3 of dentine unless mesial/distal of primary 4.

For primary and permanent dentition – all risk status – intervention is according to the Caries Management System- only if cavitation detected.

For Low and Medium risk in the primary dentition and Low risk in the permanent dentition - intervention is based on age of patient, fluoride exposure, caries risk, location of lesion, oral hygiene practices, parental supervision and guidance, dexterity

For both primary and permanent dentitions – intervention is based on caries risks and other clinical findings and taught on case-by-case basis. Age of child, time to exfoliation, access to surface remineralising agents

For intervention in the primary dentition - depends on a number of different variables:

 A) Dependent on the ‘age’ of the tooth i.e. how long before exfoliation

 B) The site of the caries

 C) Any patterning noticed

 D) The length of time the lesion has taken to develop (usually gauged by looking at the case notes from the last examination etc.)

 E) The potential for caries arrest or at least hamper in its continued development.

For Medium Risk in Primary Dentition - Would usually consider intervention once the caries has breached the DEJ by 1-2 mm

For High Risk in Primary Dentition - often you are seeing lesions with these patients beyond the middle third and beyond a reversible pulpitis

For Low Risk in the Permanent Dentition – it is sometimes dependant on the potential for remineralisation/caries arrest, the site, the duration of formation etc.