Key Points

  • Dental caries is a multifactorial disease that results from the interaction between the bacterial biofilm (i.e., dental plaque), the environment (e.g., diet, saliva composition and flow rate, fluoride exposure), and the tooth structure.
  • Caries lesions can be classified into two categories: non-cavitated and cavitated. In addition, lesions can be active or arrested. Only active caries lesions require management.
  • School-based dental sealant programs grapple with the dilemma of how to best deal with cavitated caries lesions in children who may not receive restorative oral health care. Although dental sealants are not necessarily the treatment of choice for cavitated lesions, in these instances, it is up to the oral health professional authorized to select teeth for sealant placement in the program to decide whether to place sealants.
  • "Caries detection" implies finding a sign of the disease (e.g., finding a non-cavitated lesion). This is the first step in the diagnosis process. "Caries diagnosis" implies determining whether lesion(s) or disease are present (detection); determining how severe the disease is, if it is present; and deciding whether lesions are active or arrested (assessment).
  • Explorers are not necessary for detecting non-cavitated or cavitated lesions. Evidence suggests that use of an explorer does not improve detection.
  • X-rays should not be taken for the sole purpose of determining whether sealants should be placed.
  • Oral health professionals working in school-based dental sealant programs who evaluate long-term sealant retention should use their professional judgment when evaluating whether sealants placed the previous year need repair or replacement.