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Review Article
Modern Caries Prevention: From Risk Assessment to Minimally Invasive Management—An Evidence-Based Review
Dr. Anjali Navadiya1
Dr. Vidhi Kevadiya2
Dr. Hetvi Parmar3
Dr. Vivek Kher4
Dr. Chaitanya Parmar5
1 2 Tutor at College of Dental Science and Hospital, Amargadh, Gujarat, India. 3 4 5 Dental Intern at College of Dental Science and Hospital, Amargadh, Gujarat, India.
Published Online: July-August 2026
Pages: 96-107
Cite this article
↗ https://www.doi.org/10.59256/ijrtmr.20260604011References
1. World Health Organization. WHO guideline on environmentally friendly and less invasive oral health care for preventing and managing
dental caries. Geneva: World Health Organization; 2025.
2. World Health Organization. Prevention and treatment of dental caries with mercury-free products and minimal intervention. Geneva:
World Health Organization; 2022.
3. Nigel B. Pitts, Svante Twetman, Julian Fisher, et al. Understanding dental caries as a non-communicable disease. Br Dent J.2021;231(12):749–753.
4. Marsh PD, Head DA, Devine DA. Dental plaque as a biofilm and a microbial community—Implications for treatment. Journal of Oral
Biosciences. 2015 Nov;57(4):185–91.
5. CAMBRA Consensus Group. Caries Management by Risk Assessment (CAMBRA): evidence-based clinical practice.
6. ICCMS™. International Caries Classification and Management System™ clinical framework.
7. Fejerskov O, Nyvad B, Kidd EAM, editors. Dental Caries: The Disease and Its Clinical Management. 3rd ed. Oxford: Wiley-Blackwell;
2015.
8. Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017;3:17030.
doi:10.1038/nrdp.2017.30.
9. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;369(9555):51-59.
10. Marsh PD. Are dental diseases examples of ecological catastrophes? Microbiology. 2003;149(Pt 2):279-294.
11. Featherstone JDB. Dental caries: a dynamic disease process. Aust Dent J. 2008;53(3):286-291.
12. Featherstone JDB, Chaffee BW. The evidence for Caries Management by Risk Assessment (CAMBRA®). Adv Dent Res. 2018;29(1):9-
14.
13. American Dental Association. Caries risk assessment and management [Internet]. Chicago (IL): American Dental Association; 2023 [cited
2026 Jul 9]. Available from: https://www.ada.org/resources/ada-library/oral-health-topics/caries-risk-assessment-and-management
14. Pitts NB, Ekstrand KR. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and
Management System (ICCMS™): methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral
Epidemiol. 2013;41(1):e41-e52.
15. Young DA, Featherstone JDB. Caries management by risk assessment. Community Dent Oral Epidemiol. 2013;41(1):e53-e63.
16. Ismail AI, Pitts NB, Tellez M, Hassan A, Sohn W, et al. The International Caries Classification and Management System (ICCMS™): an
example of a caries management pathway. BMC Oral Health. 2015;15(Suppl 1):S9.
17. Bratthall D, Hansel Petersson G. Cariogram—a multifactorial risk assessment model for a multifactorial disease. Community Dent Oral
Epidemiol. 2005;33(4):256-264.
18. Tellez M, Gomez J, Pretty IA, Ellwood RP, Ismail AI. Evidence on existing caries risk assessment systems: are they predictive of future
caries? Community Dent Oral Epidemiol. 2013;41(1):67-78.
19. Cagetti MG, Bontà G, Cocco F, Lingström P, Strohmenger L, Campus G. Are standardized caries risk assessment models effective in
assessing actual caries status and future caries increment? A systematic review. BMC Oral Health. 2018;18(1):123.
20. Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, et al. Powered versus manual toothbrushing for oral
health. Cochrane Database Syst Rev. 2014;(6):CD002281.
21. Walsh T, Worthington HV, Glenny AM, Marinho VCC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental
caries. Cochrane Database Syst Rev. 2019;3(3):CD007868.
22. Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev. 2013;(7):CD002279.
23. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. Evidence-based clinical practice
guideline on nonrestorative treatments for carious lesions. J Am Dent Assoc. 2018;149(10):837-849.e19.
24. Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, et al. Water fluoridation for the prevention of dental
caries. Cochrane Database Syst Rev. 2015;(6):CD010856.
25. Moynihan PJ, Kelly SAM. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res.
2014;93(1):8-18.
26. World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization; 2015.
27. Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, et al. Evidence-based clinical practice guideline for the use of pit-and-
fissure sealants. J Am Dent Assoc. 2016;147(8):672-682.e12.
28. Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-amorphous calcium phosphate: a review. J Dent
Res. 1997;76(9):1587-1595.
29. Amaechi BT, AbdulAzees PA, Okoye LO, Meyer F, et al. Clinical evidence for nano-hydroxyapatite in caries prevention: an updated
review. BDJ Open. 2023;9:36.
30. Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults.
Cochrane Database Syst Rev. 2015;(3):CD010743.
31. Gao X, Lo ECM, Kot SC, Chan KCW. Motivational interviewing in improving oral health: a systematic review. J Clin Periodontol.
2014;41(7):687-697.
32. Kay EJ, Locker D. Is dental health education effective? A systematic review of current evidence. Community Dent Oral Epidemiol.
1998;26(4):231-235.
33. Paris S, Meyer-Lueckel H. Resin infiltration of caries lesions: an efficacy review. Dent Clin North Am. 2010;54(2):325-340.
34. Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and
permanent teeth. Cochrane Database Syst Rev. 2015;(11):CD010431.
35. Gao SS, Zhao IS, Hiraishi N, Duangthip D, Mei ML, Lo ECM, et al. Clinical trials of silver diamine fluoride in arresting dent al caries: a
systematic review. J Dent Res. 2016;95(2):201-210.
36. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries—a review:
report of a FDI task group. Int Dent J. 2012;62(5):223-243.
37. de Amorim RG, Leal SC, Frencken JE. Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis. Clin
Oral Investig. 2012;16(2):429-441.
38. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations
on carious tissue removal. Adv Dent Res. 2016;28(2):58-67.
39. Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst
Rev. 2013;(3):CD003808.
40. Innes NPT, Evans DJP, Stirrups DR. The Hall Technique for managing carious primary molars: a randomized controlled clinical trial.
BMC Oral Health. 2007;7:18.41. Schwendicke F, Gostemeyer G, Stolpe M, Krois J. The Hall Technique for managing carious primary molars: a systematic review and
meta-analysis. J Dent. 2018;73:8-15.
42. Crystal YO, Niederman R. Silver modified atraumatic restorative treatment (SMART): a review. J Calif Dent Assoc. 2016;44(11):763-
768.
43. Schwendicke F, Samek W, Krois J. Artificial intelligence in dentistry: opportunities and challenges. J Dent Res. 2020;99(7):769-774.
44. Lee JH, Kim DH, Jeong SN, Choi SH. Detection and diagnosis of dental caries using a deep learning-based convolutional neural network
algorithm: a systematic review. J Dent. 2018;77:106-111.
45. Schwendicke F, Golla T, Dreher M, Krois J. Convolutional neural networks for dental image diagnostics: a systematic review. J Dent.
2019;91:103226.
46. Pretty IA. Caries detection and diagnosis: novel technologies. J Dent. 2006;34(10):727-739.
47. Gomez J. Detection and diagnosis of the early caries lesion. BMC Oral Health. 2015;15(Suppl 1):S3.
48. Kühnisch J, Bücher K, Hickel R. The clinical performance of quantitative light-induced fluorescence for early caries detection: a
systematic review. J Dent. 2009;37(12):907-913.
49. Machoy M, Seeliger J, Szyszka-Sommerfeld L, Koprowski R, Gedrange T, Woźniak K. The use of optical coherence tomography and
near-infrared imaging in dentistry: a review. J Clin Med. 2020;9(11):3570.
50. Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Huang B, Kruger E, Tennant M. A proof-of-concept evaluation of a cloud-based store-
and-forward telemedicine app for screening for oral diseases. J Telemed Telecare. 2016;22(6):319-325.
51. World Health Organization. Global strategy on digital health 2020–2025. Geneva: World Health Organization; 2021.
52. Pitts NB, Banerjee A, Mazevet ME, et al. Towards prevention and patient-centred, minimally invasive management of dental caries: future
directions in precision cariology. Br Dent J. 2021;231(11):701-707.
53. American Academy of Pediatric Dentistry. Guideline on infant oral health care. Pediatr Dent. 2023;45(6):310-315.
54. American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants, children, and adolescents. Pediatr Dent.
2023;45(6):266-274.
55. Twetman S. Prevention of dental caries in adults through evidence-based interventions. Oral Health Prev Dent. 2019;17(5):393-396.
56. Nicolau B, Marcenes W, Sheiham A. The relationship between oral health promotion and dental caries prevention in older adults and
special care populations. Community Dent Health. 2003;20(4 Suppl):17-24
dental caries. Geneva: World Health Organization; 2025.
2. World Health Organization. Prevention and treatment of dental caries with mercury-free products and minimal intervention. Geneva:
World Health Organization; 2022.
3. Nigel B. Pitts, Svante Twetman, Julian Fisher, et al. Understanding dental caries as a non-communicable disease. Br Dent J.2021;231(12):749–753.
4. Marsh PD, Head DA, Devine DA. Dental plaque as a biofilm and a microbial community—Implications for treatment. Journal of Oral
Biosciences. 2015 Nov;57(4):185–91.
5. CAMBRA Consensus Group. Caries Management by Risk Assessment (CAMBRA): evidence-based clinical practice.
6. ICCMS™. International Caries Classification and Management System™ clinical framework.
7. Fejerskov O, Nyvad B, Kidd EAM, editors. Dental Caries: The Disease and Its Clinical Management. 3rd ed. Oxford: Wiley-Blackwell;
2015.
8. Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017;3:17030.
doi:10.1038/nrdp.2017.30.
9. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;369(9555):51-59.
10. Marsh PD. Are dental diseases examples of ecological catastrophes? Microbiology. 2003;149(Pt 2):279-294.
11. Featherstone JDB. Dental caries: a dynamic disease process. Aust Dent J. 2008;53(3):286-291.
12. Featherstone JDB, Chaffee BW. The evidence for Caries Management by Risk Assessment (CAMBRA®). Adv Dent Res. 2018;29(1):9-
14.
13. American Dental Association. Caries risk assessment and management [Internet]. Chicago (IL): American Dental Association; 2023 [cited
2026 Jul 9]. Available from: https://www.ada.org/resources/ada-library/oral-health-topics/caries-risk-assessment-and-management
14. Pitts NB, Ekstrand KR. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and
Management System (ICCMS™): methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral
Epidemiol. 2013;41(1):e41-e52.
15. Young DA, Featherstone JDB. Caries management by risk assessment. Community Dent Oral Epidemiol. 2013;41(1):e53-e63.
16. Ismail AI, Pitts NB, Tellez M, Hassan A, Sohn W, et al. The International Caries Classification and Management System (ICCMS™): an
example of a caries management pathway. BMC Oral Health. 2015;15(Suppl 1):S9.
17. Bratthall D, Hansel Petersson G. Cariogram—a multifactorial risk assessment model for a multifactorial disease. Community Dent Oral
Epidemiol. 2005;33(4):256-264.
18. Tellez M, Gomez J, Pretty IA, Ellwood RP, Ismail AI. Evidence on existing caries risk assessment systems: are they predictive of future
caries? Community Dent Oral Epidemiol. 2013;41(1):67-78.
19. Cagetti MG, Bontà G, Cocco F, Lingström P, Strohmenger L, Campus G. Are standardized caries risk assessment models effective in
assessing actual caries status and future caries increment? A systematic review. BMC Oral Health. 2018;18(1):123.
20. Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, et al. Powered versus manual toothbrushing for oral
health. Cochrane Database Syst Rev. 2014;(6):CD002281.
21. Walsh T, Worthington HV, Glenny AM, Marinho VCC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental
caries. Cochrane Database Syst Rev. 2019;3(3):CD007868.
22. Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev. 2013;(7):CD002279.
23. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. Evidence-based clinical practice
guideline on nonrestorative treatments for carious lesions. J Am Dent Assoc. 2018;149(10):837-849.e19.
24. Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, et al. Water fluoridation for the prevention of dental
caries. Cochrane Database Syst Rev. 2015;(6):CD010856.
25. Moynihan PJ, Kelly SAM. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res.
2014;93(1):8-18.
26. World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization; 2015.
27. Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, et al. Evidence-based clinical practice guideline for the use of pit-and-
fissure sealants. J Am Dent Assoc. 2016;147(8):672-682.e12.
28. Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-amorphous calcium phosphate: a review. J Dent
Res. 1997;76(9):1587-1595.
29. Amaechi BT, AbdulAzees PA, Okoye LO, Meyer F, et al. Clinical evidence for nano-hydroxyapatite in caries prevention: an updated
review. BDJ Open. 2023;9:36.
30. Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults.
Cochrane Database Syst Rev. 2015;(3):CD010743.
31. Gao X, Lo ECM, Kot SC, Chan KCW. Motivational interviewing in improving oral health: a systematic review. J Clin Periodontol.
2014;41(7):687-697.
32. Kay EJ, Locker D. Is dental health education effective? A systematic review of current evidence. Community Dent Oral Epidemiol.
1998;26(4):231-235.
33. Paris S, Meyer-Lueckel H. Resin infiltration of caries lesions: an efficacy review. Dent Clin North Am. 2010;54(2):325-340.
34. Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and
permanent teeth. Cochrane Database Syst Rev. 2015;(11):CD010431.
35. Gao SS, Zhao IS, Hiraishi N, Duangthip D, Mei ML, Lo ECM, et al. Clinical trials of silver diamine fluoride in arresting dent al caries: a
systematic review. J Dent Res. 2016;95(2):201-210.
36. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries—a review:
report of a FDI task group. Int Dent J. 2012;62(5):223-243.
37. de Amorim RG, Leal SC, Frencken JE. Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis. Clin
Oral Investig. 2012;16(2):429-441.
38. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations
on carious tissue removal. Adv Dent Res. 2016;28(2):58-67.
39. Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst
Rev. 2013;(3):CD003808.
40. Innes NPT, Evans DJP, Stirrups DR. The Hall Technique for managing carious primary molars: a randomized controlled clinical trial.
BMC Oral Health. 2007;7:18.41. Schwendicke F, Gostemeyer G, Stolpe M, Krois J. The Hall Technique for managing carious primary molars: a systematic review and
meta-analysis. J Dent. 2018;73:8-15.
42. Crystal YO, Niederman R. Silver modified atraumatic restorative treatment (SMART): a review. J Calif Dent Assoc. 2016;44(11):763-
768.
43. Schwendicke F, Samek W, Krois J. Artificial intelligence in dentistry: opportunities and challenges. J Dent Res. 2020;99(7):769-774.
44. Lee JH, Kim DH, Jeong SN, Choi SH. Detection and diagnosis of dental caries using a deep learning-based convolutional neural network
algorithm: a systematic review. J Dent. 2018;77:106-111.
45. Schwendicke F, Golla T, Dreher M, Krois J. Convolutional neural networks for dental image diagnostics: a systematic review. J Dent.
2019;91:103226.
46. Pretty IA. Caries detection and diagnosis: novel technologies. J Dent. 2006;34(10):727-739.
47. Gomez J. Detection and diagnosis of the early caries lesion. BMC Oral Health. 2015;15(Suppl 1):S3.
48. Kühnisch J, Bücher K, Hickel R. The clinical performance of quantitative light-induced fluorescence for early caries detection: a
systematic review. J Dent. 2009;37(12):907-913.
49. Machoy M, Seeliger J, Szyszka-Sommerfeld L, Koprowski R, Gedrange T, Woźniak K. The use of optical coherence tomography and
near-infrared imaging in dentistry: a review. J Clin Med. 2020;9(11):3570.
50. Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Huang B, Kruger E, Tennant M. A proof-of-concept evaluation of a cloud-based store-
and-forward telemedicine app for screening for oral diseases. J Telemed Telecare. 2016;22(6):319-325.
51. World Health Organization. Global strategy on digital health 2020–2025. Geneva: World Health Organization; 2021.
52. Pitts NB, Banerjee A, Mazevet ME, et al. Towards prevention and patient-centred, minimally invasive management of dental caries: future
directions in precision cariology. Br Dent J. 2021;231(11):701-707.
53. American Academy of Pediatric Dentistry. Guideline on infant oral health care. Pediatr Dent. 2023;45(6):310-315.
54. American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants, children, and adolescents. Pediatr Dent.
2023;45(6):266-274.
55. Twetman S. Prevention of dental caries in adults through evidence-based interventions. Oral Health Prev Dent. 2019;17(5):393-396.
56. Nicolau B, Marcenes W, Sheiham A. The relationship between oral health promotion and dental caries prevention in older adults and
special care populations. Community Dent Health. 2003;20(4 Suppl):17-24
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