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In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc. which focused on the imperative for change in academia, clinical practice, and public health. For decades, new scientific evidence on caries and how it should be managed have been discussed among experts in the field. However, there has been some limited change, except in some Scandinavian countries, in the models of caries management and reimbursement which have been heavily skewed toward 'drilling and filling'. There is no overall agreement on a caries' case definition or on when to surgically intervene. The participants in the workshop defined a new mission for all caries management approaches, both conventional and new. The mission of each system should be to preserve the tooth structure, and restore only when necessary. This mission marks a pivotal line for judging when to surgically intervene and when to arrest or remineralize early noncavitated lesions. Even when restorative care is necessary, the removal of hard tissues should be lesion-focused and aim to preserve, as much as possible, sound tooth structure. Continuing management of the etiological factors of caries and the use of science-based preventive regimens also will be required to prevent recurrence and re-restoration. These changes have been debated for over a decade. The Caries Management Pathways includes all systems and philosophies, conventional and new, of caries management that can be used or modified to achieve the new mission. The choice of which system to use to achieve the mission of caries management is left to the users and should be based on the science supporting each approach or philosophy, experience, utility, and ease of use. This document also presents a new 'Caries Management Cycle' that should be followed regardless of which approach is adopted for caries prevention, detection, diagnosis, and treatment. To aid success in the adoption of the new mission, a new reimbursement system that third party payers may utilize is proposed (for use by countries other than Scandinavian countries or other countries where such systems already exist). The new reimbursement/incentive model focuses on the mission of preservation of tooth structure and outcomes of caries management. Also described, is a research agenda to revitalize research on the most important and prevalent world-wide human disease. The alliance of major dental organizations and experts that started in Philadelphia will hopefully propel over the next months and years, a change in how caries is managed by dentists all over the world. A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation of sound teeth rather than counting the number of surgical restorative procedures provided., (© 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Objectives: To use a novel statistical analysis in the development of caries risk assessment models for preschool children for use in a particular community setting., Methods: Data were collected longitudinally on a cohort of approximately 1500 children born in one calendar year in the city of Dundee, Scotland. A dental examination and oral microbiological saliva sample, together with parental and health visitor questionnaires, were completed for each child at ages 1, 2, 3 and 4 years. The 1-year data were analysed using chi-squared automated interaction detector analysis (CHAID) to produce a set of caries risk assessment models for predicting caries in 4-year-olds., Results: Four risk models were developed using CHAID analysis for caries at 4 years of age using risk assessment data collected at age 1. These models included two 'any' caries-risk models (n = 697, dmft >0) and two 'high' caries-risk models (n = 784, dmft ≥3) depending on the use of the d(1) (enamel and dentine) or d(3) (dentine only) level of caries detection. The most appropriate model developed for use was shown to be the CHAID high caries-risk model at the d(3) level of detection (d(3) mft ≥3). This had a sensitivity of 65% and specificity of 69%., Conclusions: An appropriate risk assessment model for use in a particular community setting predicting caries at age 4 years from data collected at age 1 year was developed. This has been termed the Dundee Caries Risk Assessment Model., (© 2011 John Wiley & Sons A/S.)

Currently a range of systems and classifications are used by clinicians, epidemiologists and clinical research workers to sub-divide carious lesions into different grades. These systems are based on the depth of the lesion and/or the presence/absence of macroscopic cavitation. In order to improve upon the meaningfulness and comparability of such systems in the light of increasing knowledge about the disease process, lesion behaviour and caries management options, the authors propose a new system of categorisation that differentiates between lesions which normally require operative intervention and those which do not. In future, it is proposed that in addition to existing conventional criteria, diagnostic systems should also allow results to be expressed in terms of 1) lesions for which appropriate non-invasive Preventive Care Is Advised (PCA lesions) and 2) lesions for which Operative Care Is Advised (OCA lesions). Locally acceptable sub-divisions may have to be developed and agreed for certain specific applications. The adoption of this additional nomenclature and approach in the future should aid communications between the different groups involved in caries diagnosis and research. It may facilitate the dissemination of research findings, as well as helping to "drive" researchers working on caries diagnostic methods to focus on techniques which will aid in the accurate assessment of lesion activity and behaviour. Such a focus should also increase our understanding of treatment decision making and promote the development of clinical guidelines. The facility to retain existing criteria in parallel, for local and other purposes, would preserve comparability with data collected previously.