An Agreed Terminology for Carious Tissue Removal

Understanding the carious process as a biofilm disease rather than an infectious disease has changed lesion management focus towards less invasive options. This has led to new and ongoing changes in recommendations for practitioners. However, the lack of clarity over what to do, and when, is complicated by different teaching, research, and policy documents containing different terms and definitions for carious lesions and management strategies. Lack of clear messages and communication over recommendations hampers moving evidence into practice. The International Caries Consensus Collaboration (ICCC) recommendations on terminology are one part of improving communication for discussing the diagnosis and management of dental caries and dental carious lesions. The term dental caries is the name of the disease, its use being limited to situations involving control of the disease using preventive and non-invasive measures at the patient level. Carious lesion management should be used where management is directly related to disease symptoms at the tooth level. As terminology cannot be used to directly relate the visual appearance of the carious lesion to the histopathology, the terms have been based around the clinical consequences of the disease: soft, leathery, firm and hard dentine. The 3 main carious tissue removal options are described as: (1) selective removal of carious tissue (to both soft and firm dentine), (2) stepwise removal, and (3) non-selective removal to hard dentine (previously known as complete removal and no longer recommended). Use of these terms across clinicians, researchers, dental educators, and even with patients, will help improve understanding and communication.