Caries Excavation: Evidence Gaps

Dental caries, the most common chronic disease in the world, affects over 3 billion people globally. Its management comprises a large proportion of dental care providers' clinical responsibility, yet despite the extensive evidence base for the management of cavitated carious lesions, gaps in the evidence persist. This promotes uncertainty and debate among providers. This chapter reiterates the 3 key components of evidence-based practice (EBP): clinical expertise, an awareness and appreciation of patient values, and use of best available evidence. Secondly, we give a brief summary of current best evidence pertaining to some key areas of caries excavation in the context of lesion management, and highlight respective gaps in the evidence. Consideration is given to the state of the evidence for: how carious-lesion excavation is best achieved, the extent to which excavation should occur, contemporaneous practice, the timing of dental intervention in relation to the extent of the disease, and some areas of contention. Finally, there is discussion around how dental care providers might proceed when high-quality evidence does not exist to inform that part of the EBP collective.