Treatment of caries in relation to lesion severity: Implications for minimum intervention dentistry D.S. Brennan * , M. Balasubramanian, A.J. Spencer Australian Research Centre for Population Oral Health School of Dentistry, Faculty of Health Sciences, The University of Adelaide, 122 Frome Street, Adelaide 5005, SA, Australia 1. Introduction Long-term trends in oral health of Australian children have shown marked declines in caries in the permanent dentition of 12 year-olds, but untreated decay in one or more teeth still affected between 28.5% and 42.6% of children aged 5 to 12 years. 1 While there has been a marked decline in edentulism among adults in Australia, 2–4 caries remains prevalent affecting approximately a quarter of adults. 5 Among adult private dental patients in Australia approximately a quarter had a main diagnosis of caries, and these patients had a pattern of dental treatment characterized by higher rates of extraction, end- odontic and restorative services. 6 Further, adult patients with a main diagnosis of caries were reported to have more oral health impacts and a worse general health state. 7 Caries is of public health significance as it a major reason for tooth loss among adults. 8–15 Retention of teeth is associated with having a healthy diet, 16 a satisfactory nutritional status, and acceptable body mass index. 17 Tooth loss is also associated with oral health impacts, general health state and well-being. 18 In managing the dental care needed to address the high burden j o u r n a l o f d e n t i s t r y 4 3 ( 2 0 1 5 ) 5 8 – 6 5 a r t i c l e i n f o Article history: Received 8 August 2014 Received in revised form 20 October 2014 Accepted 24 October 2014 Keywords: Dental service provision Minimum intervention dentistry Private general practice Restorative services a b s t r a c t Objectives: To date there is little evidence of minimum intervention in relation to treatment patterns, particularly for initial carious lesions. The objective of this study was to investigate treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion. Methods: A random sample of Australian dentists was surveyed by mailed questionnaires in 2009–2010 (response rate 67%). Data on services, patient characteristics and main diagnosis were collected from a service log. Results: Models of service rates adjusted for age, sex, insurance status and reason for visit showed that compared to the reference category of gross caries lesions, there were higher rates [rate ratio, 95% CI] of restorative services for initial [1.63, 1.31–2.03] and cavitated [1.69, 1.39–2.05] lesions, higher rates of prophylaxis for initial [3.77, 2.09–6.79] and cavitated [3.88, 2.29–6.58] lesions, lower rates of endodontic services for initial [0.07, 0.02–0.30] and cavitated [0.11, 0.04–0.30] lesions, and lower rates of extraction for initial [0.15, 0.06–0.34] and cavitated [0.15, 0.07–0.31] lesions. Conclusions: Treatment of coronal caries was characterized by high rates of restorative services, but gross lesions had lower restorative rates and higher rates of endodontic and extraction services. There was little differentiation in treatment of coronal caries between initial and cavitated lesions, suggesting scope for increased management of initial carious lesions by the adoption of more minimum intervention approaches. # 2014 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +61 8 8313 4046; fax: +61 8 8313 3070. E-mail address: david.brennan@adelaide.edu.au (D.S. Brennan). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden http://dx.doi.org/10.1016/j.jdent.2014.10.009 0300-5712/# 2014 Elsevier Ltd. All rights reserved.