Effectiveness of the Non-restorative Cavity Control (NRCC) Approach in Managing Dentinal Caries in Primary Teeth: A Systematic Review

TL;DR

This systematic review finds that non-restorative cavity control methods, like silver diamine fluoride, are effective and well-accepted for managing tooth decay in children's primary teeth.

Contribution

The study provides updated evidence supporting non-restorative cavity control as a preferred approach over traditional restorative methods for dentinal caries in primary teeth.

Findings

38% silver diamine fluoride (SDF) effectively arrested dentinal caries with minimal application.

SDF was well accepted by children and parents despite aesthetic concerns.

Restorative techniques like the Hall technique showed higher survival rates than SDF in one study.

Abstract

Early childhood caries (ECC) is a highly prevalent, transmissible, and infectious disease affecting 60-90% of children worldwide. Conventional restorative therapy has traditionally been the mainstay of ECC management, but it often shows unfavorable outcomes in pediatric populations. Recently, there has been a shift toward minimally invasive interventions or non-restorative cavity control (NRCC). This review evaluated the effectiveness of NRCC in managing dentinal caries in primary teeth. A comprehensive search was conducted in Scopus, PubMed, MEDLINE, and Web of Science using keywords related to NRCC and primary dentition. Inclusion criteria were peer-reviewed randomized clinical trials (RCTs) published from 2015 to 2025, involving children ≤12 years with active dentinal lesions scored using the International Caries Detection and Assessment System (ICDAS) form 3 to 6. Studies were assessed for quality and risk of bias using the Cochrane Risk of Bias 2 (ROB-2) tool. Nine RCTs were finally included in the review. Most studies demonstrated that 38% silver diamine fluoride (SDF) effectively arrested dentinal caries, even with minimal application (30 seconds). One study reported that restorative techniques, such as the Hall technique, had higher survival rates than SDF. Nevertheless, SDF was well accepted by children and parents, who reported high satisfaction. Current evidence supports NRCC over conventional restorative therapy for managing dentinal caries in primary teeth. Despite aesthetic concerns, SDF remains an effective, safe, feasible, and well-accepted option for children and parents.

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