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T
he modern understanding of caries has shifted diagnosis at both tooth/surface and patient levels.4
from the traditional concept of caries being As a result, the clinical, epidemiological, research,
only an endpoint—a cavity—towards the car- and educational implications of caries management
ies process itself, especially since there is evidence need to be considered.
that the caries process can be arrested, mainly in its Even though the prevalence of caries has
first manifestations.1-3 These changes have had at declined worldwide, in developing countries such
least three consequences in the conception of caries as those in Latin America, caries continues to be a
and the clinical diagnosis process: 1) there are dif- public health problem5 associated with barriers to
ferent degrees of caries severity, involving enamel health care access and economic, educational, and
and dentin lesions; 2) visual examination has become social inequalities.6-8 The responsibility for develop-
more reliable for caries detection and assessment; and ment of appropriate oral health care as the basis for
3) caries management is no longer considered to rely clinical decision making should be with the dental
solely on operative treatment but includes non-op- schools,9 and education of future practitioners must
erative strategies, so that treatment decisions should follow an evidence-based curriculum.10 Like dental
be made according to a comprehensive synthesis of schools in North American and European countries
Figure 3. Visual-tactile operative treatment decision thresholds at responding dental schools (n=54)