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Site-specific prevention

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Site-specific prevention

Suitable for:

  • a primary tooth with an initial lesion in an occlusal or proximal surface
  • a primary anterior tooth with an initial lesion
  • a primary tooth with arrested caries or when the tooth is close to exfoliation
  • a permanent tooth with an initial lesion in a proximal surface
  • a permanent anterior tooth with an initial lesion

Aim: To stop enamel caries progressing and promote remineralisation of initial lesions.

The evidence that this approach can be effective is mainly for permanent teeth. Children are likely to find this more acceptable than more invasive techniques but success will be reliant on the parent/carer and child changing their oral health behaviours (see Behaviour change). 

Show the parent/carer and child the carious lesions and explain the proposed treatment and the important role that they have in its success. 

Ensure that the child or young person, or in the case of younger children their parent/carer, are made fully aware of their role and responsibility for the success of this approach. 

If this approach is acceptable and agreed, provide site-specific prevention as follows.

  • Demonstrate effective brushing of the lesion (e.g. to brush a multi-surface lesion may require the brush to be moved laterally).
  • Give dietary advice.
  • Apply fluoride varnish to the lesion four times per year. 

Keep a record of the site and extent of the lesion to enable active surveillance and an alteration of the treatment plan if the lesion does not arrest, for example, via radiographs or photography (see SDCEP Oral Health Assessment and Review guidance for further details).

Record details of the agreed treatment in the patient’s notes. At each visit, assess for the presence or absence of plaque biofilm on the surface of the lesion and consider recording plaque scores (see Assessing toothbrushing). If the child or parent/carer cannot keep the lesion free from plaque, consider an alternative management strategy.

Review the lesion after three months and if active lesions are not arrested (or showing signs of arresting) or previously inactive lesions have become active, then consider an alternative strategy.

  • Although radiographs are necessary for active surveillance of proximal lesions, the minimum recommended interval for taking bitewing radiographs is six-monthly.27

Continue to provide Enhanced Prevention as described in Caries prevention.