The best evidence for deciding which treatment is appropriate and when has been assembled by a group of 75 international academics and practitioners in a cyclical format with four main elements which together lead to beneficial patient outcomes (see Fig. 1.2). These elements are:

Leading to OUTCOMES assessed in the domains of health maintenance, disease control, patient-centred quality metrics and wider impacts on systems and society.

Important features of the ICCMS^TM are that it is risk based. For some years there have been groups advocating the CAMBRA philosophy (Caries Management by Risk Assessment), and in terms of planning appropriate recall strategies for patients, the UK National Health Service’s National Institute for Clinical Excellence (NICE) convened a guideline development group to look at the evidence in this area. They recommended that for dental recall, the interval between routine dental examinations should be personalised and risk based (NICE 2004). For caries management this means monitoring and review is required.

Figure 1.3 shows the key components of the clinical caries management element of care. These are all underpinned by risk management strategies and comprise (a) preventing new caries for sound surfaces; (b) nonoperative care of lesions, that is, caries control using remineralisation strategies including fluorides and newer methods; and (c) as a last resort – tooth-preserving operative care of lesions that cannot be arrested or reversed or are to extensive when a patient is first seen.