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In the present study, it was found that people with better socio-economic position had fewer treatment needs for dental caries, lower experience of dental extractions, and a higher experience of receiving restorative care. While these trends held when contrasting various indicator variables – such as access to health insurance (public or private), higher level of formal schooling of the mother and father, and socio-economic position according to occupation – it was evident that one fundamental indicator was whether the mother could read and write. Because this is a single variable, with little apparent confusion or self-report bias, it may be a high sensitivity question to discriminate between those who have and those who do not have better oral health profiles. The present study has limitations that must be taken into account to correctly interpret the findings. First, its cross-sectional design may lead to inaccuracies in estimating cause and effect. Also, resorting to self-reported variables introduces possibly biased perspectives that study participants might have of their own situations. In terms of strengths, we have proposed an individual- and a population-level indicator of tooth extractions; this tool will allow comparisons between population groups, over time in the same group. In conclusion, we can say that in this population of Mexican adolescents, we observed some unmet treatment need for dental caries (TNI) and little experience of restorative treatment (CI). Although the experience of extractions (TEI) was limited, the fact that there were some extracted teeth at these early ages can serve as an indicator of poor oral health and restricted dental service utilization for future comparisons. While it is generally necessary to expand programs aiming at the prevention of dental caries, putting special attention on the physical, biological, cultural and access characteristics for different age groups appears necessary to effectively address unmet oral health needs of adolescents. Purpose The American Academy of Pediatric Dentistry (AAPD) intends these recommendations to help practitioners make decisions regarding restorative dentistry, including when it is necessary to treat and what the appropriate materials and techniques are for restorative dentistry in children and adolescents. Methods These recommendations originally were developed by the Restorative Dentistry Subcommittee of the Clinical Affairs Committee and adopted in 1991.1 The last comprehensive revision by the Council of Clinical Affairs of this document was in 2014,2 and an addition regarding the Hall technique (HT) for preformed metal crowns was added in 2016.3 A thorough review of the scientific literature in the English language pertaining to restorative dentistry in primary and permanent teeth was completed to revise the previous guideline. Electronic database and hand searches, for the most part between the years 2000-2019, were conducted using the terms: dental caries, intra-coronal restorations, restorative treatment decisions, caries diagnosis, caries excavation, dental amalgam, glass ionomers, resin modified glass ionomers, conventional glass ionomers, atraumatic/alternative restorative technique (ART), interim therapeutic restoration (ITR), resin infiltrations, resin based composite, dental composites, compomers, full coverage dental restorations, stainless steel crowns (SSC), Hall technique, primary molars, preformed metal crowns, strip crowns, pre-veneered crowns, zirconia crowns, esthetic restorations; parameters: clinical trials, randomized controlled clinical trials (RCTs). Full evaluation and abstraction included examination of the clinical efficacy on specific restorative dentistry topics, research methods, and potential for study bias (e.g., patient recruitment, randomization, blinding, subject loss, sample size estimates, conflicts of interest, statistics). Research that was considered deficient or had high bias was eliminated. In those topic areas for which there were rigorous meta-analyses or systematic reviews available, only those clinical trial articles that were not covered by the reviews were subjected to full evaluation and abstraction. The assessment of evidence for each topic was based on a modification of the American Dental Association’s grading of recommendations: strong evidence (based on well-executed RCTs, meta-analyses, or systematic reviews); evidence in favor (based on weaker evidence from clinical trials).4 When to restore Historically, the management of dental caries was based on the belief that caries was a progressive disease that eventually destroyed the tooth unless there was surgical and restorative intervention.5 It is now recognized that restorative treatment of dental caries alone does not stop the disease process,6 and restorations have a finite lifespan. Conversely, some caries lesions may not progress and, therefore, may not need restoration. Contemporary management of dental caries includes identification of an individual’s risk for caries progression, understanding of the disease process for that individual, and active surveillance to assess disease progression and manage with appropriate preventive services, supplemented by restorative therapy when indicated.7,8 With the exception of reports of dental examiners in clinical trials, studies of reliability and reproducibility of detecting dental caries are not conclusive.9 There also is minimal information regarding validity of caries diagnosis in primary teeth,5 as primary teeth may require different criteria due to thinner enamel and dentin and broader proximal contacts.10 Furthermore, indications for restorative therapy only have been examined superficially because such decisions generally have been regarded as a function of clinical judgment.11 Decisions for when to restore caries lesions should include at least clinical criteria of visual detection of enamel cavitations, visual identification of shadowing of the enamel, and/or
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