Patient caries status in the context of practical, evidence-based management of the initial caries lesion.

This consideration of the determination of patient caries status in the context of practical, evidence-based management of the initial caries lesion relates to assessments of caries in individuals. It provides the diagnostic basis for the related topics of radiographic monitoring, caries activity testing, and lesion management strategies that follow in subsequent papers. The "totality" of caries experience must be recognized in making individual assessments; this ranges from sub-clinical, to initial, and then dentinal (including hidden) lesions. The detection of initial and dentine lesions using existing diagnostic tools is imperfect and to an extent unreliable, but, notwithstanding the limitations of existing technology, this step is of pivotal importance. Similarly, the measurement of lesion extent and depth by existing methods is problematic but possible. Having identified different types of caries, categorization of lesions by the appropriate management "option" permits clear statements of intent to be made to both patients and dental funding agencies. The NAC/PCA/PCA + OCA system is suggested as a simple and explicit method of describing caries status for individual lesions and for communicating their current caries status to patients.