The concept of using evidence to guide clinical decision-making was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada in the 1990s. They established a new paradigm for medical education designed to incorporate current research into education and practice to enable practitioners to provide the best care for their patients (1). Evidence-based health care utilizes a systematic process to critically appraise the health related scientific evidence for validity, and then apply the evidence to patient care while considering patients’ preferences, values and circumstance.

Clinical management protocols based on evidence-based medicine/dentistry provide standardized care regarding diagnosis, prevention and treatment of a disease, and are frequently used in medicine to improve quality of care. They are based on evidence from current literature, the judgment of expert panels, and the clinical experience of practitioners. Caries management protocols are dependent on a specific patient’s risk levels.

The illustration from the AAPD Guidelines on Caries-risk Assessment and Management for Infants, Children, and Adolescents is based on results of clinical trials, systematic reviews, and expert panel recommendations.  Similar protocols have demonstrated better clinical outcomes and more cost-effective caries treatment for preschool children.  Additionally, clinical protocols have the potential to standardize decision making and treatment strategies and foster appropriate levels and preventive care and restorative procedures. The basis for these protocols includes identification of an individual’s risk for caries, early detection of noncavitated lesions, and “active surveillance” to apply appropriate preventive measures and to monitor disease arrestment/progression.