Overview of Treatment

-An ms test should be used in patients that are in the moderate and hight risk category.  Bacterial levels under 100,000 indicate a caries inactive status and this level should be achieved before any permanent restorative procedures are invoked. Caries activity assessment will also be aided by evaluating the appearance and texture of white spot lesions and cavitated lesions.  Treatment to control ms consists mainly of 2-3 weeks, 1/2 oz before bed rinsing with chlorhexidine (CHX).  Along with this the following is also performed:

-All cavitated lesions should have caries removed and are restored with glass ionomer on a temporary basis.

-Smooth surface incipient lesions (non-cavitated) with caries not extending greater than 1/3 of the way through the dentin, are treated with a remineralization protocol. This consists of:

1. Have the patient use a home fluoride rinse (.05%) or fluoride varnish. In patients where you suspect caries may be hard to control use 1.1% NaF, prevident.
2. The patient should chew 2 sticks of Xylitol gum for 5 minutes 5 times/day especially after meals.
3. Stress diet compliance.
4. Stress measures to maintain normal salivary flow.
   -After 1-2 months an ms test should be used to assess bacterial levels and assess white spot lesions for remineralization (hard, smooth enamel surface).
5. Once the patient is under bacterial control (ms levels < 100,000) complete those teeth requiring permanent restorations.

-Recall the patient every 3-4 months to monitor for the first year.

-Incipient pit and fissure caries (non-cavitated) with caries not extending greater than 1/3 of the way through the dentin, are treated with a fluoride release sealant and also use CHX and other treatments as outlined above.

-Root caries, in the very early stages (if non-cavitated), can have a remineralization protocol as outlined above.  The protocol is similar to that listed for smooth surface incipient lesions.  Deeper, cavitated lesions use glass ionomers.  As in all other patients, ms levels must be controlled as previously outlined.

References
1. Benn DK Practical evidence based management of the initial caries lesion. JDent Educ 1997; 61(11):853-854.
2. Pitts NB. Patient caries status in the context of practical, evidence-based management of initial caries lesion. fDent Educ 1997; 61(1 1):861-865.
3., Benn DK.Dankel DD, Clark D, Lesser RB, Bndgewater AB. Standardizing data collection and decision making with an expert system. .JDentEduc 1997; 61(11):885-894.
4. Suddick RB Dodds MM. Caries activity estimates and implications:Insights into risk versus activity. J Dent Educ 1997; 61(11):87~884.
5. TanzerjM. Salivary and plaque microbiological tests and the management of dental caries. JDent Educ 1997; 61(11):86~873.
6. Brown JR Indicatoes for caries management from the patient history. JDent Educ 1997; 61(1 1):855-860.