risk patient: Caries active
risk patient: Caries inactive
This patient has several white spot
lesions, none of which are cavitated. These lesions are caries active
(enamel surface rough and not shiny).
Bacterial exam is not required. Caries
activity is assessed through the texture and appearance of the white spot lesion.
The appearance of the enamel surface indicates that ms infection is present.
Remember that the ms infectious stage alone, without any enamel surface
damage, is the first phase of the dental caries process. Therefore, bacterial
the infection) is the first procedure indicated before proceeding.
Caries progression from the enamel
surface to the DE junction takes approximately 3-4 years in adults.
It takes approximately 2-2 1/2 years in primary teeth
Once the infection control is initialted,
a remineralization protocol is statred (see below). Pit and fissures
are treated best with the use of fluoride releasing sealants.
- On smooth surfaces, if x-rays
indicate that penetration is >25% through the dentin and there is no cavitation,
the incipient lesions should be restored. If penetration into the dentin
is less and the enamel calcifying matrix is intact (no cavitation), this lesion
should treated with a remineralization protocol and watched. Six month
or yearly x-rays should be taken of this area to monitor the status of the
lesions. If the patient has the ms population controlled, lesions should
not progress. Studies(2) have demonstrated that most incipient
lesions (with limited dentin penetration) may remain dormant or even regress
and heal with treatment.
has shown that bonded or sealed restorations placed over
frank cavitated lesions arrested their clinical progress.
a remineralization treatment the following considerations are important:
- 1. Host factors
- Salivary flow status maintained.
- Fluoride usage maintained.
- Oral hygiene maintained and
- 2. The diet
must be monitored.
- 3. Bacterial
levels should now be low since caries is not active.
protocol of caries active white spot lesions (no cavitation).
to enhance remineralization:
- 1: Daily home fluoride
rinse (.05%) or apply fluoride varnish. (various types of fluoride preperations
and more on remineralization).
- 2: Stress diet compliance.
- -Use of Xylitol gum.
2 sticks, 5 x/day, chew 5
products such as cheese
and milk since human studies (3) suggest that the phosphoprotein, casein,
and calcium phosphate may be anticariogenic (present in Trident Advantage gum--Recaldent).
chewing this gum provides calcium phosphate on the tooth surface for
- 3: Maintain normal salivary
- 4: Maintain oral hygiene.
- After the office and home
care treatment are completed:
- -Home fluoride rinse (.05%)
during the first year after therapy is completed.
- -Stress diet compliance.
- -Stress use of Xylitol gum
especially after meals and snacks.
2 sticks 5x/day for 5 minutes.
- -Recall every 3-4 months to
monitor white spot lesions and preventive maintenance for 1 year. By the
end of this time period the patient should be able to be classified into
the low caries risk category. If not, the patient will be reassessed.
- 1. Pitts F, Lond, FR, Current Methods
and and Criteria for Caries Diagnosis in Europe. 53:409-24, 1993
2.Anusavice KJ, Efficacy of nonsurgical management of the initial caries lesion.
J Dent Educ, 1997,61:895-905.
3. Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized
calcium phosphate solutions. J.Dent.Res 1997;76:1587-1595..
Arnold D. Steinberg, 2001.