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Catching and Treating Dental Caries Early

Date: November, 2020

Author: Jessica Raymond-Allbritten CRDH BASDH

Dental caries is one of the most prevalent diseases worldwide. A significant percentage of the population also has untreated dental caries. According to the US Centers for Disease Control and Prevention (CDC), for 2015-2016, the prevalence of dental caries was 45.8% for children aged 2 to 19 years, and 13% of children in the same age group had untreated caries. Among adults aged 20 to 44 years, for 2013-2016, 31.6% had untreated dental caries. Untreated dental caries can lead to progressively larger lesions, pain, infection, and even tooth loss. There are several factors that affect a person’s caries risk. Lifestyle, dietary habits, oral care, medications, and/or systemic conditions are factors that play a role in risk for dental caries. Depending on a person’s caries risk level, preventive treatment may be needed. Should dental caries occur, catching it early is important.

Process of Dental Caries

Dental caries is a dynamic process involving cycles of demineralization and remineralization. When cariogenic bacteria produce acids this causes an acid attack that can lead to demineralization. In cases where remineralization does not occur or is insufficient, demineralization progresses. In the early phase of this, incipient caries are present which may or may not be visible to the naked eye as white spot lesions. If demineralization progresses, dental caries will reach dentin. With unhindered progression, cavitation occurs.

Preventive care based on caries risk is essential to help prevent dental caries. If it does occur, by catching dental caries early it is possible to implement care that can halt or reverse the caries lesion.

Catching Dental Caries Early Tips for Caries Detection

A visual and tactile examination, together with radiographs, can detect incipient lesions. White spot lesions typically develop adjacent to fixed orthodontic appliances and may also be visible in patients in general the cervical area near the gingival margin or adjacent to existing restorations. Blowing air to thoroughly dry these areas will help aid in caries detection. Although the sharp end of a probe should not be used to check for sticky or softish areas, the side of an explorer, rounded explorer or a ball probe can be gently passed over a white spot to see if it is smooth or rough. A rough surface suggests active dental caries. Radiographs are recommended periodically, based on age and caries risk level. These show early approximal lesions, which are usually not visible to the naked eye until more advanced. Adjunctive devices are also available. Regular dental visits are necessary for routine examinations, preventive care, and other care that may be needed. Regular visits also make it possible to catch dental caries early, should it have occurred. Patients with a higher caries risk may benefit from a more frequent hygiene re-care schedule.

Managing Caries Lesions

A dental professional should assess a patient’s caries risk level when developing a caries-prevention plan. Where the patient lives, the fluoride content of their drinking water, home care products used, the patient’s overall health, and dietary habits should all be considered. Patients with a low caries risk may not need additional fluoride treatments other than fluoridated water and twice-daily use of over-the-counter fluoride toothpaste, whereas a patient with a higher risk will benefit from additional topical fluorides. These additional sources include 5% sodium fluoride varnish and prescription-level fluoride toothpaste.

The in-office application of fluoride varnish two to four times per year is recommended for both children and adults at elevated risk for dental caries. While this method is an “off label” use, it has been proven effective in caries management. In a Cochrane Review assessing results of studies in children and adolescents, it was found that the use of fluoride varnish is effective in preventing dental caries when applied two to four times per year, with a substantial reduction in incremental caries.

Colgate PreviDent Varnish is a great fluoride varnish to offer to your patients and has a pleasing taste. It is provided in a unit-dose, and provides for a quick, easy and smooth application. At home use of a prescription-level fluoride toothpaste containing 5000 ppm fluoride provides patients at risk for caries with extra fluoride on a daily basis. Its use is recommended for patients aged 6 years and over. Colgate PreviDent 5000 Booster Plus delivers four times the fluoride of over-the-counter toothpaste, increasing protection against dental caries. It has been proven to help reverse white spot lesions and to remineralize root surface caries.

Conclusion

Dental caries remain prevalent across the world. It is every clinician’s duty to check for incipient caries at every visit in order to recommend and provide appropriate preventive care. If caught early, incipient lesions can be arrested/reversed. Fluoride prescription toothpaste and fluoride varnish are great treatment modalities in caries prevention and management.