According to Dr. V. Kim Kutsch, there are 3 prescriptive phases when treating dental caries.
The 3 prescriptive phases include:
- Reparative: remineralization, restoration
- Therapeutic: antimicrobial therapy, metabolic strategies and pH strategies
- Behavioral: homecare, diet, medications, special needs
In this article we will focus on reparative strategies
1. Remineralization (Fluoride)
“Fluoride varnish seems to be an effective treatment for the reversal of incipient carious lesions in primary and permanent dentition; however, further clinical trials concerning efficacy of topical fluorides for treating those lesions are still required, mainly regarding the fluoride gel.” (Lenzi TL, Montagner AF, Soares FZ, de Oliveira Rocha R. Are topical fluorides effective for treating incipient carious lesions?: A systematic review and meta-analysis. J Am Dent Assoc. 2016 Feb;147(2):84-91. Sys Rev, 754>21>5>3)
2. Prevention (Sealants)
“Pupils with 4 FS showed the lowest number of teeth with caries. Children with an early application of FS had a lower D-component than children with a later or missing application. Pupils with less than 4 FS had a higher risk of developing caries in their permanent dentition compared to peers with 4 FS (OR 4.36).” (Heinemann F, Ifland S, Heinrich-Weltzien R, Schüler IM. [Influence of Fissure Sealants on Dental Health of Elementary School Children in Weimar – A Longitudinal Observational Study under Real-life Conditions]. Gesundheitswesen. 2015 Dec 2. [Epub ahead of print][Article in German]505 7-10yr/o, 5yr
Conclusion: FS is an effective caries preventive measure under real-life conditions. Early application and sealing of all 4 molars can optimize the prevention of caries in the permanent dentition.
3. Restoration (Drill and Fill)
According to a survey of nearly 17,000 dentists showed wide diversity in when lesions were restored and when the doctor would wait and attempt remineralization strategies.
Investigators use questionnaire surveys to evaluate treatment philosophies in dental practices. The aim of this study was to evaluate the management strategies California dentists use for approximal and occlusal caries lesions.
In May 2013, the authors e-mailed a questionnaire that addressed approximal and occlusal caries lesion management (detection and restorative threshold, preferred preparation type, and restorative materials) to 16,960 dentists in California. The authors performed a χ2 statistical analysis to investigate the relationship between management strategies and respondent demographic characteristics.
The authors received responses from 1,922 (11.3%) dentists; 42.6% of the respondents would restore approximal lesions at the dentinoenamel junction, and 33.4% would wait until the lesion reached the outer one-third of dentin. The preferred preparation type was the traditional Class II preparation. Dentists who graduated more recently (20 years or less) were more likely to delay approximal restorations (P < .0001); 49.9% of the more recent graduates would wait to restore an occlusal lesion until the outer one-third of dentin was involved, and 42.6% would restore a lesion confined to enamel.
There is wide variety among California dentists regarding their restorative treatment decisions, with most dentists restoring a tooth earlier than the literature would advise. More recent dental graduates were more likely to place their restorative threshold at deeper lesions for approximal caries lesions.
Clinical evidence shows that noncavitated caries lesions can be remineralized; therefore, early restorative treatment may no longer be necessary or appropriate. Noninvasive and minimally invasive measures should be taken into consideration. (Rechmann P, Doméjean S, Rechmann BM, Kinsel R, Featherstone JD. Approximal and occlusal caries lesions: Restorative treatment decisions by California dentists. J Am Dent Assoc. 2016 Feb 9. pii: S0002-8177(15)01037-5. doi: 10.1016/j.adaj.2015.10.006. [Epub ahead of print)