Dental caries is the term used to
describe the symptoms and signs caused by chemical demineralisation in an area
of the tooth that is covered with a biofilm. Caries activity and caries risk
allows a dentist to carry out a diagnosis and prognosis which then leads to the
formation of a treatment plan. Patients are presented with a treatment using a
medical model consisting of four steps: bacterial control; reduction of risk
levels for at-risk patients; reversal of active sites by remineralization; and
follow-up and maintenance.

Bacterial control in the oral cavity
can be achieved by two methods. Surgical antimicrobial or Chemotherapeutic
antimicrobial. Surgical antibiotic control should only be used when there is
active caries with cavitation, then only should a dentist remove tooth
structure and replace with restorative material. Indication for restorative
treatment is when the tooth is sensitive to hot, cold or sweet; when occlusal
and proximal lesions extend into dentin and the pulp is endangered; if previous
attempts to arrest the lesion have failed and the lesion is progressing; or if
the ability to provide effective home care is impaired. If tooth is found to
have arrested caries or secondary caries, invasive treatment should not be
given. In these situations, chemotherapeutic antimicrobial control can be used.

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Reduction of risk level for at risk
patients include reducing sugar consumption, reducing frequent consumption by
confining sugar to meal time and using sugar substitutes. Brushing twice daily
with effective fluoride tooth paste in order to control plaque level. Using
dental floss and application of topical fluoride gels, solutions, and
varnishes. Stimulate saliva by use of sugar free gums. Caries in pits and
fissures are difficult to diagnose in its early stages and because fissures are
susceptible sites for caries development, the dentist can fissure seal
susceptible teeth as soon as possible after eruption.

Reversal of active sites by
remineralization can be used in interproximal areas as caries in these areas
develop more slowly taking 3-4 years. Early enamel lesion should be given a
chance to become arrested by applying preventive measures. Caries in root area
can be remineralised and hardened through preventive measure. However, as the
area hardens a brownish black discoloration will be seen. Root caries should be
restored when it endangers the pulp, when cavitation is encouraging plaque
buildup, or if sensitivity and appearance are problems

Follow-up is a must if treating
arrested caries with preventive measures as it requires frequent application of
varnishes and gels. Follow up for patients who have had fillings placed is
still a must as there is a chance of developing secondary caries if proper home
care is not sufficient. How to carry out proper maintenance should be explained
to the patient and patient should carry out effectively.

The general idea of caries treatment
is if caries is not progressive or if caries is arrested then no treatment is
needed. If caries is progressive but clinically there is no signs of cavitation
then antimicrobial/ fluoride therapy should be given. If caries is progressive
and cavitated a restoration is needed with antimicrobial/fluoride therapy.

 

 

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