Management of Caries as a Dynamic Disease Process

Domenick T. Zero DDS, MS

Dental caries is a dynamic dietomicrobial disease that involves multiple cycles of demineralization and remineralization before its consequences are expressed clinically.

The early stages of this process can be arrested or reversed by modifying the cariogenic challenge (etiologic factors) through control of plaque biofilm and cariogenic dietary factors, and increasing protective factors such as fluoride exposure and insuring adequate salivary flow. It is now widely recognized that the surgical (restorative) approach to managing dental caries does not prevent further disease progression. The principles of the modern management of dental caries involve: detecting and assessing caries lesions at an earlier stage; determining the caries risk status of the patient; making a diagnosis if disease is actually present; establishing a prognosis; applying intervention strategies focused on preventing, arresting, and possibly reversing the carious process; and delaying restorative treatment until absolutely necessary.

There is increasing interest in when and how we detect caries and the development of new technologies to assist in this process. Caries risk assessment tools have been developed, but past caries experience remains the best predictor of future caries. The recognition that dental caries can be arrested and possibly reversed if detected at an early stage is leading to renewed interest in innovative intervention strategies. There is considerable enthusiasm for new approaches to manage dental caries, i.e., nutraceuticals and non-fluoride remineralizing agents; however, clinical recommendation must be based on sound scientific evidence. The use fluoride toothpaste, fluoride mouthrinse, professionally applied fluoride (varnish), preventive and therapeutic use of dental sealants remain the mainstays of caries prevention.

Participants will learn:

• Describe how the theoretical understanding of the caries process can be applied to your clinical practice.
• Describe how caries risk assessment can assist in the diagnosis and management of early carious lesions.
• Identify the best approaches for preventing, arresting or reversing early caries development based on available evidence.
• Describe fluoride works in modifying the dynamic nature of caries
• Describe how to optimize fluoride use based on patient caries risk.
• Identify the changes in your practice necessary to provide evidence-based care to prevent dental caries.