Arrested Dental Caries

Caries can exist before there is a visible lesion. A white spot can mark mineral loss in the tooth and may regress when plaque-control measures interrupt the process.

Frequent sugar consumption changes the biofilm toward acid-producing, acid-tolerant bacteria. Regular exposure to fermentable carbohydrates and a cariogenic biofilm drive mineral loss in the tooth.

White spot lesions, including initial occlusal lesions, can be managed conservatively. Approximal lesions limited to enamel or only just into dentin on a bitewing image are also often non-cavitated.

A lesion can progress if the acid challenge continues. Frequent sugars, plaque left on teeth and insufficient fluoride exposure support the conditions in which caries advances.

Assessment considers whether the lesion is active or inactive, including its location, colour and surface appearance. Bitewing radiographs can show dentin extension that may not be apparent on a non-cavitated surface.

Existing caries is first managed with non-invasive care such as remineralisation, biofilm removal and sealing rather than removing dental tissue. A cavitated lesion is controlled with a minimally invasive approach, including repair of a defective restoration rather than automatic replacement.

The difference between an early lesion and one with lost tooth structure changes the work needed. Prevention and minor intervention can reverse an early lesion, while moderate disease requires the tooth to be filled and rebuilt.

Progressing caries can lead to pain, infection and tooth loss. Complications can include apical periodontitis, periapical abscess, cellulitis and osteomyelitis; infection spreading through facial spaces can threaten the airway.

Daily brushing and flossing remove the plaque microorganisms that caries needs to progress. Fluoride slows demineralisation and supports remineralisation; fluoride toothpaste, rinses, gels and varnishes are available ways to apply it.