Professor of Cariology, Guy's, King's and St. Thomas' Schools of Medicine, Dentistry & Biomedical Sciences, Floor 25, Guy's Tower, Guy's Hospital, London Bridge, London SE1 9RT
Dentine becomes infected as a result of caries lesion formation on root surfaces and when lesions progress following cavitation of enamel lesions. However, this infection is unimportant because the driving force for lesion formation and progression is the overlying biofilm. This explains why root surface caries can be controlled by mechanical plaque control and fluoride, and restorations are not needed to arrest these lesions. Similarly, the infected dentine in cavitated coronal lesions does not have to be removed to arrest the lesion. If the lesion is either accessible or opened for cleaning by the patient or parent, the lesion can be arrested. Sealing of infected dentine within the tooth, either by a Hall crown in the primary dentition or by partial caries removal prior to placing a well-sealed filling, will also arrest the lesion. When restoring deep lesions in symptomless, vital teeth, vigorous excavation of infected dentine is likely to expose the pulp and make root canal treatment necessary. Thus ‘complete excavation’ is not needed and should be avoided.
CPD/Clinical Relevance: Root surface caries can be arrested by cleaning and fluoride application. Restorations are not essential. Vigorous excavation of softened dentine in deep cavities of symptomless, vital teeth is contra-indicated. It is not needed and increases the risk of pulp exposure.
Article
Dental caries is a result of dynamic processes occurring in a dental biofilm. It is a chemical dissolution brought about by metabolic activity in the microbial deposit (biofilm or plaque) covering a tooth surface at any given time. This metabolic activity results in numerous fluctuations in pH at the interface between the biofilm and tooth surface. Over time these fluctuations may result in a disturbance of the equilibrium between the tooth mineral and the surroundings. Mineral loss, subsequent lesion formation and possible cavity formation in teeth, is a symptom of an imbalance in these dynamic processes and is designated ‘dental caries’.1 Biofilm formation and its metabolism is an ubiquitous natural process; it is part of having teeth. However, its possible consequence, lesion formation and progression, can be controlled so that a clinically visible lesion never forms or an established lesion arrests. The term caries control (rather than caries prevention) reflects the fact that biofilm formation and metabolism cannot be prevented but lesion formation and progression can be controlled so that lesions never become visible or established lesions arrest. Control of the biofilm is the treatment of caries.2 The most important control measures are to clean teeth regularly, and thus disturb the biofilm mechanically, with a fluoride-containing toothpaste and regulate sugar intake.
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