Arrested CariesArrested Caries

Arrested Caries: Arrested Caries: IntroductionIntroduction

No longer an active lesionNo longer an active lesion This is a carious lesion that does not This is a carious lesion that does not

progress; the stage where the decay progress; the stage where the decay process has stoppedprocess has stopped

Can occur in enamel and dentineCan occur in enamel and dentine It is seen when the oral environment It is seen when the oral environment

has changed from conditions has changed from conditions predisposing to caries to conditions predisposing to caries to conditions that tend to slow the lesion downthat tend to slow the lesion down

How Do Arrested Caries Appear How Do Arrested Caries Appear Clinically?Clinically?

Mostly on lingual/labial aspect, Mostly on lingual/labial aspect, sometimes occurs interproximallysometimes occurs interproximally

Steps in the Formation of Steps in the Formation of Arrested CariesArrested Caries

a) Dentine: tubule contains a ↑ [ ] of dissolved mineral salts.

b) If bacterial acid production is ↓sed, & pH ↑ses → salts precipitate into large crystals of tricalcium phosphate which temporally block the tubule.

c) c) If further bacterial activity is suppressed, the odontoblast secretes collagen and calcium salts. Crystals of hydroxyapatite then form and block the tubule more effectively (After Daculsi et al, 1987)

Properties of Arrested Properties of Arrested CariesCaries

Arrested white spotted lesion:Arrested white spotted lesion:– has shiny surface; may be brown in colorhas shiny surface; may be brown in color– is more resistant to attack by acid than is more resistant to attack by acid than

sound enamelsound enamel– regarded as scar tissue; thus should not regarded as scar tissue; thus should not

be attacked with a dental drillbe attacked with a dental drill Arrested caries in dentine: Arrested caries in dentine:

– discolored (yellow, brown or black)discolored (yellow, brown or black)– Hard or leather consistency, due to Hard or leather consistency, due to

presence of tertiary and sclerotic dentinepresence of tertiary and sclerotic dentine– rest of dentine appears polishedrest of dentine appears polished

Arrested Caries Stained by Arrested Caries Stained by Caries DetectorCaries Detector

LP= light pink; P= pink; T= transparent; A= aparently normal zone

Tooth on right appears more brown; The more active lesions appear lighter in color.

How can Arrested Lesions be How can Arrested Lesions be Induced?Induced?

Caries can be arrested by simple Caries can be arrested by simple clinical measures, e.g.:clinical measures, e.g.:– improved plaque control with a fluoride improved plaque control with a fluoride

toothpastetoothpaste– altered dietaltered diet

Thus, its vital for the clinician to Thus, its vital for the clinician to detect enamel caries in its earliest detect enamel caries in its earliest form by visual inspection of teeth form by visual inspection of teeth after cleaning and dryingafter cleaning and drying

Promoting Arrest of Carious Promoting Arrest of Carious LesionsLesions

FluorideFluoride– ↑↑ses resistance of hydroxyapetite in ses resistance of hydroxyapetite in

enamel and dentine to dissolution by enamel and dentine to dissolution by plaque acidsplaque acids

– E.g., toothpastes, water fluoridationE.g., toothpastes, water fluoridation– Greatest benefit when there is constant Greatest benefit when there is constant

availability for remineralizationavailability for remineralization– E.g., Glass ionomer cementsE.g., Glass ionomer cements

GluterdialdehydeGluterdialdehyde– Collagen fixation, reduced diffusion of ions Collagen fixation, reduced diffusion of ions

out of lesions, and antibacterial actionsout of lesions, and antibacterial actions

Promoting Arrest of Carious Promoting Arrest of Carious LesionsLesions

Sugar SubstitutesSugar Substitutes– E.g., xylitol or sorbitol in chewing gumE.g., xylitol or sorbitol in chewing gum– Increased saliva flowIncreased saliva flow

Atraumatic Restorative TechniqueAtraumatic Restorative Technique Make cavities accessible to cleaningMake cavities accessible to cleaning Sealing in Caries?!Sealing in Caries?!

ConclusionConclusion

Gaining caries arrest involves intensive diet Gaining caries arrest involves intensive diet control to reduce frequency of acid attack on control to reduce frequency of acid attack on teeth, high-fequency, low-dose fluoride teeth, high-fequency, low-dose fluoride applications to increase remineralization and applications to increase remineralization and resistance to attack and gross caries excavation resistance to attack and gross caries excavation to decrease bacterial load and allow the fluoride to decrease bacterial load and allow the fluoride to reach the leading edge of the progressing to reach the leading edge of the progressing decay. Once caries activity has been completely decay. Once caries activity has been completely suppressed, affected teeth will have lost tooth suppressed, affected teeth will have lost tooth structure (“cavity”) but will not need to be structure (“cavity”) but will not need to be restored except to restore function and esthetics.restored except to restore function and esthetics.