white spot lesion

Non Cavitated Carious Lesions

Presented By: Dr. Vini Mehta MDS 2nd Year

Dept. of Public Health Dentistry

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Contents Introduction Zone of Incipient Caries Clinical Features Classification Detection System Diagnostic Protocol Remineralising Agents Treatment Conclusion References

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Introduction

A non-cavitated caries lesion ( an early lesion, an incipient lesion, a white spot lesion or a surface softened defect) is a demineralized lesion without evidence of cavitation.

As the lesion progresses, the outer surface, which is in contact with plaque and is protected by the salivary pellicle, is exposed to cycles of demineralization and remineralization

At this stage, the demineralization process can be reversed or arrested

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Definition

The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as a white spot lesion, an incipient carious lesion.

--Sturdevant’ Art and Science of Operative

dentistry fifth edition 2006

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Zone of Incipient Caries

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What causes white spot lesions to form?

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Risk Factors Inadequate oral hygiene

Existing White Spot Lesion

New lesions start during orthodontic treatmen

High DMFT

Lack of preventive measures

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Clinical Features The surface texture of an incipient lesion is unaltered and is

undetectable by tactile examination with an explorer.

A more advanced lesion develops a rough surface that is softer than the unaffected, normal enamel

Softened chalky enamel that can be chipped away with an explorer is a sign of active caries

Initial lesions are active lesions which continue to progress whereas arrested lesions do not progress.

“Micro scars” – Active lesions “Micro Cavitation – Arrested lesions

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Smooth surface caries

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Common Sites

Labial, buccal and lingual smooth surfacesProximal surfaces

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Classification

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Types of White Lesions on Enamel• According to Russell Dental Fluorosis

White / yellowish lesion Not well defined Symmetrical distribution Affected teeth are less susceptible to dental caries .

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Enamel opacities

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Detection System

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Pitts, 1997

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Fyfee 2000Permanent surface code CriteriaG Good, sound surface

W White spot lesion – visual assessment of dried tooth indicates intact surface, no clinically detectable loss ofsubstance, with a white or cream coloured area of increased opacity presumed carious by the trained examiner

B Brown spot lesion – visual assessment of dried tooth indicates intact surface, no clinically detectable loss ofsubstance, with a brown/black discolouration

E Enamel cavity – in the opinion of the trained examiner, there is a lesion with demonstrable loss of surfacebut no visual, clinical evidence of the lesion penetrating dentine

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D Dentine lesion (noncavitated) –there is a carious lesion into dentine but no visible evidence of cavitation

C dentine Cavity –there is a carious cavity into dentine

P Pulp involved – there is a carious cavity that involves the pulp, necessitating an extraction or pulp treatment

A Arrested dentinal decay – there is arrested caries in dentine

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The International Caries and Detection and Assessment System (ICDAS)

Code Description

0 Sound

1 First Visual change in Enamel (Seen only after prolonged air drying)

2 Distinct Visual Change in Enamel

3 Localized Enamel Breakdown (without clinical visual signs of dentinal involvement)

4 Underlying Dark shadow from dentin

5 Distinct Cavity with visible dentin

6 Extensive distinct cavity with visible dentin

Diagnostic ProtocolPhysical Principle Application in Caries

Diagnosis

X Rays Digital image enhancement

Visible light Quantitative fiberoptic transillumination (FOTI)Quantitative light induced fluorescence (QLF)

Laser Light DIAGNOdent22

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Quantitative light fluorescence (QLF)

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Benefits of Early Carious Lesion Detection

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Increase potential to remineralize, the dimenralized non cavitated tooth surfaces

Decreased risk of progression to cavitated stage

Preservation of natural esthetic appearance of tooth enamel

Reduced treatment cost

Remineralising Agents Use of Fluorides Casein Phosphopeptide- Amorphous Calcium Phosphate

(CPP-ACP). Combination of CPP-ACP and fluoride Novamin (sodium calcium phosposilicate) Xylitol Carrier

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Operative Treatment

Preventive Resin RestorationEnamel microabrasion

Future Prevention MethodsCarries VaccineIcon

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Conclusion

A clear understanding of the mechanism of subsurface lesion formation and progression, possibilities, treatment and their clinical applications need to be recognized to direct preventive strategies to the high caries risk individuals.

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