Tooth decay is an infectious disease that occurs as a result of the acid released by the fermentation of carbohydrates by bacteria in the mouth, disrupting the mineral structure of the tooth. Environmental factors are more effective in the formation of tooth decay than genetic factors. In other words, besides the structural weakness of the tooth, dental plaque, cariogenic (caries-causing) foods and the duration of the foods in the mouth are effective in the formation of caries. Apart from these, the anatomical structure of the teeth, the saliva structure, the amount of saliva, the alignment of the teeth, the existing restorations in the mouth and the appliances used can affect the risk of caries.
Caries always starts from the enamel layer on the outer surface of the tooth. In the initial stage of enamel caries, the enamel loses its bright white color and gains a more opaque, matte appearance as the enamel begins to dissolve and gains a porous structure. Early caries lesions, called white spot lesions, are more common in individuals with poor oral hygiene and high caries risk, and their incidence increases especially after orthodontic treatment. Opaque white enamel may cause aesthetic concerns in individuals.
Since there is no tissue loss on the outer surface of the tooth in white spot lesions, remineralization can be achieved without the need for invasive procedures and teeth can be made aesthetically acceptable with various applications.
There are many applications used today to provide remineralization in white spot lesions. Some of these are
Fluorine is a type of mineral found in nature. In early caries lesions (white spot lesions), it is incorporated into the crystalline structure of the enamel and promotes remineralization, resulting in an enamel layer that is more resistant to acid attacks. Apart from its effects on enamel, fluorine affects cariogenic bacteria and reduces their acid formation.
Casein phosphopeptide amorphous calcium phosphate (CPP-ACP)
Promotes remineralization by allowing the precipitation of Ca ions in demineralized enamel and plaque.
In white spot lesions, it promotes remineralization by destroying caries-causing microorganisms with its bactericidal and oxidizing effect.
The laser reduces the solubility of the enamel, resulting in an enamel layer that is more resistant to acid attacks and demineralization.
Apart from these techniques, a microinvasive technique called “Resin Infiltration Technique- ICON” has recently become popular.
The resin infiltration technique increases the porosity of the enamel on the surface with the help of a strong acid and then allows a fluid resin infiltrant to reach the lower layers of the enamel caries. In this way, enamel is mechanically supported and white spot lesions are aesthetically masked.
In addition to white spot lesions, the resin infiltration technique can also provide successful results in fluorosis and trauma-induced discoloration.
With the resin infiltration technique, the teeth are both mechanically strengthened and aesthetically satisfactory results are obtained without damaging the intact tooth tissue, without any abrasion or cutting from the tooth surface.
This technique can be used on the flat surfaces of the front teeth, as well as in the treatment of initial enamel caries on the interfaces of the back teeth, and very successful results can be obtained. It should be applied only for initial caries limited to the enamel, not for caries that has progressed to the dentin layer.
The first thing to do to prevent caries formation is to visit the dentist regularly and follow the recommendations of the dentist. Teeth should be brushed at least twice a day, and protective and preventive treatments should be applied in line with the recommendations of the dentist when necessary. As dentists, our aim is always to prevent the disease before it occurs with preventive measures.
*Photos taken from https://uk.dmg-dental.com/products/icon-caries-infiltrant-smooth-surface/.
Cansu Uzun Önalan