Dental Caries-Part 2: Treatment Planning

In this chapter, you will know about the treatment planning of dental caries. In previous chapter you studies the etio-pathogenesis and clinical characteristics of dental caries. If you have not gone through it, it is advised that you study the previous chapter before proceeding further.

Mechanism of Remineralisation of Enamel

When the oral environment of a person is favourable where the pH is above 5.5 and saliva contains enough calcium and phosphate ions, the remineralisation process of enamel occurs. The supersaturated saliva acts as driving force for remineralisation. In a non cavitated enamel caries lesion, the original crystalline structure of rods remains intact. When it is etched, it acts as nucleating agent for remineralisation. When trace amount of fluoride ions is added to the environment, it enhances the remineralisation process by enhancing the precipitation of calcium and phosphate. The inclusion of fluoride ions results in the formation of fluorapatite crystals in enamel rods which is more resistant to acid attack compared to calcium apatite of the natural enamel rods. Thus, the new enamel becomes resistant to caries process. 

At this point, I must reiterate that the hypocalcification and cavitation are only the symptoms of dental caries and underlying cause is infection. Although, for the comfort of the patient, symptomatic treatment in the form of restoration is of paramount importance, treatment of underlying cause must be undertaken to stop disease progression. 

Image of dental caries in maxillary central incisors 
Base on the clinical features, the diagnosis is made and a treatment plan is devised for the long-term benefit of the patient as follows:

Normal Enamel 

Since the normal enamel has normal non-pathogenic plaque biofilm and normal enamel structure, it does need neither non-restorative therapeutic treatment like antimicrobial, remineralisation or ph-balance nor restorative treatment. 

Hypocalcified Enamel 

The plaque biofilm is normal, so no antimicrobial treatment; enamel structure is abnormal but not weakened so no non-therapeutic treatment is needed. If extent of hypo-calcification is affecting aesthetics, then aesthetic restoration is provided. 

Noncavitated Caries 

The plaque biofilm is cariogenic and enamel structure is porous and weakened. Therefore, non-therapeutic treatment is required but restorative treatment is not required. 

Active Dental Caries 

The plaque biofilm is cariogenic and enamel structure is cavitated and very weak. Therefore, both non-therapeutic and restorative treatments are required. 

Inactive Dental Caries 

The plaque biofilm is non cariogenic and the enamel structure is remineralised & strong. Therefore, nontherapeutic treatment is not required and the restorative treatment is indicated for aesthetic reasons only. 


Further readings:

1. Oral diagnosis and treatment planning: part2 Dental caries and assessment of risk