Control of caries lesion development and progression

Abstract

The first three chapters of this book have introduced the basics of what dental caries is and how to detect lesions. The next chapter will consider the concept of caries control and begins by explaining why throughout this book the preferred term is caries control, rather than prevention. Remember, the formation of the dental biofilm, and its metabolism is an ubiquitous natural process; it cannot be prevented. So: Question: Who is susceptible to caries lesion development? Answer: Everyone with teeth, from cradle to grave because the metabolism in the dental biofilm is an ubiquitous, natural process. Lesion development and progression, which may occur over time, are symptoms of the process. We should aim to control these processes so that the development of a clinically visible lesion is avoided. However, if clinical lesions develop and progress these symptoms can be arrested by controlling the environment. Thus, all patients with teeth should know how lesions may form and progress, and how to control this. Please note the emphasis on the patient. It is the patient who controls caries with the support and encouragement of the professional. The goals of medicine (and dentistry) are to promote and preserve health if it is impaired, to restore health, and minimize suffering and distress. These goals are embodied in the word ‘prevention’. It is agreed that, with dental caries, this is basically what the dental profession is doing—and has always been doing. In many ways this has become a mantra—the dentists rightly claim that they are conducting prevention when recommending the population to eat less sugar, use fluorides, brush teeth, and when lesions occur, drill and fill, in order to restore the dentition and reduce pain and discomfort. Unfortunately, when dentists go for restoration—without ensuring that the patient understands how to control further caries lesion development—they indirectly stimulate the repair cycle, which ultimately may lead to loss of teeth (see Chapter 5). Sometimes the filling may be described as ‘treatment’ to contrast it with ‘prevention’. The dentist is paid for fillings (treatment) and minimally rewarded for so-called prevention.