DMG October 2009 : Page 1
Continuing Education TreatmentModalities for Caries Management, Including a New Resin Infiltration System Gerard Kugel, DMD, MS, PhD;1 Peter Arsenault, DMD, MS;2 and Athena Papas, DMD, PhD3 Abstract: Seemingly against all odds, dental caries still affects most people in the US. While fluoridated products, school-based screening and cleaning programs, better patient education, and professional and chemotherapeutic interventions have all impacted certain populations, caries is still the most prevalent chronic childhood disease and continues to affect a high percent- age of adolescents, young and middle-aged adults, and seniors. Much research has proven that dental caries is not just an occa- sional cycle of cavitation but a complex and infectious disease process. Historically, addressing the caries challenge has relied on prevention and restoration, with no intermediary means to stop lesion progression. Recently, a technique called caries infiltration was introduced that fills the noncavitated pores of an incipient lesion with a low-viscosity resin by capillary action, creating a bar- rier that blocks further bacterial diffusion and lesion development. This microinvasive method for stabilizing early lesions requires no drilling or anesthesia and does not alter the tooth’s anatomic shape. In cases of white spot lesions in the esthetic zone, it also eliminates opaqueness and blends with surrounding natural teeth. This article presents an overview of caries prevention initia- tives and a case demonstrating the new caries infiltration technique. Combined with shifting the focus to caries risk assessment, this promising technology may prove to be a significant addition to the profession’s caries treatment armamentarium. W o hile the prevalence of dental caries in the US has shown a dramatic decline in recent decades that correlates with the advent of fluoridated water, numerous tooth cleaning devices and products, antibiotic treatment, and professional intervention, dental caries remains the number one chronic childhood disease. Learning Objectives After reading this article, the reader should be able to: ■ discuss dental caries as a disease. ■ explain caries management by risk assessment. ■ discuss the concept of caries infiltration. ■ describe the caries infiltration treatment process. A high incidence continues to be reported in adults, partic- ularly in seniors.1,2 In their recent meta analysis, Griffen et al found older adults experienced the same, if not more, caries than children.3 Furthermore, perhaps as little as 10% of late adolescents and young adults have no caries;4-11 almost all adults (> 95%) are reported to have enamel and root-surface caries. Complete edentulism caused by caries occurs in 25% of people. This data seems to be at odds with the fact that dental caries—and most oral diseases—is largely preventable if patients practice good oral hygiene and receive professional plaque biofilm removal. However, those preventive methods demand optimal patient cooper- ation and motivation, which is difficult both to obtain and maintain.12 Unfortunately for many people, caries cavita- tion can be a lifelong illness13 marked by a never-ending cycle of restoration and almost inevitable re-treatment, 1Professor, Associate Dean for Research, Tufts University School of Dental Medicine, Boston, Massachusetts 2Head, Operative Division, Department of Prosthodontics and Operative Dentistry, Tufts University School of Dental Medicine, Boston, Massachusetts 3Johansen Professor of Dental Research, Head of the Division of Public Health Research and Oral Medicine; Co-Head, Division of Geriatric Dentistry, Tufts University School of Dental Medicine, Boston, Massachusetts Compendium—Volume 30 (Special Issue 3) 1
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