You Really Can Reverse Caries Chemically

Take Home Pearl

Treating caries chemically is part of a new paradigm shift in caries management. It is time that practitioners use these strategies to treat and control caries before they become drill-and-fill problems.

The treatment of caries by chemical reversal can be an alternative to the traditional drill-and-fill methods. Caries is a transmittable bacterial infection caused by mutant streptococci and Lactobacillus that ferment dietary carbohydrates. The acid dissolves the enamel sub-surface and cavitates the enamel. If the acid is neutralized, then the calcium and phosphate will remineralize the surface before it cavitates. This caries balance theory was originated by Featherstone and includes 3 factors: bacteria, poor dietary habits, and xerostomia. The protective factors are saliva, sealants, antimicrobial agents (such as chlorhexidine. iodine, and xylitol), fluoride, and an effective diet. There are also other oral acid problems, such as gastroesophageal reflux disease, bulimia, and acid drinks. Xerostomia or dry mouth is due to glandular problems such as SjÖgren’s syndrome, the use of extensive medications, and not drinking enough water. Saliva function and salivary gland health Is Important when assessing the salivary portion of the caries problem. Caries prevention with minimally invasive treatment can be accomplished with chlorhexidine, iodine, and xylitol. Iodine should be used in the office, due to less compliance with iodine when used at home. Xylitol is easier for patients to use. The biotene system uses xylitol in many forms. Topical fluoride used as a mouthwash and a therapeutic toothpaste are effective, but It must be remembered that chlorhexidine used with fluoride toothpaste will neutralize the fluoride toothpaste and interfere with the efficacy of the fluoride. Caution, should be used with children so that they will not receive a toxic dose of fluoride, Calcium and phosphate paste has been shown to remineralize incipient lesions, it can be used in chewing gum or as an additive in food. A simple solution for oral acidity is to use baking soda to buffer and neutralize the acid with a rinse or to use a baking soda toothpaste. Glass ionomers with fluoride product a good marginal seal, and the fluoride release helps minimize caries.

ConcIusions / Reviewer’s Comments: Treating caries chemically is part of a new paradigm shift in caries management. These new strategies are sound, and it is time that practitioners use these strategies to treat and control caries before they become drill-and-fill problems. I believe that advanced caries control is long over-due. Most of these techniques and technologies have been available for some time. It is a benefit to the patient and to the health of humanity as a whole that we revise the drill-and-fill technology. It takes time, effort, and some degree of expertise to learn these techniques, which are not difficult. Take courses, talk to your dental suppliers, and get with the program!