Enamel caries

Treatment should distinguish between active and inactive lesions, since such a distinction is important in management terms. The development of techniques for differentiating between active and inactive lesions is thus seen as a necessity, since very few studies in this field have been published to date (Bader & Shugars, 2004). The general clinician experiences great difficulty in distinguishing between these lesions (Ekstrand et al., 2005). When the band and plaque are removed, the clinical features of the active lesion have been recorded as a dull/opaque white area, which is said to be rough when a probe is moved across the surface. Accordingly, the signs for establishing a differentiation are: a) Whether the lesion was dull/matt or shiny/glossy; and b) The tactile sensation of the lesion to a ball-ended probe run gently across the surface was recorded as smooth or rough to the probe.

According to some studies (Pretty, 2006), laser fluorescence is able to establish differences between the readings corresponding to active and inactive enamel caries in permanent molars. In this sense, LF would be able to serve in monitoring the lesion. However, other studies (Toraman et al., 2008) consider that the technique does not register the changes that occur during remineralization and caries development arrest, and cannot serve for monitorization purposes.

Following improved oral hygiene, the lesion is no longer active, and there may be remineralization within the lesion and abrasion of the eroded surface enamel during oral hygiene procedures and normal function. This leads to a surface which feels smooth when a probe is gently run across it, and which appears shinier (Thylstrup et al., 1994). Once inactive, monitoring of the lesion should continue. Persistent activity is indicative of the need for fissure aperture and the placement of crack sealant.

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