**4.3 Enamel caries**

148 Contemporary Approach to Dental Caries

Based on the results obtained, and in the context of the diagnostic techniques that are

accessible to dental surgeons, we recommend the following protocol: Positive X-ray or FOTI findings………………………… Dentin caries


\*Stained fissure…………… No caries

 - **Ekstrand score 1-2**: - If LF < 10……………………....No Caries - If LF 10-20 ………………….... Enamel caries



 - If LF > 20 ……………………....Monitorization dentin \*Stained fissure ………….Monitorization enamel

 **- Ekstrand score 3-4**: - If LF < 20……………………….2nd measure rotating tip

protocol, we will outline the therapeutic approach applicable to each diagnosis.

The present Chapter focuses on techniques applicable to the diagnosis of hidden dentin caries. However, as a complement to the measures recommended in the above intervention

Fissure aperture applies when we believe but cannot fully confirm that dentin caries exists. A fissurotomy drill is used to open the fissure, crack or pit until reaching the dentin. A finetipped probe is then used to check dentin hardness, and if there are no carious lesions, crack sealant is applied. In contrast, if caries is identified, the lesion is eliminated, followed by

In this case the doubt is whether enamel caries exists or not. Bacterial plaque control is indicated in these situations, based on oral and dental hygiene measures and topical fluor application. If the suspicion of caries results from high LF readings with normal VI findings, monitorization fundamentally should be carried out with LF. The detection of positive VI signs or increased LF readings during follow-up, potentially indicative of lesion

If caries is suspected on the basis of the VI findings, with normal LF results, the subsequent controls should be centered on VI. The detection of an increase in positive VI signs or

 \*2nd LF < 20……………….Enamel caries - If LF > 20 ………………………Dentin caries \*Stained fissure …………..Fissure aperture

Visual inspection (better under magnification):

Visual inspection (better under magnification):

Visual inspection (better under magnification):

filling with composite resin or silver amalgam.

**3. Intervention protocol** 

**4. Treatment** 

**4.1 Fissure aperture** 

**4.2 Enamel monitorization** 

progression, requires fissure aperture.

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.
