Determination of the most effective method to retard the progression of approximal
caries requires not only identification of the most effective remineralizing agent but
also the frequency with which to employ it.
Key Point
The remineralized tissue of early caries is less susceptible to further caries.
Existing studies indicate that fluoride varnishes, solutions, and toothpastes all provide
a significant effect on the progression of approximal caries in permanent molars when
assessed radiographically. However, most of these studies were of limited duration (3
years). It would be interesting to know what happened after the completion of the
studies and poses the following questions:
- Would the lesions have developed to the restorative stage?
- What is an acceptable frequency to monitor the lesions radiographically if this is the
only acceptable way of determining progress? - Is the cost of remineralization therapy less than restorative treatment, particularly if
it entails multiple attendances of the patient?
Progress of caries through the enamel seems to be fairly slow but once the dentine is
reached it accelerates. So as a rule of thumb, restore approximal surfaces once the
lesion reaches the enamel/dentine interface.
412H
Fig. 9.2 A bitewing radiograph of a 13-
year-old boy showing early caries upper
right first permanent premolar and
molar, and both lower molars.413H
Fig. 9.3 The same boy, 18 months later,
showing rapid progress of caries in the
upper first premolar, molar, and the
lower second molar, with little or no
change in the lower second premolar and
first molar.9.4 DIAGNOSIS
While most dentists would agree that approximal caries is best diagnosed from
bitewing radiographs, detection of occlusal caries is much more difficult. Where there