Different approaches to treating microcavities

Dentists, using a variety of new and sophisticated detection methods that include fiber-optic techniques and infrared laser scanning, are finding – and treating – tooth abnormalities that may or may not develop into cavities. But should they?

Incipient carious lesions are an early form of decay some dentists call “microcavities.” These lesions don’t always lead to fully developed cavities. Some dentists say mineral-containing saliva can repair the lesions, especially when combined with fluoride.

Dentists at the Texas A&M Health Science Center (TAMHSC) Baylor College of Dentistry say the advice a patient receives about microcavities varies from dentist to dentist. While some dentists describe their efforts as a proactive approach to protect patients’ oral health, others say the procedures are unnecessary and driving up the costs of care.

“It all comes down to the ‘clinical judgment’ of the dentist, and it’s not to say one is right or one is wrong,” says Dr. Charles W. Wakefield, professor and director of the Advanced Education in General Dentistry Residency Program at TAMHSC-Baylor College of Dentistry. “It depends on the patient’s decay experience. If the patient has had a lot of decay and fillings at a relatively young age, intervention might be necessary. If he or she doesn’t have many fillings or history of decay and has good saliva quantity and quality, a more conservative approach might be the better way to go.”

Dr. Wakefield says for high-risk, high-decay patients, there are filling materials that are fluoride powerhouses to help them avoid recurrent lesions. He also says there are products that acid-etch these very early lesions and seal them so dentists don’t have to drill, and sometimes they remineralize – thus heal – the tooth.

“But of course, in this day of evidence-based care, informed consent and especially standard of care, these decisions MUST be backed up with solid clinical experience and knowledge,” Dr. Wakefield says.