Caries Monitoring - Prospects and limitations of non-operative treatment options

For the treatment of the early carious lesion, which does not cavitate the tooth surface, different treatment options have been developed. The core strategy is the regular use of fluoride, which has been proved to prevent caries at high evidence levels. In the case of existing non-cavitated lesions fluoride can result in a progression inhibition, arrestment or even reversal of the lesion. Due to the dynamic nature of caries development as a balanced result between pathological and protective factors the outcome of the fluoride application in individual cases depends on a broad range of factors, including oral, bacterial or behavioural factors. Hence, the clinical outcome of a fluoride treatment on early lesions is not certain. Particularly in patients with high caries risk fluoride applications are of limited effectivity. Other non-operative treatment options focus on the reduction of cariogenic bacteria. However, even the best valued substance, chlorhexidine, has been shown to be caries reducing within distinct limitations only. These limitations refer to the localisation of the carious process and to the risk group. Recently, the use of xylitol has aroused interest, due to its non-cariogenic and antibacterial properties. Xylitol containing products like gum have been proved to be associated with the arrest of carious lesions. The best caries inhibiting effect in high-risk individuals will be achieved by applying more than one non-operative treatment option. However, as these options demand compliance and oral self-care, there are limitations especially in these patients who are most at-need. As a further option for a non-invasive treatment, which depends to a lesser degree on patient compliance, the sealing of accessible fissures exists. There is good evidence that non-cavitated enamel lesions at fissures can be arrested by fissure sealing, if performed and controlled properly.