What are Incipient Caries? – Diagnosis and Management

Nobody likes to experience the terrible event of having tooth pain. Caries or tooth decay has become a frequent topic of dental concern.

Ever thought how this decay starts and how does it spread so rapidly leaving us in pain and discomfort?

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Tooth decay starts as a result of an acid attack from the oral bacteria. This attack causes an imbalance between the process of remineralization and demineralization of the tooth structure.

The first incidence of a tooth decay starts at areas that are left uncleaned and are layered by plaque retention.

As a result, the process of demineralization exceeds and begins to affect the layers of the tooth. The enamel becomes porous and semi-permeable to the bacterial load around the tooth.

This condition is clinically seen as a matt opaque spot referred to as a white spot lesion. It is also known as incipient caries. 

In this article, we will learn about incipient caries and find out the different ways to manage it.

What is incipient caries?

Incipient caries is defined as the reversible stage of demineralization of the outermost layer of the tooth or enamel.

It is characterized by the formation of tiny white spots on the tooth surface. (1)

These type of caries are trying to be identified by the patient. However, a dentist can detect and diagnose it on a regular dental examination.

What causes incipient caries?

The acid exposure from the oral bacteria is the main culprit behind causing a white spot lesion on the surface of the tooth.

When the teeth are not cleaned, the plaque starts to accumulate around the tooth surface especially near the gums, on the grooves of posterior teeth or around a restoration.

This retention of plaque attracts the bacteria and becomes a home for acid production.

Enamel decalcification starts and if left untreated can involve the dentin at a later stage leading to tooth sensitivity and pain. At this stage the process of demineralization becomes irreversible.

What does it look like?

Clinically incipient caries looks like a rough, chalky white area on the surface of the tooth, which has a soft base when probed by a dentist. (2)

Care must be taken to differentiate a white spot caries from a white hypo calcification of enamel.

The best way to distinguish the two conditions is by wetting the surface of the tooth. A white spot lesion often disappears when the surface is wet.

How is it diagnosed?

A clinical examination can detect any changes in the color and surface structure of the enamel.

The white spot lesion appears as a chalky rough patch which disappears when the enamel is wet and appears when it is dried.

Dental x-rays especially bitewing radiographs are used to detect the carious lesion and locate them on the interdental areas.

A dentist can promptly detect incipient caries; therefore, a regular dental examination is recommended every six months to eliminate the possibility of advanced caries.

What is the treatment?

Incipient caries is a reversible process. Hence, if detected early it can be treated by simple means of remineralizing the tooth surface to stop the process of decay.

This will not only save you from the pain of undergoing dental procedures but also save your time and money. (3)

In non-cavitated lesions where the infection has not spread to the dentin, remineralization using fluoride toothpaste can reverse the process.

Specific treatment modalities can quickly help to stop the process of caries.

  • Fluoride treatment – Depending on the extent of caries, a dentist may recommend you a professional topical fluoride application with acidulated phosphate fluoride varnish or gel.
    Sometimes, a fluoridated toothpaste recommended by a dentist can also suffice and help to arrest caries and allow remineralization of the tooth structure. (4)
  • Sealants – If the caries is detected on the occlusal surface of the tooth, sealants can smoothly flow and prevent it from progressing further.
    Sealants cover the deep grooves and make the surface cleansable. The help to keep the food and bacteria away from the surface and also continue the process of remineralization.
  • Amorphous calcium phosphate – In addition to fluoride treatment, an ACP gel can be applied on the tooth surface.
    These gels increase the process of recalcification by accelerating the absorption of fluoride onto the tooth surface.
    It strengthens the tooth and also repairs the surface. ACP is available in the form of gels, varnish, paste or gums. (5)

Other types of management may include –

  • Use of cheese – Cheese is a dairy product that has found to have an abundant amount of calcium and phosphorus essential to strengthen the teeth.
    It is often recommended to eat a piece of cheese after a meal to neutralize the effects of acidic foods and also to provide essential minerals to the tooth. (6)
  • Sugarless gums – Saliva plays a natural and an active role in washing away the bacterial load. It also provides essential mineral like calcium and phosphorus to the tooth surface.
    Hence, it is always good to chew sugarless gums to enhance the production of saliva and protect the teeth naturally.

How can you prevent it?

The primary thing that you can follow easily at home to stay away from the harmful effects of tooth decay is to maintain a good oral healthcare regime.

  • Brush with a fluoride paste and floss after brushing the teeth.
  • Rinse your mouth with water after a meal.
  • Use an antimicrobial mouthwash for added benefits
  • Keep a check on the changes in your teeth and gums

Take away message

As the name suggests, Incipient caries is hidden and often cannot be self- detected. Hence, these lesions pose a significant threat to the tooth.

Regular dental visits will not only save you time but also keep you away from the stressful dental procedures.

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Nobody likes to know that they have cavities in their mouth. So, to prevent it, you need to make sure that you have a good oral healthcare routine to follow.

Avoid sugary foods and acidic foods. Eat in moderation and always make sure to drink or rinse your mouth with water after every meal.

Only you can take care of your teeth. Always stay informed and consult your dentist for professional advice.

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