How the disease is treated today

   Given this concept of the nature of the disease, the logical and ethical standards of care for both caries diagnosis and caries management (prevention, cure and repair) are now very different from the time when caries was thought to be gangrene.

   The present molecular concept of the nature of caries leads us to very different concepts of management of the disease. This, coupled with the widespread use of fluoride and the development of restorative materials which adhere to tooth structure and which (in some cases) do not leak, has revolutionized the prevention and cure of caries, as well as the repair of carious defects in teeth. The key features of the new care paradigms are summarized below.

Diagnosis

Since we understand caries to be a dynamic process which occurs at the molecular level we can diagnose the disease before irreversible loss of tooth structure occurs. It is now reasonable to state, on the basis of diagnosis, that some people do have the disease, while others do not. Detection of lesions at the macroscopic level (Ref. to Abseil section) can no longer be considered to be diagnosis, for two reasons - (1) the disease is present before lesions can be detected macroscopically and (2) large lesions remain after the disease is cured.  Determination of both “risk state” as well as “activity state” are reasonable diagnostic goals.

Management

Treatment and cure

The goal of treatment is now to change the local biochemistry so that the patient is no longer losing tooth mineral so that the disease is then cured and the patient healed. This is logical, ethical, appropriate and achievable.

Caries can be treated by one or more of the following:

•       Changing the microflora , using agents such as topical chlorhexidine          and topical fluoride

•       Reducing the amount of dietary sucrose by dietary choice

•       Decreasing the frequency of eating, by dietary choice

•       Adding fluoride, particularly through daily application during tooth brushing

•       Increasing salivary flow using mechanical stimulation during vigorous          chewing to enhance flow, by changing drugs which reduce flow, or by using          drugs to enhance flow

•       Cure is achieved when diagnostic tests show that the disease is no longer          active and the risk is low.

Repair 

Restoration of defects, which was previously thought of as treatment of the disease, is now more reasonably considered to be repair. It will be desirable to stop using the term 'treatment' for such repair, because the standard of care for caries treatment is now behavioral and biochemical, not mechanical. If the disease is cured, restorations should no longer fail because of caries. Limitations on restoration longevity should be related only to failure by wear and fatigue under cyclic load.

Prevention