5.2 Treatment of Patterns of Caries
Smooth-Surface Caries
Reducing the risk for more dental caries and tooth loss in patients with smooth-surface caries requires effort on the parts of both the patient and the dentist.
The key factor driving caries risk assessment is the presence of active cavitated smooth-surface lesions at the time of the examination. Patients who experience smooth-surface caries must usually make significant behavior changes to reduce their levels of disease. Smooth-surface caries are probably the biggest challenge in dental caries management, even though tools are available to keep smooth surfaces clean. Odontopathic bacteria have been found living inside the enamel matrix of white spot lesions, allowing caries to progress even when the surface of the tooth appears clean.
Even one cavitated smooth-surface lesion places a patient at moderate risk for dental caries. Two cavitated smooth-surface lesions place the patient at high risk. Although topical fluorides have been shown to kill invasive odontopathic bacteria, patient compliance and ability to use such fluorides correctly can be an issue.
In patients with smooth-surface caries, plaque-covered surfaces have high counts of cariogenic bacteria, which are often fed by diets high in sugar. While (except in unusual circumstances, such as, for example, in a patient with no salivary flow, no fluoride exposure, and a virulent odontogenic infection) professionally applied fluorides are effective for patients who follow dietary guidance and have good oral hygiene practices, if either of these is not the case, the fluoride will not have the desired effect.
Rampant caries in patients addicted to street drugs such as methamphetamine is increasingly common and is difficult to treat. These patients may have multiple smooth-surface carious lesions, as well as conditions such as “meth mouth.” Treatment is complicated by the mental, emotional, and physical effects of the abused drug.
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