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Caries research has changed its course from one of eliminating decay by destroying tooth structure. Today, risk factors for decay are determined, behavior is altered, and chemistry within the oral cavity is changed to allow the natural remineralization process to occur.
The Caries Management by Risk Assessment (CAMBRA) methodology operates by the clinician identifying individual risk factors for each patient. Treatment is based on the risks identified and altering the caries balance. When CAMBRA is used, there is evidence that damage to teeth can be reversed and may be completely prevented.
Remineralization of the tooth structure can occur when the pH in the oral cavity is raised from acid to neutral and the calcium and phosphates in saliva join with fluoride to produce a new cover over the lesion. Chemical repair can involve the use of antimicrobials, chlorhexidine, iodine, xylitol, and topical fluoride combined with calcium and phosphate products. Prevention of caries and remineralization is cost-effective. Topical fluoride such as 0.05% NaFl rinses, varnish (5% NaFl), and high-fluoride toothpastes (1,000 to 5,000 ppm fluoride) have proven effective. While varnish is “approved” for sensitivity but “off label” for prevention, the ADA Council on Scientific Affairs has endorsed varnish as a preventive procedure. Amorphous calcium phosphate (ACP) is formed when calcium, phosphorus, and oxygen are combined. Saliva serves as the catalyst when the pH in the oral cavity falls within the acid range. The compound of ions formed grows on the tooth surface while speeding the process of enamel rebuilding. Casein phosphopeptides (CPP) work to stabilize the amorphous calcium phosphate supersaturating the tooth enamel, which reduces demineralization and enhances remineralization. The CPP-ACP binds to plaque, creating a large calcium pool from which to draw to remineralize tooth structure and restrict caries development.
NovaMin is made from a combination of calcium, phos-phorus, silica, and sodium. Individually, none is essential to tooth structure. When combined in their ionic form with saliva or water, billions of ions are released to assist in the process of tooth remineralization. Studies are underway at New York University to determine if genes or environment determine decay risks. If genes are indicated, treatment may include aggressive therapy with some or all of these aforementioned methods on individuals determined to be at high risk for tooth decay. (Source: Modern Hygienist, November 2007)
