The document discusses non-cavitated carious lesions, also known as incipient or white spot lesions, which are early signs of tooth decay characterized by surface demineralization without cavitation. It outlines clinical features, risk factors, detection systems, and treatment options for such lesions, emphasizing the importance of early detection and the potential for remineralization. The document concludes with a call for understanding the mechanisms of lesion formation and progression to improve preventive strategies for high caries risk individuals.

1. Non Cavitated Carious
Lesions
Presented By: Dr. Vini Mehta
MDS 2nd
Year
Dept. of Public Health Dentistry
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2. Contents
 Introduction
 Zone of Incipient Caries
 Clinical Features
 Classification
 Detection System
 Diagnostic Protocol
 Remineralising Agents
 Treatment
 Conclusion
 References
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3. Introduction
 A non-cavitated caries lesion ( an early lesion, an
incipient lesion, a white spot lesion or a surface softened
defect) is a demineralized lesion without evidence of
cavitation.
 As the lesion progresses, the outer surface, which is in
contact with plaque and is protected by the salivary
pellicle, is exposed to cycles of demineralization and
remineralization
 At this stage, the demineralization process can be
reversed or arrested
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4. Definition
The earliest sign of a new carious lesion is the appearance
of a chalky white spot on the surface of the tooth,
indicating an area of demineralization of enamel. This is
referred to as a white spot lesion, an incipient carious
lesion.
--Sturdevant’ Art and Science of Operative
dentistry fifth edition 2006
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5. Zone of Incipient Caries
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6. What causes white spot lesions to
form?
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7. Risk Factors
 Inadequate oral hygiene
 Existing White Spot Lesion
 New lesions start during orthodontic treatmen
 High DMFT
 Lack of preventive measures
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8. Clinical Features
 The surface texture of an incipient lesion is unaltered and is
undetectable by tactile examination with an explorer.
 A more advanced lesion develops a rough surface that is softer than
the unaffected, normal enamel
 Softened chalky enamel that can be chipped away with an explorer
is a sign of active caries
 Initial lesions are active lesions which continue to progress whereas
arrested lesions do not progress.
 “Micro scars” – Active lesions
 “Micro Cavitation – Arrested lesions
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9. Smooth surface caries
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10. Common Sites
Labial, buccal and lingual smooth surfaces
Proximal surfaces
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11. Classification
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12. Types of White Lesions on Enamel
• According to Russell
 Dental Fluorosis
 White / yellowish lesion
 Not well defined
 Symmetrical distribution
 Affected teeth are less susceptible to dental caries .
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13. Enamel opacities
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17. Detection System
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Pitts, 1997

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19. Fyfee 2000
Permanent surface code Criteria
G Good, sound surface
W White spot lesion – visual assessment of
dried tooth indicates intact surface, no
clinically detectable loss of
substance, with a white or cream coloured
area of increased opacity presumed
carious by the trained examiner
B Brown spot lesion – visual assessment of
dried tooth indicates intact surface, no
clinically detectable loss of
substance, with a brown/black
discolouration
E Enamel cavity – in the opinion of the
trained examiner, there is a lesion with
demonstrable loss of surface
but no visual, clinical evidence of the
lesion penetrating dentine
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20. D Dentine lesion (noncavitated) –there is a
carious lesion into dentine but no visible
evidence of cavitation
C dentine Cavity –there is a carious
cavity into dentine
P Pulp involved – there is a carious
cavity that involves the pulp,
necessitating an extraction or pulp
treatment
A Arrested dentinal decay – there is
arrested caries in dentine
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The International Caries and Detection
and Assessment System (ICDAS)Code Description
0 Sound
1 First Visual change in Enamel (Seen only after prolonged air drying)
2 Distinct Visual Change in Enamel
3 Localized Enamel Breakdown (without clinical visual signs of dentinal involvement)
4 Underlying Dark shadow from dentin
5 Distinct Cavity with visible dentin
6 Extensive distinct cavity with visible dentin

22. Diagnostic Protocol
Physical Principle Application in Caries
Diagnosis
X Rays Digital image enhancement
Visible light Quantitative fiberoptic
transillumination (FOTI)
Quantitative light induced
fluorescence (QLF)
Laser Light DIAGNOdent
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Quantitative light fluorescence (QLF)

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25. Benefits of Early Carious Lesion
Detection
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 Increase potential to remineralize, the dimenralized non cavitated
tooth surfaces
 Decreased risk of progression to cavitated stage
 Preservation of natural esthetic appearance of tooth enamel
 Reduced treatment cost

26. Remineralising Agents
 Use of Fluorides
 Casein Phosphopeptide- Amorphous Calcium
Phosphate (CPP-ACP).
 Combination of CPP-ACP and fluoride
 Novamin (sodium calcium phosposilicate)
 Xylitol Carrier
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28. Operative Treatment
Preventive Resin Restoration
Enamel microabrasion
Future Prevention Methods
Carries Vaccine
Icon
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30. Conclusion
A clear understanding of the mechanism of subsurface
lesion formation and progression, possibilities, treatment
and their clinical applications need to be recognized to
direct preventive strategies to the high caries risk
individuals.
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