hygiene the international C.E. magazine of dental hygiene

16 I the pits and fissures of permanent posterior teeth; therefore, this validates the need to seal the occlusal surfaces. According to Adair, sealants remain the mosteffectivemeansforarrestingorreversingthese lesions. Additionally, earlier detection actually maxi- mizes sealant effectiveness (Adair, 2003). Remineralization with products such as nanohy- droxyapatite and calcium phosphate technologies are a supersaturation of hydroxyapatite and fluor- apatite. Although nanoparticles of hydroxyapatite are only 20 nm in size (1/850th the width of human hair),itisthemoststableformofcalciumphosphate. Studiesdemonstratethatnanoparticlesmimicbuild- ing blocks of natural enamel and are effective as an enamel repair material and anticaries agent (Kutsch & Bowers, 2012). Other available technologies are amorphous cal- cium phosphate (ACP), casein phosphopeptide with ACP (CCP-ACP, Recaldent) and calcium sodium phosphosilicate (NovaMin). The two sources of calcium and phosphorous are salts: calcium sulfate and dipotassium phosphate. When the two salts are mixed, they rapidly form ACP that can precipitate onto the tooth surface. Once the ACP dissolves in enamel fluids, the calcium and phosphate ion pre- cipitates and recrystallizes as apatite. The challenges of low substantiality and high solubility of ACP have resultedinthedevelopmentofcarriersthatmaintain and stabilize the calcium and phosphate ions in an amorphous form. NovaMinreactswithsaliva,enablingsodiumions toexchangewithhydrogenions,thusamplifyingthe natural protective mechanisms of saliva by raising the pH of the mouth. Calcium phosphate crystal- lizes to build a new hydroxyapatite-like layer over exposed dentin and within the dentinal tubules. Tri- calcium phosphate (TCP) combines beta tricalcium phosphate and sodium lauryl sulfate to form a more functionalized calcium phosphate. TCP provides a slow release of calcium onto the tooth surface as it contacts saliva (www.rdhmag.com). Bleaching is effective because it removes plaque, reducescariesbacteria,removesplaqueandelevates pH on elderly patients. A customized tray with 10 percent carbamide peroxide is worn to reduce or kill lactobacillus, which minimizes the chance of decay (Haywood, 2007). Caries infiltration is a micro-invasive treatment for incipient lesions, which reduces the lesion pro- gression. It works in interproximal areas and smooth surfaces that mask white-spot lesions in one ap- pointment. It works through filling, reinforcing and stabilizing enamel without drilling or sacrificing healthy tooth structure. It is described as bridging the gap between prevention (fluoride) and caries restoration. Because of the role that bacterial biofilms play in the dental caries process, interest and research in probiotics has accelerated. Probiotics contain specific bacterial species that are considered GRAS, (generallyregardedassafe)forhumanconsumption. However, no two probiotics are alike, which means that consistency and reproducible results are dif- ficult to achieve. Until further research is performed regarding probiotics, clinicians and patients should focus on creating a healthy oral environment by neutralizing the pH and supporting the patient’s natural healthy oral microflora (Kutsch & Bowers, 2012; Minocha, 2009). Atraumatic restorative treatment (ART) is a mini- mallyinvasiveapproachtopreventdentalcariesand arresttheprogressionofcariouslesions.ARTincludes sealing teeth before decay sets in, and if decay is present, restoring those lesions using glass ionomer temporaryrestorations.Likecariesinfiltration,ARTis considered a treatment plan option that can bridge the gap between a surgical model of dental care and other preventive interventions (Gould, 2013). Establishing a risk management plan for caries managementshouldbenomystery.Implementation of the CAMBRA and ART approach will minimize the decay process and maximize prevention through products and protocol for caries reduction. Many peoplehaveseenbenefitsofthevariousmethodolo- gies of caries reduction, and usually it is the combi- nation of any of the previously mentioned practices. Dental caries is still an epidemic, but with the goal of educating the patients, matching the treatment and product to the problem, oral health can improve._ Editorial note: A complete list of references is avail- ablefromthepublisher. hygiene 1_2013 ReneéGraham,RDH,MEd,isaclinicaleduca- tor for DENTSPLY Professional, serving the southeastregionoftheUnitedStates.Graham earned a dental hygiene degree from Darton State College in Albany, Ga. She also has a BachelorofScienceineducationandaMaster of Education, both from Valdosta State Uni- versity in Valdosta, Ga. She brings 19 years of clinical experience in general and peri- odontal practices and 11 years of academic experience to her work on behalf of dental hygienists.Forthepast10years,shehasheld the position of director of dental programs at Valdosta Technical College. She has served as a site visitor for the Commission on Dental Accreditationsince2003andhasbeenactive with regional testing agencies, the Georgia Dental Hygiene Educators Association and dental hygiene/dental assisting curriculum development for the state of Georgia. _about the author hygiene IC.E. article_ caries management