Avrelian

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I mean when it's a " white spot". If no, than why not? How hard would it be to re-mineralize the surface?
 

preOMFS

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I mean when it's a " white spot". If no, than why not? How hard would it be to re-mineralize the surface?
I've been told fluoride varnish can work. However, I don't think this is covered in the fee schedule and it can be time consuming to have repeat patients come back for an application. So some dentists may be reluctant to do this when they can just tell the person to floss/brush better, and if it progresses to a larger lesion, then it's more money in the bank after a composite restoration.
 

djeffreyt

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It depends, but yes, I treat them. Pit and fissure decalcifications will usually be at least an enamoplasty and seal, possibly a larger PPR, and sometimes it ends up being a filling despite not looking like one.

Buccal white spots are also treated IF the patient is young and has poor oral hygiene cause they can't control their own hygiene and upkeep. Yes, you can remineralize these, but the fact is that most of the time, that doesn't happen because of patient and parent compliance. You're best intentions to be non-invasive and not treat these small white decalcification with anything but fluoride end up at recalls with cavitations into dentin requiring larger fillings and in many cases SSCs. Happens all the time. I've learned from my mistakes and have become far more aggressive. The first time you sit and talk to mom about the white spots on all the anterior baby teeth and how if you have really good hygiene and use fluoride varnish, etc. etc, you can save these teeth from filling and the mom is like...OMG, that's great. I'll totally do that instead of paying for the fillings and you are such a great doctor. So you apply the varnish and tell her not to let the kid eat or drink or brush for 30 minutes so the varnish doesn't come off, the parent promises to be much better with the kids hygiene and starts walking out and as they pass the front desk, the mom hands the kid a sippy cup of juice or some food.
 

fdu83

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Yes, we attempt to remineralize white spot lesions all the time. NYS does allow for 4 F varnish treatments a year for children under 7, and we have found that to be really helpful in preventing white spots to progress to caries. Of course, varnish alone is not enough. Caries risk assessment and anticipatory guidance are essential. Filling a "cavity" does not cure the disease. Adults can benefit from brushing with high F toothpaste like Prevident 5000 or applying MI Paste Plus. If it is just an esthetic issue you can also try microabrasion for adult teeth. The CDA published an excellent publication which covers caries risk assessment for all age groups. http://cda.org/library/cda_member/pubs/journal/jour1007/index.html
 

fdu83

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Yes, we attempt to remineralize white spot lesions all the time. NYS does allow for 4 F varnish treatments a year for children under 7, and we have found that to be really helpful in preventing white spots to progress to caries. Of course, varnish alone is not enough. Caries risk assessment and anticipatory guidance are essential. Filling a "cavity" does not cure the disease. Adults can benefit from brushing with high F toothpaste like Prevident 5000 or applying MI Paste Plus. If it is just an esthetic issue you can also try microabrasion for adult teeth. The CDA published an excellent publication which covers caries risk assessment for all age groups. http://cda.org/library/cda_member/pubs/journal/jour1007/index.html
 

yappy

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At what point is remineralization ineffective?

I once read a "blog" where someone was claiming to have remineralized a frank cavity of a tooth without fluoride; but, by improving their diet. Does this sound plausible?
 

djeffreyt

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At what point is remineralization ineffective?

I once read a "blog" where someone was claiming to have remineralized a frank cavity of a tooth without fluoride; but, by improving their diet. Does this sound plausible?
The stock answer is usually once the demineralization has entered the dentin, however, in reality remineralization of lesions into dentin has occurred, it's just not as reliable as trying to remin enamel only lesions

There are dentists who also attest that gross cavitations can be arrested with fluoride, ozone, and flowers and good thoughts and intentions.