Chapter 20. CARIES OF ENAMEL: WHITE SPOT LESION, SUPERFICIAL CARIES. CLINICAL SIGNS, DIAGNOSTICS, TREATMENT AND PREVENTION

TERMINOLOGY

Caries of enamel:

► white spot lesion = initial caries = incipient caries = non-cavitated lesion on the enamel surface;

► superficial caries = cavitated caries of enamel = a tiny cavity is located within the enamel layer and does not spread into dentin.

Primary caries = initial caries = a lesion emerging in a tooth surface for the first time which does not interact with any restoration placed earlier (if any).

Not to be confused - pay attention to the overall meaning of the sentence if you come across the term initial caries in the text below.

CLINICAL SIGNS

There are two types of caries of enamel: white spot lesion (WSL) (also called non-cavitated lesion) and superficial caries (cavitated lesion). The shape of lesion is determined by distribution of biofilm. On the approximal surface the lesion is kidney-shaped between the contact facet and gingival margin. On ves-tibular surface the lesion is mostly located in cervical area and has a crescent shape or bean shape. Its central part is the most active portion of lesion.

WHITE SPOT LESION

White spot lesion is a chalky white opaque spot of different shape (fig. 20.1-

20.3).

Fig. 20.1. Tooth #32 - caries of enamel (WSL), teeth #33, #34 - carious cavities: exposed brown dentin is surrounded with demineralized chalky white enamel

Fig. 20.2. Teeth #44, #45, #46 - WSLs in cervical area, tooth #46 - filling in buccal pit with stained border

Fig. 20.3. Teeth #46, #45, #44, #33 - caries of enamel in cervical area, tooth #43 - caries of dentin (a small brown-color cavity in cervical area)

When WSL is visible on:

► dry tooth surface, this indicates lesion is on outer enamel;

► wet tooth surface, this means that the lesion has penetrated deep in the enamel and perhaps penetrated DEJ.