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Early stages of decay (white spot lesions) and initial enamel damage are managed with non-invasive preventive methods and are closely monitored over time. High-risk children typically need more intensive treatment. This may include early restorative work to repair and address any existing decay to prevent further deterioration of the teeth.
The early carious lesion is characterized by demineralization of the tooth surface, altering the tooth's optical properties. Technology using laser speckle image (LSI) techniques may provide a diagnostic aid to detect early carious lesions.
The initial lesion appears within two to four days of gingival tissue being subjected to plaque accumulation. When not generated through clinical experimentation, the initial lesion may not appear at all, and instead, a detectable infiltrate similar to that of the early lesion, explained below, appears. [19] Features of the Initial Lesion: [15]
Early carious lesions can be treated with dental sealants in order to prevent invasive dental restorations. Dental sealants as treatment would be appropriate for occlusal caries which extend no more than a third of the way through dentine in the primary dentition and enamel lesions in the permanent dentition [ 26 ]
If the lesion is large it is more likely to be a cyst. Radiographically, both granulomas and cysts appear radiolucent. Many lesions of the mandible in particular appear cystlike in appearance. It is often necessary to obtain a biopsy and evaluate the tissue under a microscope to accurately identify the lesion. [2]
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Periapical readiograph of lower right teeth, showing a large carious lesion in the distal of the lower right second molar. The same tooth also has an extensive periodontal defect. At this stage, without further information, it is difficult to tell which process has occurred first and lead to the death of the pulp.
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