Light fluorescence may also be used as an adjunct in caries diagnosis Enamel is

Light fluorescence may also be used as an adjunct in

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interproximal lesions. Light fluorescence may also be used as an adjunct in caries diagnosis. Enamel is the most highly mineralized hard tissue in the body. The enamel matrix is made up of a protein network consisting of microscopic mineralized hydroxyapatite crystals arranged in rods or prisms. The protein network facilitates the diffusion of fluids, such as calcium and phosphate ions distributing these ions throughout the enamel. As carbohydrates are consumed by the host, the carbohydrates are broken down in the oral cavity by the protein enzyme amylase. This reaction causes lactic acid to be produced, thereby demineralizing the enamel matrix. If the demineralization of enamel is not reversed by the action of fluoride or calcium and phosphate ions, then the demineralization process continues further into the tooth structure, affecting the dentinoenamel junction (DEJ) and eventually the dentinal layer. The term “overt or frank” caries is used when it reaches the DEJ. A carious lesion develops in three stages of demineralization. The first stage in demineralization of enamel is called the incipient lesion or “white spot” (Figure 1). This beginning carious lesion
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5 Crest ® Oral-B ® at dentalcare.com Continuing Education Course, Revised August 8, 2012 can be reversed with the daily use of fluoride or calcium and phosphate, persistent oral hygiene care, and a reduction of refined carbohydrates. The second stage involves the progression of demineralization leading to the DEJ and into the dentinal layer. The third stage is the actual cavitation in the dentinal layer. Neither of the last two stages can be reversed and require mechanical removal of dental caries. There are three levels of preventive dentistry that the dental professional should understand when educating patients in the dental caries process. The first step is primary prevention. This prevents the transmission of S. mutans and delays the establishment of bacteria in infants, toddlers, and young children. The second step is secondary prevention, which prevents, arrests, or reverses the microbial shift before any clinical signs of the disease occur. The third step focuses on limiting or stopping the progression of the caries process by initiating remineralization therapy of existing lesions. Prevention Step One - Transmission and Establishment of S. Mutans
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