Caries

Caries Detecting Dye

Dental caries is one of the most common diseases that people suffer from, and yet for many the management of it remains in the 19th century - dig it out and then fix a hole. Sounds like how you might fix a road - hardly a tooth. In dental school you get taught to clean out the caries until the remaining dentin is hard. What does that even mean? How hard is hard? Vinnie Jones hard or Will Smith hard?

Even back in the 1980s this question vexed Professor Fusayama in Japan and he set out to find a more reproducible method of identifying when the caries was removed. Enter Caries Detecting Dye. Now, the thing is that you don’t actually have a solution that detects caries - and the misnomer has led to all sorts of problems. What the dye does is penetrate into the collagen network, and it stains denatured collagen. The darker the stain, then the more the cross linking of the collagen is irreversibly damaged. Where it’s pink, this is an area that can remineralise. However, due to the damaged structure of the dentin, we are limited in the quality of bond we can achieve in these areas. So we look to utilise caries detecting dye to achieve what we call Caries Removal Endpoints. By approaching the carious tooth in this fashion we can reduce the risk of pulpal exposures during cavity preparation, and remove only the tissue that is irreversibly damaged whilst selectively leaving some caries affected dentin as this will remineralise over time. We can also visualise the type of dentin substrate we are dealing with and thus maximise out bond strengths to the tooth.

Reading the latest consensus papers on managing caries highlights that this approach - a selective caries removal approach - is now the standard of care in dental caries management. Not stepwise removal, not total removal to hard dentin….selective removal is the way.

Don’t stay tied to old methodology - get trained in the best practice of restorative dentistry today.