Permanent anterior teeth
Permanent anterior teeth with carious lesions
Initial caries (anterior)
Description: Visual diagnosis - teeth with white spot lesions but no dentinal caries.
Aim: To use a preventive approach to slow or arrest caries and reduce the risk of teeth requiring a restoration.
Image shows anterior permanent teeth with initial carious lesions
Carry out site-specific prevention.
Monitor at each recall visit and if the lesion is progressing, adopt an alternative management strategy.
- Only continue with this approach if caries has arrested and there is no evidence of progression.
Some white spot lesions are only detectable on dry enamel, while other more established lesions are visible on wet enamel. Non-invasive management of initial carious lesions is the preferred approach. However, careful active surveillance of enamel lesions is required to enable more intensive prevention or restoration if the lesion is progressing.
Resin infiltration can be used for an active initial lesion or to mask where a white arrested lesion remains on the tooth (see Sealant/infiltration).
Note that for incisors affected by molar-incisor hypomineralisation (MIH) the European Association of Paediatric Dentistry (EAPD) guideline provides detailed advice on microabrasion, resin infiltration and remineralisation treatments.
Advanced caries (anterior)
Description: Visual diagnosis - teeth with cavitation or dentinal shadow.
Aim: To remove caries and provide a long-lasting restoration.
Image shows a permanent anterior tooth with an advanced carious lesion
Carry out selective caries removal and restore or consider completely removing caries and restore (see Complete caries removal).
Evidence to support selective caries removal to reduce the risk of pulp exposure is derived from studies of posterior teeth. However, in principle, if space permits, this approach may also be applied to advanced lesions in anterior teeth.