Caries process
Caries is a biofilm-mediated, sugar-driven imbalance between demineralisation and remineralisation. Activity matters as much as lesion depth.
Understand
A caries lesion reflects repeated low-pH challenges in a susceptible biofilm. Demineralisation can be balanced or reversed before cavitation; activity and cleansability guide whether non-operative care is realistic.
Assess
Examine lesion texture, plaque stagnation, radiographic depth and change over time alongside diet, fluoride and salivary factors. A lesion's colour alone is not a reliable activity marker.
Apply
Aim to control the disease process as well as the defect. Agree achievable changes, monitor the lesion and restore when cavitation, progression or inability to clean makes it necessary.
Key distinctions
Caries can be described at patient, tooth and lesion levels. The patient's risk sets background probability; a particular lesion's activity and surface integrity guide local management. A sealed inactive lesion and an active plaque-retentive cavity therefore require different decisions despite similar radiographic shadows. Monitoring needs a baseline and a specified change that would trigger intervention.
Think through a case
A chalky white spot beside a bracket is non-cavitated but plaque-retentive. Discuss active disease, cleanability, fluoride and follow-up before reaching for a bur.
The distinction to remember
Do not use radiographic depth alone to decide every lesion needs restoration; activity, surface integrity and risk matter.
Test your recall
What supports arrest of an early non-cavitated lesion?
Show answer
Changing risk factors and supporting remineralisation with fluoride.