Caries Prevention and Reversal Based on the Caries Balance

Resident: M. Swan

Article Title: Caries Prevention and Reversal Based on the Caries Balance

Author: John D.B. Featherstone, MSc, PhD

Journal: Pediatric Dentistry

Volume (number) 28:2 2006

Month/Year: March/April 2006

Major Topic: Using the caries balance concept to drive treatment planning

Minor Topic:

Type of Article: Conference Paper

Main Purpose: To encourage clinicians to make practical use of the caries balance model as they help patients combat the progression of caries

Overview of Method of research: This article is essentially a position paper, but one study regarding caries management by risk assessment is detailed in the article. The subjects in this study were adults, age 18 and older, with 1 to 7 cavitated lesions at baseline who were then randomized to either a "conventional care" control group or to a preventive intervention group. Saliva samples were taken each month for MS, lactobacilli, and fluoride evaluation. Caries exams conducted baseline and 2 years after all restorations of the cavitated lesions were completed. The intervention group used chlorhexidine gluconate .12% rinse, fluoride toothpaste daily, and .05 % NaF rinse. Caries risk status was assessed every 6 months.

Findings: MS counts fell greatly in the intervention group, and a reduction in caries risk status was strongly correlated with reduction in numbers of decayed teeth. The authors concluded that a targeted, combined antibacterial and fluoride therapy beneficially altered caries risk status and the incidence of caries.

Key Points/Summary: In this article, Dr. Featherstone highlights the "caries balance," or the balance between mineralization and demineralization that constantly fluctuates in the mouth. This balance is determined by the relative influence, or weights, of the various pathological factors, including

1. acid producing bacteria
2. frequent eating/drinking of fermentable carbs
3. inadequate saliva flow and function

and Protective Factors, such as

1. saliva flow and components
2. fluoride
3. antibacterials (Chlorhexidine, Xylitol, etc.)

The author observes that while we as clinicians know the science behind caries development, we fail to implement all the tools available to turn the process around. He advocates use of this caries balance model in treatment planning for individual patients. Simply put, we need to reduce pathological factors and increase protective factors for our patients.


Assessment of Article: Shenanigans are not an option for Dr. John D.B. Featherstone. This is a helpful article that uses a simple "seesaw" concept to explain a complex subject. I wonder if we should be prescribing more antibacterial mouth rinse and dispensing xylitol-containing products/fluoride rinses to our high-risk population in the clinic, particularly the older kids. Doing so could very possibly help curb the caries rate.