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DE-MINERALIZATION AND RE-MINERALIZATION OF ENAMEL

March 15th, 2012

One key to good preventive dental practice is the trend towards Minimally Invasive Dentistry.  That is, the employment of the least invasive treatment options available to minimize tissue loss and maximize patient comfort.  The first basic treatment step in treatment of early tooth decay is the re-mineralization of enamel.
Think of tooth enamel as a matrix, sort of like a sponge structure, with the spaces filled with hard minerals that give it strength.  The first step in the decay process occurs when those minerals are dissolved out of the matrix by acids.  The acids might be the result of bacterial plaque on the teeth.  Sugars are metabolized by the bacteria and acid is the end product.  Or the acids might be placed in the mouth directly in the form of acidic food or drinks, particularly soft drinks, both carbonated and non-carbonated.  Acids will wash out the minerals and leave the matrix intact for a short time.  During this time, removal of the acids and the plaque will allow fluoride and calcium rich minerals to re-harden the matrix and re-mineralize the enamel.  The fluoride atoms may actually create enamel that is harder than the natural tooth structure.
Fluoride and other minerals are most commonly delivered by toothpastes and fluoride rinses and gels.  Some of these over the counter products are quite effective in this process.  But the effectiveness depends upon reducing the levels of acid and proper oral hygiene to reduce bacterial plaque.
A new procedure to reverse more advanced demineralization is called Icon®.   The process involves the cleaning of the matrix and infusing it with acrylic resin to seal and harden the affected area.  As a side benefit, it requires no anesthetic and no drilling.
The Icon system can be effectively used both on the smooth outside surfaces of the teeth as well as the areas between the teeth.  It will stabilize the weakened areas and prevent the need for a conventional filling.
Even once a filling is imminent, minimally invasive techniques call for the least amount of tooth structure to be removed to accomplish a proper restoration.

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