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An Update on Demineralization/Remineralization

Course Number: 73


History - Figure 1

Draftee rejection due to poor oral health.

Many years ago the JDHA carried this quote by L. S. Fosdick, "It is quite possible that in the not too distant future, mass control of caries may be achieved; but until that time, each dentist and hygienist should become acquainted with the fundamental mechanism of the caries process, and pass this information on to the patient, along with suitable methods of control." We took Dr. Fosdick at his word and moved the management of dental caries from a personal concern to a national concern...developing sensitive scales for the measurement of dental caries. We have also continued to learn about the mechanisms of the caries process; building an understanding that caries is not a one way process. Rather, early caries can be inhibited, and even reversed, through the process of remineralization.

The single greatest reason for rejecting draftees from enlisting in World War II was poor oral health. We saw a personal concern become a social concern and, ultimately, a significant concern for national security.

One of the primary responses to these challenges was the development of effective anticaries approaches, most notably in the form of fluoride. From water fluoridation to our professional recommendations of an OTC product, fluoride touches the lives of our patients on a daily basis. Unlike the concerns of the 1940s and 1950s, where the focus was on CURE, our focus today is on PREVENTION.

History - Figure 2
History - Figure 3


Today we face many questions about fluoride from well-informed patients. We are no longer simply asked, "WHEN will I get my fluoride treatment?", but rather we face more complex questions such as "Who should get fluoride, when and how much...does fluoride affect permanent teeth, should we give a topical fluoride treatment to a caries-free child, and what do we do when we see rampant caries?" The evidence to support these decisions has become increasingly more important in the practice of dentistry today. Some basic background on "evidence-based dentistry" and how it applies to demineralization/remineralization is an integral part of this course. What is the evidence supporting your clinical decision, and what is the strength of this evidence? These questions, in addition to those above, have been asked with increasing frequency by students and practitioners alike. In a world that allows both patients and practitioners to instantly access information over the Internet, we must be prepared to face these questions with scientific support. In that way, we can be fully prepared to work with our patients, sharing the most up-to-date knowledge with them in a way that enhances not only our role in providing dental health but also in their role of being healthier, more well-informed patients.