Under a microscope, the structure of tooth enamel looks a lot like a net with crystals in it. When the bacteria in our mouths create acids from the foods we eat, they remove the crystals (mineral) from the net (organic material) causing decay. The first signs of "demineralization" are the formation of chalky white spots on teeth or subsurface lesions detected on xrays. It is sometimes possible to remineralize these very small (incipient) cavities with topical fluoride applications or other agents like MI Paste.
Silver Diamine Fluoride (SDF)
Surgical treatment of cavities in children and patients with special health care needs often requires advanced behavior management techniques to keep them safe, including sedation and general anesthesia. It is sometimes possible to delay or avoid these procedures by arresting the decay process with SDF applications. SDF is effective at both killing the bacteria and hardening the tooth surface in a cavity. Dr. David will be happy to talk to you about the advantages / disadvantages of this treatment as well as whether or not it is appropriate for your child's condition.
Interim Therapeutic Restorations (ITR)
Sometimes traditional cavity preparations are just not feasible for very young patients, uncooperative patients, or patients with special health care needs. ITR involves gentle, stepwise excavation of decay without the use of an anesthetic, and placement of white adhesive restorative material in order to prevent the progression of cavities. These procedures are quick and easy, and allow us to minimize patient anxiety by postponing placement of definitive restorations.