Volume 8 • 2021 • Issue 1

Diet is a good tool for protecting the indigenous bacteria from exogenous pathogen,whichcreatescolonization resistance. Dr. Nový says foods helpful for a remineralizing biofilm include spinach, soy, seafood, cheese and nuts. create a remineralizing rather than demineralizing biofilm,” says Dr. Nový. Diet is a good tool for protecting the indigenous bacteria from exogenous pathogen, which creates colonization resistance. 2 Dr. Nový says foods helpful for a remineralizing biofilm include spinach, soy, seafood, cheese and nuts. He also counsels his patients to be wary of non-sugar sweeteners, with the exception of xylitol and erythritol, which have been shown to prevent caries. “Many of them, like sorbitol, feed right into the metabolic pathways that cause bacteria to generate acid,” he says. Treating caries with remineralization Nový worries about using a sharp probe to determine if pits and fissures have tooth decay. “You can concentrate so much force on the tip of the probe that you can actually shatter the enamel crystals that are left after demineralization, which could itself create caries,” he says. He prefers to visually identify caries. [A] Patient with decay due to severe xerostomia caused by prescription medications. [B] White spot lesions on two teeth during first visit with Eddie. Can we reverse demineralization? In 2001, Dr. Bob ten Cate found that remineralizing solutions can remineralize outer enamel 99% and inner enamel 50%. The solution also worked on both inner and outer dentin. 3 The solution he used was one part per million fluoride ion. “The evidence says that fluoride really works, but what if a patient is resistant to fluoride?” asks Dr. Nový. “Luckily, our tool kit has grown.” One of Dr. Nový’s patients, Eddie, came to him with white spot lesions on two teeth [ Photo B ]. It wasn’t fluorosis; the white spots were in an area of plaque stagnation [ Photo C] . “I immediately set about trying to remineralize those white spot lesions,” Dr. Nový says. He told Eddie to brush those two spots, specifically. “I believe you can change a patient’s caries risk overnight with a significant change in behaviour,” he says. S upporting Y our P ractice 29 Issue 1 | 2021 |