Volume 8 • 2021 • Issue 1

To avoid initiating the restorative cycle, Dr. Nový often treats initial caries lesions with glass ionomer sealants. Glass ionomers are bioactive; they encourage remineralization of the surrounding tooth structure. "Theevidence shows that sealing in decay stops the progression of lesions," he says. [C] Disclosing tablet shows areas of plaque stagnation on Eddie’s teeth. [D] Eddie’s teeth after treatment, almost 2 years later, when he was able to get braces. Dr. Nový also observed the lesions over time, a task that he thinks can be difficult if dentists don’t document the location and how advanced lesions are. “How can you tell if remineralization is working if you can’t compare a lesion to the last time you saw it? Is it arrested? Is it improved?” he says. To avoid initiating the restorative cycle, Dr. Nový often treats initial caries lesions with glass ionomer sealants. Glass ionomers are bioactive; they encourage remineralization of the surrounding tooth structure. “The evidence shows that sealing in decay stops the progression of lesions,” he says, “but I’m a little obsessive compulsive, so I clean the area first with a little bit of air abrasion. I try to get it squeaky clean before I apply sealants.” The lesions resolved and Eddie was able to get braces [ Photo D ]. Silver diamine fluoride (SDF) Silver diamine fluoride (SDF) has been shown to be effective in arresting caries lesions. “Dentists often ask what’s the evidence for using SDF in combination with potassium iodide,” says Dr. Nový. Dentists often use the two together in the hopes of preventing the dark stains caused by applying SDF alone. “But the reality is you cannot apply enough potassium iodide to totally prevent a black stain,” he says. So in his office, he uses SDF by itself. Dr. Nový says the stain can actually be helpful [ Photo E ]. “Every time I look in the patient’s mouth, I see the stain, and I know that caries lesion is not progressing,” he says. Dr. Nový has used SDF with older patients, especially if the treatment area will not be visible. When he uses it with children, he’s careful not get any SDF on their tongues, “because the dental visit will be over. It tastes horrible,” he says. S upporting Y our P ractice 30 | 2021 | Issue 1