The Marketplace for New Caries Management Products: Dental Caries Detection and Caries Management by Risk Assessment

The number of new technologies emerging each year in the realm of dental caries management is growing at an exponential rate. Examining the patent literature, one can see that this growth rate will likely continue, with the outcome that dentistry will see an expanded growth in managing dental caries by risk assessment with medicinal therapeutic interventions. Restorative dentistry solutions, treating the results of dental caries, will continue to grow, while technologies to identify the caries process at its earliest stages will soon invade practices everywhere. The most interesting aspect of these changes will be how industry responds to the inexorable, yet slow change in dental professional demand for these new technologies, while trying to be the "first to market" within the various categories of this business opportunity. This paper will take a close look at how businesses with the core competence to be key players in this emerging growth category will assess the marketplace, and match up their business interests with the changing needs of the dental profession. The paper will also address the strategic planning and business processes that the dental industry will undertake to bring new technologies to market, and how these technologies will be positioned to health care professionals and consumers. The results of the key interactions between industry and the dental profession will determine the extent to which dental caries is managed as a disease, in addition to being managed by surgical restorative interventions.     

龋活跃性检测与龋病现状及发展的相关性研究——Dentocult SM、Dentocult LB试验应用评价

目的探讨Dentocult SM、Dentocult LB龋活跃性试验在反映龋病现状及预测龋病发展方面的有效性、可靠性及可行性。方法以91名3岁的幼儿为研究对象，均行口腔检查，并计算龋、补牙数（decay ＆ filling teeth，dft）和龋严重度指数（caries severity index，CSI）；龋活跃性检测采用Dentocult SM、Dentocult LB龋活跃性试验（记录等级分值）。2年后复查dft和CSI。结果Dentocult SM各等级之dft及CSI在同期及2年后差异均有统计学意义；且各等级与dft及CSI在同期及2年后均呈高度正相关。Dentocult LB各等级之dft及CSI在同期及2年后差异亦有统计学意义；且各等级与dft及CSI在同期及2年后亦呈正相关。结论Dentocult SM能真实反映龋病的现状，较准确地预测现有龋病的进展和新龋的发生。Dentocult LB在反映龋病现状方面准确度不及Dentocult SM；但在预测现有龋病的进展方面可信度较高，有一定的临床应用价值。     

Caries detection and diagnosis: novel technologies

Recent years have seen an increase in research activity surrounding diagnostic methods, particularly in the assessment of early caries lesions. The drive for this has come from two disparate directions. The first is from the dentifrice industry who are keen to develop techniques that would permit caries clinical trials (CCTs) to be reduced in duration and subject numbers to permit the investigation of novel new anti-caries actives. The second is from clinicians who, armed with the therapies to remineralise early lesions are now seeking methods to reliably detect such demineralised areas and implement true preventative dentistry. This review examines novel technologies and the research supporting their use. Techniques based on visual, optical, radiographic and some emerging technologies are discussed. Each have their benefits although systems based on the auto-fluorescence (such as QLF) of teeth and electrical resistance (such as ECM) seem to offer the most hope for achieving reliable, accurate detection of the earliest stages of enamel demineralisation.     

Caries and heredity

Although host genes play a certain role, the development of carious lesions is determined predominantly by local influences in the oral cavity, especially by microbial plaque and dietary carbohydrates as substrate for acidogenic bacteria. How strong or weak the influence of the hereditary component on caries really is, has been the subject of discussions for the last decades. The geneticist Professor Sofear is optimistic about prospects to decrease the caries risk by manipulation of genes. However, more detailed analysis of known facts shows that the majority of genetic differences is caused by indirectly operating mechanisms. Furthermore, these genetic factors can be overruled by local protective and compensating influences.     

Caries and fluoride

The cariostatic effect of fluoride is well documented, but the exact mechanisms of action are still subject of many studies. Re-evaluations of the clinical data of water fluoridation studies have confirmed that fluoride can have a pre-eruptive effect. But in general, the post-eruptive effects of low concentrations of fluoride on the de- and remineralisation processes are regarded to be of greater importance. Infrequent applications of concentrated fluoride solutions may only be effective in demineralised enamel. The Dutch national recommendations for the use of fluorides correspond well with the present views on the mechanisms of action of fluoride.     

Caries profunda: current views and treatment concepts

Current insight of the caries process demands new, more selective and less invasive techniques and methods for excavation. Nowadays the biological aspects of teeth and pulp tissue in reaction to caries need to be respected and even used. The general practitioner is confronted with a wide range of new techniques and methods and needs to choose the best suitable. The purpose of this article is to inform the general practitioner about the current views concerning treatment of caries profunda and the different treatment concepts. Thereby the authors hope to assist the general practitioner in their choice for the proper treatment.