Development of the Carious Lesion

The initial stages of the carious lesion are characterized by partial demineralization of enamel, resulting in a subsurface lesion beneath a relatively intact surface layer approximately 2-50 μm thick. This lesion typically shows a mineral loss of 30% to 50% may extend into the underlying enamel and even into dentin. Clinically, the lesion will appear as a chalky white, opaque area with a roughened surface, commonly referred to as a white spot lesion.

At this stage, the carious process is still non-cavitated and potentially reversible through remineralization strategies, such as fluoride therapy and dietary modifications. Therefore, the clinical goal is to identify and manage lesions at this stage to prevent progression and avoid surgical intervention.

Figure 5. Examples of caries lesions at different stages in a patient at high-risk for caries. Note heavy plaque accumulation and gingival inflammation.

Figure 5. Examples of caries lesions at different stages in a patient at high-risk for caries. Note heavy plaque accumulation and gingival inflammation.

If the demineralization continues unchecked, the surface layer may eventually collapse, resulting in cavitation. Once cavitated, the lesion becomes irreversible and requires restorative treatment. Clinically, advanced lesions into dentin may present as visible holes in the enamel and often feel “sticky” or soft when gently probed, indicating structural breakdown of the tooth.