Incipient Caries: Causes, Treatment & Prevention

Incipient caries are just a fancy word for early cavities. There are cavities that cannot be seen with the naked eye, that is why dentists carry out different dental tests to differentiate stains from incipient caries.

Sometimes the spots resemble cavities because of the color of both. When touching them with the explorer, we discover that they are hard, and that is when they should not be manipulated, since the stains are only enamel scars, to put it simply, that is, remineralizations of the enamel that result in a dark color.

The detection of more complex caries is verified, in addition to the use of the hook, with the help of complementary tests such as X-rays. First, we suspect that it exists because of the change in color of the enamel; and then, we confirm it with the X-ray.

What are incipient caries?

To understand what incipient caries are and how we have to treat them, we must be clear about what dental caries is. Dental caries is one of the most frequent diseases in oral health, characterized by being a dynamic process, in which our dental surface is constantly being demineralized and remineralized.

The fact that it “incipient caries” or not is determined by those factors that influence cavities, such as the consumption of sugars in our diet, poor oral hygiene, exposure to fluoride and the characteristics of the teeth and saliva from each person. For example, if we do not have a good oral hygiene habit and we eat sugar constantly, the bacteria that adhere to the teeth will metabolize the sugars in the food, producing acids in large quantities. These, over time, will demineralize the enamel surface, resulting in a cavity in the tooth, which is what is known as moderate or advanced caries (depending on its depth).

Although, we must know that there are also caries lesions that are not so easily seen with the naked eye, and they are the well-known incipient caries.

incipient caries are active lesions that only involve tooth enamel. If viewed under a microscope, they appear as areas of mineral loss, like pores in the structure, but the outer surface maintains its shape. For this reason, it is so difficult to detect them because they look like white spots that can be seen when drying the tooth surface very well. It is even very common for white spots to be covered by bacterial plaque in the part just before the gum.

Sometimes they are hidden in the surfaces that are between teeth or in the fissures of the molars. However, the good news is that these incipient cavities can be treated by remineralizing these surfaces, so that the cavities do not continue to progress and normal cavities do not end up forming. To achieve this, it is essential to have a strict control of the risk factors and a good fluoridation therapy supervised by a dentist. For this reason, it is advisable to carry out regular check-ups, so that these cavities can be detected before they are irreversible.

Caries (from the Latin: caries = decay) is defined as a bacterial infection of the teeth. The acid produced by bacteria in plaque damages tooth enamel. This damage becomes visible as discoloration or painful “holes” in the tooth.

Caries or incipient caries occurs particularly frequently on molars and in the spaces between the teeth. It is one of the most common diseases worldwide. Left untreated, incipient caries can lead to tooth loss. However, caries can often be avoided with proper oral hygiene.

Incipient caries : Risk factor and causes

Bacteria in the mouth, together with leftover food and saliva, form a biofilm that settles on the teeth as plaque. Certain bacteria in this plaque, particularly the so-called mutans streptococci and lactobacilli, feed by converting carbohydrates, especially sugars, in the diet into acid. This extracts minerals from the tooth enamel.

As a rule, the saliva then has the task of remineralizing the damaged tooth enamel. However, if the acid load becomes too great, this no longer works. Then incipient caries develops: the tooth enamel becomes porous, damage and holes form, and cariogenic microorganisms can penetrate deeper and deeper into the tooth substance.

Incipient caries is influenced by several factors: bacteria, dental hygiene and eating habits. The development of incipient caries is based on an interaction of these factors. In addition, the saliva and the immune system also play a role.

To help children answer the question “How does incipient caries occur?” The history of the bacteria “Carius and Baktus” helps to explain this in more detail. It shows what happens in the teeth when there is caries. Today, the pair of bacteria can also be found on posters at the dentist, in the form of comics or in short stories that warn against caries in milk teeth.

Caries bacteria

There are over 700 types of bacteria in our mouth. To a certain extent, these microorganisms are necessary for a healthy oral flora. However, some bacteria feed mainly on food residues, especially sugar. They use sugar from food and excrete acids as waste products. These attack the tooth enamel by leaching minerals. If this process is not stopped, eventually the hole will form in the tooth.

Diet high in sugar

The development of Incipient caries is promoted by sweet foods and drinks. Above all, household sugar (sucrose), grape sugar (glucose) and fruit sugar (fructose) can be easily utilized by caries bacteria and thus indirectly damage the teeth. On the other hand, long-chain sugar compounds, i.e. complex carbohydrates, such as those found in whole grain products, do not promote incipient caries.

Dental hygiene

Brushing your teeth reduces the number of bacteria in your mouth. Immediately after brushing your teeth, however, a coating of bacteria and saliva components slowly forms on the tooth surface – called plaque or biofilm. If someone brushes their teeth rarely, irregularly or carelessly, this plaque has enough time and opportunity to become thicker and thicker. The problem with this is that it is mainly the bacteria that cause incipient caries that multiply in it.


If there is a lot of saliva, the minerals it contains can replace losses in the hard tooth substance. An increased amount of saliva also serves to liquefy ingested food. In this way, they can be transported away better and are less likely to get stuck on and between the teeth. Some components of the saliva also have a neutralizing effect on the acids produced by bacteria. Others have antibacterial properties.

In summary, this means that if there is little saliva, incipient caries is more likely to form. In the space between the teeth and on the crown of the tooth, food residues can then easily get caught and settle, which caries bacteria are happy about.

Immune system

The condition of the immune system also determines how well the body can defend itself against harmful bacteria. People with a weakened immune system often suffer from incipient caries. A weakening of the immune system occurs, for example, with chronic diseases such as HIV or diabetes mellitus. Medications such as antibiotics or corticosteroids (e.g. cortisone) also reduce the resistance of the immune system.

Incipient Caries

In the visible area of the tooth (tooth crown), the tooth bone is closed off from the enamel on the outside. Inside the tooth, dentin protects the pulp, which contains blood and lymphatic vessels, nerves, and connective tissue. In the dentin there are dentin canals through which stimuli (pressure and temperature) are transmitted to the nerves of the tooth.

Since the tooth consists mainly of dentin, treatments must be carried out in the dentin, especially in the case of caries. The aim here is to remove all affected areas, while at the same time preserving the still healthy dentine substance as much as possible. The hole is then closed with a suitable, dentin-adhesive filler. There are biocompatible artificial dentines for this purpose.

Is incipient caries contagious?

Incipient caries is a bacterial infection and, like other bacterial infections, is contagious. In normal everyday life, however, the risk of infection with incipient caries does not play a major role. The bacteria that are responsible for the development of caries are carried in everyone’s mouth. Individual risk factors must therefore definitely be added before caries can break out. A transmission of caries-causing bacteria between two adult people (e.g. through kissing or shared cutlery) is therefore irrelevant for the development of caries.

The fact that caries Is contagious plays a role in small children. They have fewer bacteria and microorganisms in their mouths than adults, and even none at all in small children without teeth.

Theoretically, adults who, for example, briefly put their child’s pacifier in their mouth to clean it themselves, may transmit their caries bacteria to their offspring. Experts dispute whether the risk of infection is really that great.

Family influence

Contrary to popular belief, tooth caries is not hereditary. incipient cavities can run in families. For example, hereditary factors such as deep tooth grooves represent a potential risk factor for caries. There are also eating and hygiene habits that children learn from their parents: in families where sweet foods and drinks are often served and/or little emphasis is placed on thorough and regular brushing of teeth, the risk of incipient cavities in children is far higher than in other families.

Incipient cavities : investigations and diagnosis

If incipient cavities is suspected, the dentist is the right contact person. In a short conversation, he will first collect the medical history. You (or your child) have the opportunity to describe the symptoms in detail. The doctor can then ask further questions, for example:

  • When did the symptoms first become noticeable?
  • Are there relatives who often suffer from dental problems?
  • Have you had problems with your teeth in the past?
  • How often do you brush your teeth a day?

A detailed examination of the teeth then takes place. The dentist can detect incipient cavities by examining the teeth with a small mirror. The disease is initially noticeable through changes on the surface of the teeth. If such changes are present on the surface, the dentist uses a small probe to check how far the damage has progressed into the interior of the tooth. The treatment depends on it.

Since incipient cavities is usually very difficult to detect in the initial stage, X-rays can be helpful. Carious areas can be identified very well on this. Incipient caries is often only discovered by chance on routine X-rays taken during a dental check-up.

There are also other modern methods that can be used to diagnose incipient cavities. This includes, for example, the measurement of electrical resistance and various fluorescence methods:

Electrical resistance measurement: Healthy tooth enamel moistened with saliva conducts electricity. In the case of caries damage, this conductivity in the enamel increases, i.e. the electrical resistance – measured using a hand electrode – decreases.

Fluorescence methods: They are based on the fact that the tooth structure fluoresces under certain conditions. The fluorescence properties depend on the condition of the tooth substance: Carious areas fluoresce differently than healthy tooth substance.

Where is incipient cavities most common?

Tooth decay in adults occurs primarily where plaque is difficult to remove. It is comparatively rare on the incisors and is usually recognized in good time so that effective countermeasures can be taken.

Incipient caries occurs more frequently in the spaces between the teeth, on the back molars and wisdom teeth or in the area of bridges and braces. Teeth with many deep grooves on the chewing surface that are difficult to keep clean are particularly susceptible to incipient cavities.

Caries can also form under crowns if the carious areas were not completely removed during dental treatment before the crown was placed or if caries bacteria get under the crown due to insufficient cleaning at the edge of the crown.

So-called root caries (also: tooth neck caries) occurs on exposed tooth necks. Gum recession, often caused by inflammation of the periodontium, precedes tooth neck caries.

The risk of incipient cavities increases with age because the gums recede over time. Diabetics also have an increased risk of disease, as they suffer from periodontitis more often than average.

Treatment of incipient cavities

In the case of caries in the early stages, improved oral hygiene and avoiding a high-sugar diet is sometimes sufficient. However, tooth decay is often only discovered when it is already more advanced. Then the dentist has to step in: He usually removes the decayed area on the tooth with a drill and closes the resulting hole with a filling.

Tips to prevent and eliminate incipient cavities

Brush your teeth frequently

The appearance of incipient caries is usually the result of poor dental hygiene. Therefore, it is advisable to prevent incipient cavities by brushing your teeth within 30 minutes after eating, for at least 2 minutes and using the correct technique. In this way, we will eliminate the remains of food that have been deposited on the teeth, minimizing the appearance of bacterial plaque. In the same way, it is also advisable to brush the tongue, since it is where a large part of the bacteria found in the mouth are concentrated.

Use mouthwash

The mouthwash is an antimicrobial liquid that helps reduce the level of bacteria in the mouth. Fluoride rinses are especially recommended, which prevent incipient cavities by strengthening the enamel, and making it more resistant to bacterial attacks. They can also remineralize the enamel, and in this way, eliminate small incipient cavities.

Flossing every day

Dental floss is a perfect complement to tooth brushing, since it helps to clean those interdental areas, where the brush does not reach and where the appearance of incipient cavities is very frequent.

Eat fruit

Some fruits, such as apples, help prevent incipient cavities by stimulating saliva production. Saliva helps to break down small food residues that are deposited between the teeth. As for citrus fruits, it is advisable to eat them in the company of other foods, since they have a very acidic pH, they can break down the enamel over time.

Chew more

Chewing food well stimulates the production of saliva, which, as we have mentioned before, is a natural antimicrobial.

Eat foods rich in calcium

Calcium is vital for healthy and strong teeth. It is found, above all, in dairy products such as milk, cheese or yogurt. In addition, eating cheese stimulates the generation of saliva by our body.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.