Episode Details

Should we still be drilling early caries lesions?

Where do peptides, resin infiltration, fluoride varnish and SDF actually fit in modern practice?

Is hydroxyapatite toothpaste a genuine alternative to fluoride, or just another dental trend?

And when you see that suspicious grey occlusal shadow, do you seal it, explore it, or actively surveil it?

In part two of this modern caries management episode, Jaz continues the conversation with Prof. Avijit Banerjee on minimal intervention dentistry. This episode moves beyond diagnosis and communication into the practical management of early and progressing caries lesions, including peptides, SDF, hydroxyapatite toothpaste, fissure sealing, xerostomia, root caries and selective caries removal.

Protrusive Dental Pearl

Use the Contemporary Caries Management Implementation Pack as a chairside aid to turn the episode into daily clinical action.

⚠️ Learning the evidence is not enough if it never makes it into your patient conversations, risk assessment or treatment planning.

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Disclaimer: This is an educational resource produced by Team Protrusive, derived from the two-part Protrusive Dental Podcast episode featuring Prof. Avijit Banerjee. Its contents were not written, reviewed, or endorsed by Prof. Banerjee; they represent Team Protrusive’s own interpretation of the material discussed. It is intended as a practical summary and is not a substitute for primary sources. We strongly encourage all clinicians to consult the latest Clinical Practice Guidelines before making treatment decisions.

Key Takeaways:

• Peptides are designed to infiltrate early enamel lesions and create a scaffold for mineral deposition.
• Peptide technologies still need minerals from saliva, toothpaste, mouthwash or other sources to work.
• Fluoride supports remineralisation; it acts more like the “mortar” than the “bricks”.
• Early E1 lesions are usually managed with prevention, fluoride, oral hygiene, diet control and biofilm control.
• Deeper enamel lesions, such as progressing E1 or E2 lesions, may be suitable for resin infiltration or peptide infiltration.
• SDF is better suited to cavitated lesions where arrest and stabilisation are needed.
• In the UK, SDF is licensed for dentine sensitivity, so caries arrest is an off-label use.
• SDF can be very useful for children, older adults, medically compromised patients and care-home patients.
• The main downside of conventional SDF is black staining, especially on anterior teeth.
• Hydroxyapatite toothpaste has more science behind it than charcoal-style fad toothpastes.
• Fluoride toothpaste remains the preferred baseline recommendation when patients are happy to use fluoride.
• A suspicious grey occlusal lesion should be assessed in the context of the patient’s overall caries risk.
• In selected cases, a tiny exploratory opening can act like a diagnostic biopsy.
• Sealing fissures on the same tooth being restored can be sensible when the fissure pattern is deep.
• For severe xerostomia and root caries risk, consider high-fluoride regimes, close recalls, trays or dentures as carriers for remineralising agents.

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