Early carious lesions in Türkiye

What it is

Tooth decay starts below the surface. The first stage, before the surface has broken into a cavity, is called a non-cavitated or early carious lesion. The treatments for this stage are described as nonrestorative: they aim to arrest or reverse the lesion rather than drill and fill it.

The register lists this treatment as "Early Carious Leions Treatment"; the spelling error is in the register's English name, and we use the correct term, early carious lesions, here. In Turkish the heading is "Başlangıç Çürüğü Tedavisi", literally early decay treatment.

An American Dental Association guideline on nonrestorative treatments for carious lesions (2018) names these options for non-cavitated lesions: sealants (a coating placed over the surface of a tooth), fluoride varnish, fluoride gel, and resin infiltration (a resin that penetrates the lesion). It advises against using one product, CPP-ACP paste, when other fluoride treatments, sealants or resin infiltration are available.

Who it is for, and who it is not for

It is for lesions that are still non-cavitated. Once a cavity has formed, the question changes to restorative dental treatment. The guideline sets out options by the surface of the tooth:

• On the chewing surface, sealants, with or without fluoride varnish, are preferred over several alternatives. The guideline rates the certainty of the evidence as moderate and the rating as strong.
• Between teeth (approximal surfaces), it lists fluoride varnish, resin infiltration alone or with varnish, or sealants alone. The certainty is low to very low and the rating conditional, which means the evidence is thinner here.
• On the cheek or tongue side, it lists fluoride gel or varnish applied every three to six months, with moderate to low certainty.

That the evidence is weaker for some surfaces is a reason to ask your dentist why a particular option is proposed for your tooth, not a reason to refuse it. It is also not a treatment for a tooth that already hurts or has a visible hole; that needs examination for a different problem.

How it is done in Türkiye

The method depends on the lesion. A varnish or gel is painted on the tooth. A sealant is a coating placed on the surface. Resin infiltration is a more involved procedure in which a resin is introduced into the lesion. We cannot say which methods a given Turkish clinic uses; the register does not record it.

Under the Ministry of Health's regulation on private oral and dental health facilities:

• Intra-oral work must be done by a dentist; staff who are not dentists may not carry out intra-oral procedures. That includes applying varnish or placing sealants.
• Records, including diagnosis and treatment with tooth numbers, must be kept electronically, and a consent form is required for interventions.
• Promotion may not include misleading or exaggerated claims or claims that are not scientifically proven.
• Dentists may not announce themselves as specialists beyond what their diploma or specialty certificate allows.

We have not found a Turkish rule that reserves this treatment to specialists.

What to check before you book

• Facility and dentist. Look up the facility with register search and ask for the dentist's full name and title.
• The finding. Ask where the lesion is, on which tooth and surface, how it was found (examination, X-ray) and how far it has gone. Ask for the X-ray.
• The proposed method and why. Ask which treatment is proposed (varnish, sealant, resin infiltration, or monitoring), the reason for your surface, and what the alternative is.
• Follow-up. The guideline describes some treatments as repeated at intervals. Ask what the plan assumes, who does the follow-up, and whether the clinic will liaise with your own dentist.
• Check against your own dentist. A lesion that does not need drilling is also something your own dentist can see. Take their view into account.
• Records. Ask for tooth-numbered records, X-rays or photographs, and product names.

What a package must state

• each tooth and surface treated, by tooth number;
• the method used for each (varnish, gel, sealant, resin infiltration);
• the products and manufacturers;
• whether examination and X-rays are included;
• the follow-up, including any repeated applications and who provides them;
• exclusions: fillings that may be needed if the lesion progresses;
• the guarantee, if any, with what it covers; a treatment that aims to arrest decay cannot carry a promise that it will;
• an itemised invoice or receipt, which Turkish rules require for every patient treated;
• the deposit: what it holds and whether it is refundable.

Risks, complications and aftercare

The principal risk of a non-drilling approach is that the lesion progresses anyway, which is why monitoring matters; we cannot give a rate. We did not find in the sources we reviewed a verified list of adverse effects for these treatments, so none is given. Ask the dentist to explain the downsides of the option proposed.

Aftercare depends on the method. Ask for written instructions on eating and cleaning after varnish or sealant, and for the date of the next check. Report pain, a visible cavity, swelling or fever to a dentist promptly. Our guide to dental treatment in Türkiye explains what the register can and cannot tell you.

Questions to ask in writing

• Where exactly is the lesion, and is it non-cavitated?
• Which treatment do you propose for it, and why for this surface?
• What are the alternatives, including monitoring without treatment?
• Which products will you use, and from which manufacturer?
• How often must the treatment be repeated, and who will do it?
• How will the lesion be monitored after I return home?
• What will I receive in the way of X-rays and records?
• What does the guarantee, if any, cover?

This page is an information service, not medical advice. Clinimora is an independent, patient-funded research service. It does not sell treatment, does not diagnose and does not recommend any clinic.