Podcast: Play in new window | Download (Duration: 56:47 — 78.9MB)
Subscribe: RSS
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.
✅ Print it, laminate it, and use it to support communication, diagnosis, active surveillance and minimally invasive decision-making.
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.
YouTube Highlights:
- 00:00 Teaser
- 01:17 Introduction
- 02:17 Pearl: Caries Management Implementation Pack
- 05:54 What are Peptides?
- 14:42 SDF: Silver Diamine Fluoride
- 14:55 Early Enamel Lesion Pathway
- 15:11 When to Consider Resin or Peptide Infiltration
- 15:51 Best Use Case for SDF
- 20:14 Hydroxyapatite Toothpaste
- 21:18 Fluoride Safety and Evidence
- 27:00 Midroll
- 40:53 Preventive vs Therapeutic Sealants
- 42:09 Severe Xerostomia and Root Caries
- 44:40 Using Trays or Dentures as Carriers
- 45:48 Tooth Mousse and CPP-ACP
- 47:11 Artificial Saliva
- 47:46 Why the Patient Has Dry Mouth Matters
- 49:35 Current Position on Stepwise Excavation
- 50:09 Selective Caries Removal
- 51:15 Deep Caries Guidelines
- 53:01 Materials Are Not Everything in Caries Management
- 55:59 Further Learning Resource
- 56:44 Outro
Want more?
Check out part one of this modern caries management series for communication, diagnostics, triangulating data and deciding which caries detection tools are actually worth using.
🦷 Download the Contemporary Caries Management Implementation Pack
Head to protrusive.co.uk/MID to access the free implementation pack, including key communication points, diagnosis guidance, management flowcharts and evidence links.
Professor Avijit Banerjee’s recommended reading and ongoing work:
- New textbook: A Clinical Guide to Advanced Minimum Intervention Restorative Dentistry (Banerjee A., Elsevier, 2024) — the most comprehensive single reference for modern MIOC and MID.
👉 uk.elsevierhealth.com (ISBN 978-0-443-10971-3)
Resources mentioned in this episode:
S3 Guidelines: https://pmc.ncbi.nlm.nih.gov/articles/PMC13099699/
🦷 Interested in Proximal Resin Infiltration?
- Explore The Iconic Method with Cat Edney: a free 1-hour webinar on 24 June 2026, followed by a hands-on 1-day Birmingham course on 4 July 2026 covering Icon resin infiltration, tooth whitening and NIRI-guided enamel management, with verifiable CPD available.
- Don’t miss out!DMG Icon Proximal discount for dental professionals at protrusive.co.uk/dmg
#PDPMainEpisodes #BreadandButterDentistry
This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.
This episode meets GDC Outcomes C
AGD Subject Code: 250 Operative (Restorative) Dentistry
Aim: To improve dentists’ confidence in modern minimal intervention caries management by applying risk-based decision-making, active surveillance, appropriate use of remineralising and arresting therapies, and evidence-informed restorative strategies.
Dentists will be able to –
- Assess early and progressing caries lesions using patient risk, clinical signs, symptoms and radiographic findings.
- Select appropriate non-operative, microinvasive and stabilisation strategies, including fluoride, peptides, resin infiltration, sealants and SDF.
- Manage high-risk patients, including those with xerostomia or root caries risk, using prevention, recall planning and patient-specific delivery methods.
Continuing Education Information
This activity may be eligible for continuing education credit through Protrusive Guidance. Participants must complete the associated quiz inside Protrusive Guidance to obtain CPD certification.
Cost:
Access to this CE activity is included with an active Protrusive Guidance membership. Current membership pricing is available at
www.protrusive.app.
Cancellation & Refund Policy:
Memberships may be cancelled at any time. Access to CE activities remains active until the end of the current billing cycle. Subscription charges are non-refundable once processed. Full details are available at
www.protrusive.app.
