Techniques of Caries Management in Primary Dention

8/10/2019 Techniques of Caries Management in Primary Dention

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BYDR.FAMUREWA B.A.

O.A.U.T.H.C., ILE-IFE NIGERIA.


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INTRODUCTIONAETIOPATHOGENESISMETHODS OF DIAGNOSIS

CARIES RISK ASSESSMENTTREAMENT TECHNIQUESCONCLUSION

01/07/2013 FAMUREWA B.A.


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TREATMENT TECHNIQUES;NON-OPERATIVE/PREVENTIVE THERAPYCONVENTIONAL RESTORATIVE

TREATMENTATRAUMATIC RESTORATIVE TREATMENTCHEMOMECHANICAL APPROACHHALL TECHNIQUE



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Dental caries with its sequelae is the most commonclinical entity presenting to a paediatric dentalpractice

Dental caries is defined as localized, post-eruptive,pathological process of external origin involvingsoftening of hard tooth tissue & proceeding to theformation of cavity(WHO)



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This seminar focuses on the management ofestablished caries(cavitated & non cavitated) inprimary dentition.

Emphasis is not on various time tested andemerging novel preventiveapproaches(replacement therapy, caries vaccine).



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Dental caries is a multifactorial disease.Aetiological factors:

Dental plaque- Streptococcus mutans(initiation&cavitation), LactobacilliSubstrates- fermentable carbohydrateHost factors-tooth morphology, salivary flow

rateTime- frequency of cariogenic challenges



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Caries occur when oral environment favoursdemineralization.Caries is revesible to an extent!(remineralization)



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Prerequisite for caries diagnosis:Good lightingClean teethSharp eyesReproducible bitewing radiographs



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Visual method- Mouth mirror & blunt/ballended probe

Non cavitated appear as :Caries seen as white spot-dry teeth(in superficialdepth of enamel)Glossy white spot- arrested caries

Matt white spot- active cariesBrown/white spot- wet teeth(caries in enamel &may be in dentine)



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Cavitated lesions- usually active, may exposedentine or pulp



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Tactile methodBlunt ended probe- confirms the presence ofcavities, restoration & sealantsSharp probes are contraindicated- stickyprobe(probe fits fissure), breaks down weakdemineralized enamel(iatrogenic cavity!!),inoculation of caries free sites



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Radiographic methodBitewing radiographs-1 st choice for caries detectionPeriapical radiographsFor detection & progress monitoring



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Fibre-optic trans illumination(FOTI)Placement of a 0.5mm light source in theembrasure of posterior teeth. Carious lesion shows

as dark shadow



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Laser fluorescence deviceThis measures the fluorescence of tooth & that ofthe bi-product of bacteria in the carious lesion.

This produces a digital reading indicating thecarious status of teeth. Example is Diagnodent



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Electronic caries meterMeasures resistance of carious lesions & comparesthis to that of sound tooth structure



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NON-OPERATIVE/PREVENTIVETHERAPYCONVENTIONAL RESTORATIVETREATMENTATRAUMATIC RESTORATIVETREATMENTCHEMOMECHANICAL APPROACHHALL TECHNIQUE



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To cure/heal incipient caries(white lesions)To arrest caries progression

Suitable for high risk children.Four pillars of caries prevention:1. Diet modification2. Fluorides3. Fissure sealants4. Plaque control



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Diet modificationo Dietary history & dietary chart very importanto Frequency of intake NOT quantityo Discourage grazing or snacking btw meals o Frequent intake of carbonated drinks-

cariogenic & erosiveo Intake of sweet drinks, use of pacifier-nursing

bottle caries



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Diet modificationo Positive alternatives should be provided;

coconut, groundnut, sugar free chewing

gum(Orbit

)o Use of sugar free medications by medically

compromised children



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FluoridesSystemic & topical applicationsMechanisms of action in caries prevention;

1. Inhibition of demineralization(fluorapatite)2. inhibition of plaque bacteria(enolase).3. Enamel more stable & resistant to acid



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Fissure sealantsFissure & pits are prone to cariesLight cure & self cure resin(bis-GMA)GIC can be used as temporary sealants(anxiouschild)



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Guidelines for fissure sealantsapplication(British Society of PaediatricDentistry 2000) :

Patient selection1. Children with special needs- apply on occlusal

surfaces of 2 teeth

2. Children with extensive caries in their 1

dentition3. Children with no caries in 1 dention- no need



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Tooth selection1. Occlusal surface of 2 molar teeth; can be

applied on cingulum pits(upper incisors),

buccal pits(lower molars), palatal pits(uppermolars)

2. Sealants to be applied ASAP(good moisturecontrol)



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Tooth selection:3. Any child with caries on 1 st 2 molar should havethe fissures of unaffected of the 1 st 2 molars sealed

4. Occlusal caries affecting one/more 1 st 2 molarsindcate a need to fissure seal the 2 nd 2 molars assoon as they erupt



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Plaque controlToothbrushing- supervised, twice dailyFlossing- starting from early mixed dentitionProphylaxis- Scaling & PolishingAntimicrobial agents- adjuncts to mechanicalplaque removal. Indicated in high caries

children & medically compromised child



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Materials used in Paediatric Dentistry:Dental amalgam

Merits: simple, quick, cheap, durable & techniqueinsensitiveDemerits: not adhesive, need for mechanicalretention, environmental & occupational hazards

& public concern



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Composite resinMerits: aesthetics, adhesive, command set,reasonable wear property

Demerits: technique sensitive, expensive, needmoisture control



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Glass ionomer cement(GIC)-Aluminosilicatepowder+ polyalkenoic acid

Merits: adhesive, aesthetic, fluoride leaching

Demerits: long setting time, brittle, prone toerosion & wear, radiolucent.



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Factors affecting choice of materials:Age of patient- ability to cooperate & durabilityCaries risk: SS crown(in risk) than composite Level of child s cooperation



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ART Technique involves the use of handinstrument only to remove carious lesions &restoration of the cavity with sealing any adjacent

fissures using conventional GIC

Minimally invasive procedure- pain free &acceptable to children



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Chemomechanical caries removal (CMCR) is a noninvasive technique eliminating infected dentine viachemical agents aided by atraumatic mechanical

force.Restoration of cavities is done with compositeresins or GICCMCR preserves healthy dental tissues, avoidspulpal irritation(& exposure) & child s discomfort



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CMCR agents:N-monochloroglycine(NMG)= GK 101(1972)N-monochloroaminobutyric acid= Caridex (75)Carisolv- developed in Sweden in 1998.

Has 2 components:3 amino acids(glutamic acid, leucine & lysine)

+NaOHNa hypochlorite



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Papacarie developed in 2003(Brazil)Papacarie contains:

o Papain-extracted from leaves & fruits of Carica papaya. Acts by cleaving collagen moleculespartially destroyed by caries(tissues that lackprotease inhibitor, -1-antitrypsin)

o

Chloramine =Chlorine+ NH Chemically softens carious dentine; bactericidal



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Merits: no need of L.A, ultraconservation of soundtooth, risk of iatrogenic pulp exposure, precludesanxiety associated with drilling, no droplet

infection(from aerosol)Indications: dentally anxious patient, medicallycompromised child, physically handicapped child,patient with infectious air-borne diseases(TB)



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Developed by Dr. Norna Hall in 2006sealing in caries technique in 1 dentitionThe technique involves seating preformed metalcrown(SS Crown) over carious 1 molars with nocaries removal, tooth prep & local anaesthesiaHall technique was acceptable topatients(children), carer(parents/guardians) &treating dentists



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Contraindications Irreversible pulpitisDentoalveolar abscessPresence of buccal sinusNon physiological tooth mobilityInsufficient sound tooth tissue to retain crown

Interradicular pathology/ furcationinvolvement



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ContraindicationsUncooperative child- to allow for crownplacement without risk of aspiration

Child @ risk of bacterial endocarditis- managetooth with traditional restoration.Tooth near physiologic exfoliation

Where aesthetic is of concern to child/ parent



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Indications :Early to moderate proximal caries in 1 molarsActive caries in 1 molars with no sign &symptoms of pulp pathologyModerately advanced class I caries- no goodseal ffg conventional caries removal &restoration with adhesive material



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Indications :Non cavitated class I lesion- if patient is unableto accept fissure sealant or conventional

restorationCavitated class I lesion- if patient is unable toaccept partial caries removal technique orconventional restoration



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o Explain the procedure to the childo Let the child handle a spare crowno Crown as- shiny helmet, Princess crown

Tell the child that:o He/she will help by biting the crown into placeo Cement won t taste nice & can like salt or

vinegar crisps



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ArmamentariumMouth mirrorStraight probe- to remove separators(if used)Excavator- to remove crown if necessary &used to remove cementFlat plastic- to load crown with cement

Cotton wool rolls- for child to bite on & pushcrown over tooth; to wipe away excess cement



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Protecting the airwayo Sit the child upright oro Use gauze swab- place btw the tooth & tongue

with extension to oropharynx.Alternatively,

o Use elastoplast tape to secure the crown



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Locate & seat- fitting the crownPlace the crown over the toothSeat the crown either by finger pressure or the

child seats it by biting on it



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WipeRemove excess cement as soon as the crown isseated



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Check & cleanRemove excess cementFloss between the contact points



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The present advancement in knowledge ofcariology & overwhelming evidences of noveltechniques of caries management should lead to a

shift from Black s dogma of caries mgt to a moretooth conserving & child friendly approachesespecially in primary dentition.Proper & timely management of caries in primary

teeth is advocated to prevent untowardcomplications- premature tooth loss, facialcellulitis, e.t.c



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A Users Manual of Hall technique by D. Evans & N.InnesHandbook of Paediatric Dentistry edited by Cameron& Widmer

Paediatric Dentistry edited by Welbury & Duggal.Pickards Manual of Operative Dentistry 8 th EditionGanesh M, Parikh D(2011). Chemomechanical cariesremoval agents: review & clinical applications inprimary teeth. J. Dent. Oral HygSmales R.J. , Yip H(2000). The atraumatic restorativetreatment approach for primary teeth: review ofliterature. Pediatr Dent 22:294-298.



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Techniques of Caries Management in Primary Dention

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