CARIES MANAGEMENT STRATEGIES

IN PRIMARY MOLARS

PRESENTED BY:

DR FASAHAT AHMED BUTT

OBJECTIVES

• WHAT IS CARIES??

• CLASSIFICATIONS OF CARIES

• DIAGNOSIS

• CARIES RISK ASSESSMENT

• OBJECTIVES OF MANAGING CARIES IN PRIMARY MOLARS

• TREATMENT

CARIES

MICROBIAL DISEASE OF CALCIFIED

TISSUES OF THE TEETH CHARACTERIZED

BY DEMINERALIZATION OF INORGANIC

PORTION & DESTRUCTION OF ORGANIC

SUBSTANCE OF TOOTH

CLASSIFICATIONS

G.V BLACK

MOUNT’S SITE & SIZE

DIAGNOSIS

HISTORY

CLINICAL EXAMINATION

VISUAL EXAMINATION

PALPATION

PERCUSSION

MOBILITY

BITE TEST

RADIOGRAPH

BITEWING

PERIAPICAL

RISK ASSESSMENT

• PLAQUE CONTROL

• DIETARY HABITS

• USE OF FLUORIDE

• SALIVARY ANALYSIS

• MULTIPLE CARIOUS LESIONS/RESTORATIONS

• MEDICAL CONDITION

OBJECTIVES

• PREVENT PAIN AND DISCOMFORT

• PREVENT LOCAL INFECTION

• PREVENT INJURY TO PERMANENT DENTITION

• PREVENT MALOCCLUSION

• MAINTAINENCE OF GOOD MASTICATION & AESTHETIC

HISTORY, CLINICAL

EXAM & RADIOGRAPH

TREATMENT

S/S OF ABSCESS

FORMATION

PULP THERAPY,

RESTORED WITH PMCEXTRACT THE TOOTH

TOOTH FREE FROM S/S

OF SEPSIS

TOOTH NEAR TO

EXFOLIATION OR IS

THERE ANY ORTHO

REASON TO EXTRACT IT?

CARIES ACTIVE?

ENHANCED

PREVENTION AND

MONITOR TOOTH

TREATMENT

• PREVENTIVE • RESTORATIVE

INVOLVING ENAMEL-

DENTINE

INVOLVING PULP

PREVENTIVE

• Plaque control & tooth brushing with

fluoride toothpaste

• Dietary advise

• Use of fluoride

• Fissure sealants

• Regular dental check up

INVOLVING ENAMEL-DENTINE

PITS AND FISSURE

CARIES APPROXIMAL CARIES

PULPAL INVOLVEMENT

VITAL

PULP THERAPY

NON-VITAL

PULPOTOMY

DEVITALIZATION

PULPOTOMY

PRESERVATION PULPOTOMY

PULPECTOMY

DEVITALISATION PULPOTOMY

• INTENT TO DESTROY VITAL PULP

• TREATMENT WITH FORMOCRESOL OR LASER/ELECTROCAUTERY

PRESERVATION PULPOTOMY

• INTENDED TO MINIMALLY INSULT PULP TISSUE

• DONE WITH GLUTARALDEHYDE OR FERRIC SULPHATE

INDICATIONS

• INFLAMMATION OR INFECTION CONFINED TO CORONAL PULP

• ABSENCE OF ABSCESS

• TOOTH FREE FROM RADICULAR PULPITIS

CONTRAINDICATIONS

• HISTORY OF SPONTANEOUS TOOTHACHE

• NON-RESTORABLE TOOTH

• TOOTH NEAR TO EXFOLIATION

• PRESENCE OF PERIAPICAL PATHOSIS

• NECROTIC PULP

• UNCONTROLLABLE HAEMORRHAGE

FOLLOW-UP

CLINICALLY:

ABSENCE OF SYMPTOMS

ABSENCE OF ANY ABSCESS OR DRAINING SINUS

NO EXCESSIVE MOBILITY

RADIOGRAPHICALLY:

NO FURTHER BONE LOSS IN FURCATION REGION

NO EVIDENCE OF INTERNAL RESORPTION

PULPECTOMY

INDICATIONS

• IRREVERSIBLE PULPITIS INVOLVING BOTH CORONAL AND

RADICULAR PULP

• ABSCESSED PRIMARY MOLARS

• PRIMARY MOLARS WITH RADIOGRAPHIC EVIDENCE OF FURCATION

PATHOLOGY

• NON-VITAL PRIMARY MOLARS THAT NEED TO BE MAINTAINED IN

THE ARCH

CONTRAINDICATIONS

• UNRESTORABLE TOOTH

• INTERNAL RESORPTION IN THE ROOTS

• TEETH WITH MECHANICAL OR CARIOUS PERFORATION OF FLOOR

OF PULP CHAMBER

• EXCESSIVE PATHOLOGICAL LOSS OF BONE SUPPORT

FOLLOW UP

CLINICALLY:

ALLEVIATION OF PAIN

TOOTH FIRM IN ALVEOLUS

RADIOGRAPHICALLY:

NO CHANGES IN BONE CONDITIONS IN FURCATION REGION

STAINLESS STEEL CROWNS

INDICATIONS

• EXTENSIVE CARIES

• PULPOTOMY/PULPECTOMY

• SEVERE ATTRITION IN PRIMARY TEETH

• RESTORATION OF PRIMARY MOLARS IN CHILDREN WITH RAMPANT

CARIES

• FRACTURED PRIMARY MOLAR

CONTRAINDICATIONS

• AESTHETICS

• TEETH NEAR TO EXFOLIATION

SPACE MAINTAINERS

REFERENCES

• PAEDIATRIC DENTISTRY BY RICHARD WELBURY

• COHEN’S POP

• GOOGLE FOR PICTURES