Caries Management

1. CARIES MANAGEMENT STRATEGIES
IN PRIMARY MOLARS
PRESENTED BY:
DR FASAHAT AHMED BUTT

2. OBJECTIVES
• WHAT IS CARIES??
• CLASSIFICATIONS OF CARIES
• DIAGNOSIS
• CARIES RISK ASSESSMENT
• OBJECTIVES OF MANAGING CARIES IN PRIMARY MOLARS
• TREATMENT

3. CARIES
MICROBIAL DISEASE OF CALCIFIED
TISSUES OF THE TEETH CHARACTERIZED
BY DEMINERALIZATION OF INORGANIC
PORTION & DESTRUCTION OF ORGANIC
SUBSTANCE OF TOOTH

4. CLASSIFICATIONS
 G.V BLACK
 MOUNT’S SITE & SIZE

7. DIAGNOSIS
 HISTORY
CLINICAL EXAMINATION
 VISUAL EXAMINATION
 PALPATION
 PERCUSSION
 MOBILITY
 BITE TEST

8. RADIOGRAPH
 BITEWING
 PERIAPICAL

9. RISK ASSESSMENT
• PLAQUE CONTROL
• DIETARY HABITS
• USE OF FLUORIDE
• SALIVARY ANALYSIS
• MULTIPLE CARIOUS LESIONS/RESTORATIONS
• MEDICAL CONDITION

10. OBJECTIVES
• PREVENT PAIN AND DISCOMFORT
• PREVENT LOCAL INFECTION
• PREVENT INJURY TO PERMANENT DENTITION
• PREVENT MALOCCLUSION
• MAINTAINENCE OF GOOD MASTICATION & AESTHETIC

11. HISTORY, CLINICAL
EXAM & RADIOGRAPH
TREATMENT
S/S OF ABSCESS
FORMATION
PULP THERAPY,
RESTORED WITH PMC
EXTRACT 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

12. TREATMENT
• PREVENTIVE • RESTORATIVE
 INVOLVING ENAMEL-
DENTINE
 INVOLVING PULP

13. PREVENTIVE
• Plaque control & tooth brushing with
fluoride toothpaste
• Dietary advise
• Use of fluoride
• Fissure sealants
• Regular dental check up

14. INVOLVING ENAMEL-DENTINE
PITS AND FISSURE
CARIES APPROXIMAL CARIES

15. PULPAL INVOLVEMENT

16. VITAL
PULP THERAPY
NON-VITAL
PULPOTOMY
 DEVITALIZATION
PULPOTOMY
 PRESERVATION PULPOTOMY
PULPECTOMY

17. DEVITALISATION PULPOTOMY
• INTENT TO DESTROY VITAL PULP
• TREATMENT WITH FORMOCRESOL OR LASER/ELECTROCAUTERY

21. PRESERVATION PULPOTOMY
• INTENDED TO MINIMALLY INSULT PULP TISSUE
• DONE WITH GLUTARALDEHYDE OR FERRIC SULPHATE

22. INDICATIONS
• INFLAMMATION OR INFECTION CONFINED TO CORONAL PULP
• ABSENCE OF ABSCESS
• TOOTH FREE FROM RADICULAR PULPITIS

23. CONTRAINDICATIONS
• HISTORY OF SPONTANEOUS TOOTHACHE
• NON-RESTORABLE TOOTH
• TOOTH NEAR TO EXFOLIATION
• PRESENCE OF PERIAPICAL PATHOSIS
• NECROTIC PULP
• UNCONTROLLABLE HAEMORRHAGE

24. 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

25. PULPECTOMY

32. 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

33. 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

34. FOLLOW UP
CLINICALLY:
 ALLEVIATION OF PAIN
 TOOTH FIRM IN ALVEOLUS
RADIOGRAPHICALLY:
 NO CHANGES IN BONE CONDITIONS IN FURCATION REGION

35. STAINLESS STEEL CROWNS

36. INDICATIONS
• EXTENSIVE CARIES
• PULPOTOMY/PULPECTOMY
• SEVERE ATTRITION IN PRIMARY TEETH
• RESTORATION OF PRIMARY MOLARS IN CHILDREN WITH RAMPANT
CARIES
• FRACTURED PRIMARY MOLAR

37. CONTRAINDICATIONS
• AESTHETICS
• TEETH NEAR TO EXFOLIATION

38. SPACE MAINTAINERS

39. REFERENCES
• PAEDIATRIC DENTISTRY BY RICHARD WELBURY
• COHEN’S POP
• GOOGLE FOR PICTURES