Caries management strategies in primary molars
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Transcript of Caries management strategies in primary molars
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