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CARIES MANAGEMENT STRATEGIES
IN PRIMARY MOLARS
PRESENTED BY:
DR FASAHAT AHMED BUTT
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OBJECTIVES
• WHAT IS CARIES??
• CLASSIFICATIONS OF CARIES
• DIAGNOSIS
• CARIES RISK ASSESSMENT
• OBJECTIVES OF MANAGING CARIES IN PRIMARY MOLARS
• TREATMENT
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CARIES
MICROBIAL DISEASE OF CALCIFIED
TISSUES OF THE TEETH CHARACTERIZED
BY DEMINERALIZATION OF INORGANIC
PORTION & DESTRUCTION OF ORGANIC
SUBSTANCE OF TOOTH
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CLASSIFICATIONS
G.V BLACK
MOUNT’S SITE & SIZE
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DIAGNOSIS
HISTORY
CLINICAL EXAMINATION
VISUAL EXAMINATION
PALPATION
PERCUSSION
MOBILITY
BITE TEST
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RADIOGRAPH
BITEWING
PERIAPICAL
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RISK ASSESSMENT
• PLAQUE CONTROL
• DIETARY HABITS
• USE OF FLUORIDE
• SALIVARY ANALYSIS
• MULTIPLE CARIOUS LESIONS/RESTORATIONS
• MEDICAL CONDITION
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OBJECTIVES
• PREVENT PAIN AND DISCOMFORT
• PREVENT LOCAL INFECTION
• PREVENT INJURY TO PERMANENT DENTITION
• PREVENT MALOCCLUSION
• MAINTAINENCE OF GOOD MASTICATION & AESTHETIC
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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
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TREATMENT
• PREVENTIVE • RESTORATIVE
INVOLVING ENAMEL-
DENTINE
INVOLVING PULP
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PREVENTIVE
• Plaque control & tooth brushing with
fluoride toothpaste
• Dietary advise
• Use of fluoride
• Fissure sealants
• Regular dental check up
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INVOLVING ENAMEL-DENTINE
PITS AND FISSURE
CARIES APPROXIMAL CARIES
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PULPAL INVOLVEMENT
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VITAL
PULP THERAPY
NON-VITAL
PULPOTOMY
DEVITALIZATION
PULPOTOMY
PRESERVATION PULPOTOMY
PULPECTOMY
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DEVITALISATION PULPOTOMY
• INTENT TO DESTROY VITAL PULP
• TREATMENT WITH FORMOCRESOL OR LASER/ELECTROCAUTERY
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PRESERVATION PULPOTOMY
• INTENDED TO MINIMALLY INSULT PULP TISSUE
• DONE WITH GLUTARALDEHYDE OR FERRIC SULPHATE
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INDICATIONS
• INFLAMMATION OR INFECTION CONFINED TO CORONAL PULP
• ABSENCE OF ABSCESS
• TOOTH FREE FROM RADICULAR PULPITIS
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CONTRAINDICATIONS
• HISTORY OF SPONTANEOUS TOOTHACHE
• NON-RESTORABLE TOOTH
• TOOTH NEAR TO EXFOLIATION
• PRESENCE OF PERIAPICAL PATHOSIS
• NECROTIC PULP
• UNCONTROLLABLE HAEMORRHAGE
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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
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PULPECTOMY
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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
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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
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FOLLOW UP
CLINICALLY:
ALLEVIATION OF PAIN
TOOTH FIRM IN ALVEOLUS
RADIOGRAPHICALLY:
NO CHANGES IN BONE CONDITIONS IN FURCATION REGION
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STAINLESS STEEL CROWNS
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INDICATIONS
• EXTENSIVE CARIES
• PULPOTOMY/PULPECTOMY
• SEVERE ATTRITION IN PRIMARY TEETH
• RESTORATION OF PRIMARY MOLARS IN CHILDREN WITH RAMPANT
CARIES
• FRACTURED PRIMARY MOLAR
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CONTRAINDICATIONS
• AESTHETICS
• TEETH NEAR TO EXFOLIATION
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SPACE MAINTAINERS
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REFERENCES
• PAEDIATRIC DENTISTRY BY RICHARD WELBURY
• COHEN’S POP
• GOOGLE FOR PICTURES
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