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Caries management strategies in primary molars

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Caries Management

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Caries management strategies in primary molars

  1. 1. CARIES MANAGEMENT STRATEGIES IN PRIMARY MOLARS PRESENTED BY: DR FASAHAT AHMED BUTT
  2. 2. OBJECTIVES • WHAT IS CARIES?? • CLASSIFICATIONS OF CARIES • DIAGNOSIS • CARIES RISK ASSESSMENT • OBJECTIVES OF MANAGING CARIES IN PRIMARY MOLARS • TREATMENT
  3. 3. CARIES MICROBIAL DISEASE OF CALCIFIED TISSUES OF THE TEETH CHARACTERIZED BY DEMINERALIZATION OF INORGANIC PORTION & DESTRUCTION OF ORGANIC SUBSTANCE OF TOOTH
  4. 4. CLASSIFICATIONS  G.V BLACK  MOUNT’S SITE & SIZE
  5. 5. DIAGNOSIS  HISTORY CLINICAL EXAMINATION  VISUAL EXAMINATION  PALPATION  PERCUSSION  MOBILITY  BITE TEST
  6. 6. RADIOGRAPH  BITEWING  PERIAPICAL
  7. 7. RISK ASSESSMENT • PLAQUE CONTROL • DIETARY HABITS • USE OF FLUORIDE • SALIVARY ANALYSIS • MULTIPLE CARIOUS LESIONS/RESTORATIONS • MEDICAL CONDITION
  8. 8. OBJECTIVES • PREVENT PAIN AND DISCOMFORT • PREVENT LOCAL INFECTION • PREVENT INJURY TO PERMANENT DENTITION • PREVENT MALOCCLUSION • MAINTAINENCE OF GOOD MASTICATION & AESTHETIC
  9. 9. 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
  10. 10. TREATMENT • PREVENTIVE • RESTORATIVE  INVOLVING ENAMEL- DENTINE  INVOLVING PULP
  11. 11. PREVENTIVE • Plaque control & tooth brushing with fluoride toothpaste • Dietary advise • Use of fluoride • Fissure sealants • Regular dental check up
  12. 12. INVOLVING ENAMEL-DENTINE PITS AND FISSURE CARIES APPROXIMAL CARIES
  13. 13. PULPAL INVOLVEMENT
  14. 14. VITAL PULP THERAPY NON-VITAL PULPOTOMY  DEVITALIZATION PULPOTOMY  PRESERVATION PULPOTOMY PULPECTOMY
  15. 15. DEVITALISATION PULPOTOMY • INTENT TO DESTROY VITAL PULP • TREATMENT WITH FORMOCRESOL OR LASER/ELECTROCAUTERY
  16. 16. PRESERVATION PULPOTOMY • INTENDED TO MINIMALLY INSULT PULP TISSUE • DONE WITH GLUTARALDEHYDE OR FERRIC SULPHATE
  17. 17. INDICATIONS • INFLAMMATION OR INFECTION CONFINED TO CORONAL PULP • ABSENCE OF ABSCESS • TOOTH FREE FROM RADICULAR PULPITIS
  18. 18. CONTRAINDICATIONS • HISTORY OF SPONTANEOUS TOOTHACHE • NON-RESTORABLE TOOTH • TOOTH NEAR TO EXFOLIATION • PRESENCE OF PERIAPICAL PATHOSIS • NECROTIC PULP • UNCONTROLLABLE HAEMORRHAGE
  19. 19. 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
  20. 20. PULPECTOMY
  21. 21. 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
  22. 22. 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
  23. 23. FOLLOW UP CLINICALLY:  ALLEVIATION OF PAIN  TOOTH FIRM IN ALVEOLUS RADIOGRAPHICALLY:  NO CHANGES IN BONE CONDITIONS IN FURCATION REGION
  24. 24. STAINLESS STEEL CROWNS
  25. 25. INDICATIONS • EXTENSIVE CARIES • PULPOTOMY/PULPECTOMY • SEVERE ATTRITION IN PRIMARY TEETH • RESTORATION OF PRIMARY MOLARS IN CHILDREN WITH RAMPANT CARIES • FRACTURED PRIMARY MOLAR
  26. 26. CONTRAINDICATIONS • AESTHETICS • TEETH NEAR TO EXFOLIATION
  27. 27. SPACE MAINTAINERS
  28. 28. REFERENCES • PAEDIATRIC DENTISTRY BY RICHARD WELBURY • COHEN’S POP • GOOGLE FOR PICTURES

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