Rampant caries

1. RAMPANT CARIES AND CHEMO -
MACHANICAL REMOVAL OF CARIES
UNDERTHE GUIDANCE OF-
DR.ASHISH KATIYAR
PRESENTED BY-
SRISHTI SRIVASTAVA
(IVth yr)05-11-2016 1

2. CONTENTS-
• INTRODUCTION
• ETIOLOGY
• TREATMENT
RAMPANT
CARIES
• CARIDEX
• CARISOLV
• PAPAIN GEL
CHEMO-
MECHANICAL
CARIES
REMOVAL
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3. INTRODUCTION
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4. WHAT IS DENTAL CARIES-
“Dental caries is defined as a progressive
irreversible microbial disease affecting
the tooth , resulting from
demineralization of the inorganic
constituents and dissolution of the
organic constituent, thereby leading to
a cavity formation.”
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5. DEFINITIONS OF RAMPANT CARIES-
“RAMPANT CARIES defined as suddenly appearing
widespread , burrowing type of caries ,resulting in
early involvement of pulp and affecting those teeth
, which are usually regarded as immune to decay” -
MASSLER (1945)
“RAMPANT CARIES defined as caries of acute onset
involving many or all the teeth in areas that are
usually not susceptible . They further defined the
condition to be associated with rapid destruction
of crowns and frequent involvement of pulp.” -
WINTER (1966)05-11-2016 5

6. CLINICAL APPEARANCE
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7. The initial lesion usually appears on the labial
surface of maxillary incisors , close to the gingival
margins as a whitish area of decalcification which
soon become pigmented to light yellow and
extended laterally to proximal surface and
downward to incisal edge and finally leading to
fracture of crown.
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10. ETIOLOGY
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11. TWO MAJOR PREDISPOSING FACTORS IN RAMPANT CARIES ARE-
1- MICROORGANISM-
Streptococcus mutans is an important pathogen in development of
dental caries and along with that lactobacillus and veillonella are
also responsible for development of rampant caries.
- cariogenicity of s.mutans is based upon it’s ability for–
a- colonization of teeth.
b- production of large amount of acid
c- breakdown of salivary glycoprotein, which might be of
great importance for the initial development of carious lesions.
d- production of large amounts of extracellular
polysaccharide that enable voluminous plaque formation.05-11-2016 11

12. 2- DIET-:
The carbohydrate component of diet is associated with
formation of dental caries.
- The cariogenic potential is related to texture of the
carbohydrate and the frequency of consumption of
sticky sugars ,rather than to the amount of sugar eaten.
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13. • the main CAUSE of rampant caries is found in an infant
who falls asleep with milk or sugar containing substances
or children who use pacifiers are commonly seen with
rampant caries.
• Decrease in salivary flow rate during sleep, as well as
pooling of sweet fluids around the teeth results in highly
cariogenic environment.
• Rampant caries may also occur in permanent dentition of
teenagers because of their frequent intake of cariogenic
snacks b/w meal .
 Breast milk is considered to be more cariogenic than
bovine milk because it is high in lactose content where as
bovine milk contains more of Ca and P.05-11-2016 13

14. TREATMENT
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15. EARLY CARIES WITH MINIMAL LOSS OF ENAMEL-
Weekly professionally applied fluoride therapy.
EXTENSIVE CAVITATION WITH NO PULPAL INVOLVEMENT -
glass ionomer restorations,
composite restoration,
pedo-strip crowns
WITH PULPAL INVOLVEMENT-
Pulpotomy or pulpectomy, followed by restoration.
extraction followed by space maintainer or partial or complete
denture.
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16. CHEMO-MECHANICAL CARIES
REMOVAL
• Chemo mechanical caries removal (CMCR) is
a non-invasive technique eliminating infected
dentine via a chemical agent.
• This is a method of caries removal based on
dissolution. Instead of drilling, this method
uses a chemical agent assisted by an
atraumatic mechanical force to remove soft
carious structure.
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17. • It was introduced to dentistry as an
alternative method of caries removal and is
mainly indicated to overcome the
inconvenience of using burs and local
anaesthesia , causing less discomfort to
patients and preserving healthy dental
structure, there by applying the concept of
the minimal invasive dentistry .
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18. HISTORY-:
• IN 1975, HABIB introduced a method using 5%
SODIUM HYPOCLORITE to remove carious tissues and
since then, many studies have attempted to improve
this early technique.
• The sole use of 5% sodium hypochlorite was known
to be toxic and aggressive to adjacent healthy
tissues. Therefore , a new solution was developed
adding sodium hydroxide, sodium chloride and
glycine to the 5% sodium hypochlorite.
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19. • This modified formula was known as GK-101 and it
was comprised of N-monochloroglycine. It was more
effective than the hypochlorite alone but was very
slow in carious tissue removal. Caridex was later
developed by CM HABIB from a formula made of N-
monochloroglycine and amino butyric acid and it was
called as GK101E. Krogman,Goldman published first
report on this material in 1975 and it gained FDA
approval in 1984.
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20. VARIOUS AGENT WHICH ARE USED IN
CHEMO-MECHANICAL CARIES REMOVAL -:
1-CARIDEX 2-CARISOLV
3-
PAPAIN GEL
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21. 1- CARIDEX-
it was initially introduced in US market in 1985,the system involved
the intermittent application of preheated N-monochloro –DL-2-
aminobutyric acid (GK-101E) in carious lesion . The solution was
claimed to cause disruption of collagen in the carious dentine ,thus
facilitating its removal.
• Caridex was not widely adopted due to expense ,additional
clinical time and the bulky caridex delivery system which consist of
reservoir , a heater , a pump and a handpiece.
• It also transpired that conventional tooth preparation was faster
in removing caries than caridex.
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22. DISADVANTAGES OF CARIDEX-:
1. Expensive
2. Large quantity required
3. Short shelf life
4. Hand instruments were not optimum
5. Solution had to be heated.
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23. CARISOLV-:
In January 1998 Chriser Hedwards with
Lars Strid of mediteam collaborated with Dan Ericson
and Rolf Bronstein in SWEDEN lead to development
of new system for chemo-mechanical caries removal
called CARISOLV.
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24. CONSTITUENTS OF CARISOLV- THE formulation of carisolv is
isotonic in nature and consist of –
• Syringe one: sodium hypochlorite (0.5%)
• Syringe two: three amino acids (glutamic acid ,leucine,
lycine)
• Gel substance : carboxymethylcellulose
• Sodium chloride/sodium hydroxide
• Saline solution coloring indicator (red).
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25. • Available as SINGLE or MULTIPLE mix syringes
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26. INDICATIONS FOR USE-
• Atraumatic restorative technique.
• Where the preservation of tooth structure is
important .
• Removal of root/cervical caries.
• The removal of caries at the margins of crown and
bridge abutment.
• Management of primary carious lesion in deciduous
teeth.
• Caries management in patient with special needs.
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27. INSTRUMENTS-
• To ensure the most effective removal of the softened carious
dentine,
specially-designed instruments have been developed. Most of
them are atraumatic, while others are designed to remove
harder carious lesions. The instruments help to preserve
tissue and speed up the treatment.
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29. PowerDrive-;
The PowerDrive is an electronic torque-controlled instrument
developed to simplify and speed up the Carisolv treatment.
Studies have shown that the PowerDrive makes it easier for
dentists to perform the treatment with Carisolv as the
instrument is operated in a similar way as the drill but with a
much higher degree of tissue control and at a very low sound
level.
• In addition to the Carisolv programme, the Power-drive offers
a complete programme for power operated root canal
cleaning (endo).
• It has a microprocessor that controls the torque with high
precision.
Special emphasis has been placed on making the PowerDrive
user friendly.
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31. MODE OF ACTION
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34. CLINICAL PROCEDURE-:
1-Drilling can be used whenever the cavity needs to be opened up, to
adjust the periphery of the cavity or whenever there are large
amount of caries and when the risk of affecting healthy tissue or
the pulp is minimal. Carisolv makes it possible to avoid drilling
deep into the cavity.
2- Cover the cavity with gel and wait for 30 seconds until the carious
dentine has been softened.
3- Softened caries can then be scraped away using the PowerDrive
and/or the Carisolv hand instruments.
4- Repeat steps three and four without waiting 30 seconds, until the
cavity is free from caries.
5- Inspect and fill as usual.
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38. PAPACARIE-:
In 2003 , a research project in brazil led to the
development of new formula to universalize the use of
chemo-mechanical method for the caries removal and
promote its use in public health. Known as PAPACARIE.
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39. • It is basically comprised of papain , chloramines ,
toluidine blue , salts ,which together are
responsible for papacarie`s bactericide ,
bacteriostatic and anti-inflammatory
characteristics.
• Papin comes from the latex of the leaves and
fruits of green adult papaya.
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The main characteristic of complete removal of infected dentine is glossy
appearance of the cavity
Oxygen is freed and bubbles appear on the surface
Degradation and elimination of fibrin “mantle” formed by carious process
.
Papain will digest dead cells
Application of papacarie

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42. Dental drill
Invasive
Non-selective
Low precision
Often painful
CMCR
Minimally-
invasive
Selective
(removes
carious dentine)
Precise
Minimum of
pain
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43. 05-11-2016 43
drill cmcr

44. Thank you
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