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Caries Stabilization John Zimmer, DDS R. Patrick Sewell, DMD.

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Presentation on theme: "Caries Stabilization John Zimmer, DDS R. Patrick Sewell, DMD."— Presentation transcript:

1 Caries Stabilization John Zimmer, DDS R. Patrick Sewell, DMD

2 Caries Stabilization  Interim therapeutic restorations (ITRs)  Resin and glass ionomer sealants  Regular recharging of ITRs and sealants with fluoride  Fluoride varnish applications  Twice daily brushing with fluoride toothpaste

3 ECC Initiative

4 Why Caries Stabilization?   Poor Dental Access for 0-5 year olds   Only 10% of 0-2 year olds are seen yearly in the dental clinic.   Only 25% of 3-5 year olds are seen yearly in the dental clinic.

5  Indications for interim therapeutic restorations (ITRs), and glass ionomer sealants  Appropriate technique for placing ITRs and GI sealants  Variables that influence the success of ITRs and GI sealants  Behavioral management when working with young children  Oral health messages for parents and caregivers of young children  Strategies for follow-up and coding Objectives

6 Policy Statement  The AAPD recognizes ITR as a beneficial provisional technique in contemporary pediatric restorative dentistry.  ITR may be used to restore and prevent caries in young patients, uncooperative patients, patients with special needs and situations in which traditional cavity preparation and restorations are not feasible. Download AAPD policy on ITRs.

7 Indications for ITRs  No pulpal involvement  1 or 2 surface lesions  Reduce fear  Defer treatment  Provide care at schools

8 Contraindications for ITRs  Necrotic pulp  Irreversible pulpitis  3 or more surfaces affected by decay affected by decay

9 GLASS Ionomer (GI) Materials  Bonds with tooth  Remineralization  Bacterial reduction Within dentin Oral environment

10 Interim Therapeutic Restorations: Anterior Teeth

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14 Interim Therapeutic Restorations: Posterior Teeth

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18 Positive Experience

19 Caries Stabilization

20 ITR Technique Steps

21 Step 1: Examination and Diagnosis Children 6-24 months

22 Step 1: Examination and Diagnosis Children 2 years and older Need photo

23 Step 1: Examination and Diagnosis  No pulpal involvement  One or two surface lesions

24 Step 2: Explanation  Limitations  Benefits

25 Step 3: Tray Set-Up  Instruments  Materials  Supplies

26 Step 4: Excavation

27 Incomplete caries removal: 40 month follow-up study Maltz et al. Caries Research 41: Initial placement 6 months 18 months 38 months

28 Step 5: Isolate

29 Step 6: Conditioner

30 Step 7: Placement

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32 Step 8: Fluoride Varnish

33 Step 9: Provide Parent Education

34 Factors for Success 1. Proper diagnosis 2. Adequate restoration 3. Appropriate excavation 4. Margin quality

35 Interim Therapeutic Restorations BeforeAfter

36 Glass Ionomer Sealants

37 Glass Ionomer Sealant Technique Steps 1. Examination and Diagnosis 2. Explanation 3. Preparation 4. Isolation 5. Conditioner 6. Placement 7. Fluoride varnish

38 Step 1: Examination and Diagnosis

39 Step 2: Explanation

40 Step 3: Preparation

41 Steps 4 and 5: Isolate and Condition

42 Step 6: Placement

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45 Glass-Ionomer Sealants

46 Factors for Success

47 Patient Management Tips

48 Oral Health Messages   Recharging ITR   Twice daily brushing with fluoride toothpaste   Fluoride varnish every three months   Goal setting to improve oral health

49 Coding Current Dental Terminology , Page 147, #12   2940 for ITRs   1351 for resin or glass ionomer sealants.   1203 Fluoride varnish for child at low risk for caries   1206 Fluoride varnish for child at moderate to high risk for caries   1310 Nutritional counseling provided to child and caregiver   1330 Oral hygiene instructions provided to child and caregiver

50 Goals: Improve access for young children and increase options for treating ECC.

51 We hope YOU incorporate Caries Stabilization into your dental program!

52 References  American Academy of Pediatric Dentistry, Policy on Interim Therapeutic Restorations, Reference Manual V 31/No6 09/10.  Chadwick BL, Treasure ET, Playle RA, Caries Res Jan-Feb;39(1): A randomised controlled trial to determine the effectiveness of glass ionomer sealants in pre-school children.  Community Dentistry and Oral Epidemiology Supplement , Proceedings: Conference on Early Childhood Caries, Ed: B. Burt  Lindemeyer, R. JCDA. March 2007, Vol. 73, No. 2. The Use of Glass Ionomer Sealants on Newly Erupting Permanent Molars.  Maltz M, Oliveira EF, Fontanella V, Carminatti G. Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study. Caries Res. 2007;41(6):493–496.  Mejare I, Mior, IA. Scand J Dent Res Aug;98(4): Glass ionomer and resin-based fissure sealants: a clinical study.  Ricketts DN, Kidd EA, Innes N, Clarkson J. Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database Syst Rev. 2006;3:CD  Vij, Coll, Shelton, Farooq; Caries control and other variables associated with success of primary molar vital pulp therapy. Ped Dent 2004, 26:


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