Caries Stabilization John Zimmer, DDS R. Patrick Sewell, DMD
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
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.
Objectives • 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
Download AAPD policy on ITRs. 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 youngpatients, uncooperative patients, patients with special needs and situations in which traditional cavity preparation and restorations are not feasible.
Indications for ITRs No pulpal involvement 1 or 2 surface lesions Reduce fear Defer treatment Provide care at schools
Contraindications for ITRs Necrotic pulp Irreversible pulpitis 3 or more surfaces affected by decay
Bonds with tooth Remineralization Bacterial reduction Within dentin Oral environment GLASS Ionomer (GI) Materials
Step 1: Examination and Diagnosis • No pulpal involvement • One or two surface lesions
Step 2: Explanation • Limitations • Benefits
Step 3: Tray Set-Up • Instruments • Materials • Supplies
Incomplete caries removal:40 month follow-up study Maltz et al. Caries Research 41: 493-6 2007 Initial placement 6 months 18 months 38 months
Factors for Success • Proper diagnosis • Adequate restoration • Appropriate excavation • Margin quality
Interim Therapeutic Restorations Before After
Glass Ionomer Sealant Technique Steps • Examination and Diagnosis • Explanation • Preparation • Isolation • Conditioner • Placement • Fluoride varnish
Recharging ITR Twice daily brushing with fluoride toothpaste Fluoride varnish every three months Goal setting to improve oral health Oral Health Messages
CodingCurrent Dental Terminology 2009-10, 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
Goals: Improve access for young children and increase options for treating ECC.