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Caries Stabilization

Caries Stabilization

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Caries Stabilization

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  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. 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

  6. 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.

  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

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

  10. Interim Therapeutic Restorations: Anterior Teeth

  11. Interim Therapeutic Restorations: Anterior Teeth

  12. Interim Therapeutic Restorations: Anterior Teeth

  13. Interim Therapeutic Restorations: Anterior Teeth

  14. Interim Therapeutic Restorations: Posterior Teeth

  15. Interim Therapeutic Restorations: Posterior Teeth

  16. Interim Therapeutic Restorations: Posterior Teeth

  17. Interim Therapeutic Restorations: Posterior Teeth

  18. Positive Experience

  19. Caries Stabilization

  20. ITR Technique Steps

  21. Step 1: Examination and DiagnosisChildren 6-24 months

  22. Step 1: Examination and DiagnosisChildren 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: 493-6 2007 Initial placement 6 months 18 months 38 months

  28. Step 5: Isolate

  29. Step 6: Conditioner

  30. Step 7: Placement

  31. Step 7: Placement

  32. Step 8: Fluoride Varnish

  33. Step 9: Provide Parent Education

  34. Factors for Success • Proper diagnosis • Adequate restoration • Appropriate excavation • Margin quality

  35. Interim Therapeutic Restorations Before After

  36. Glass Ionomer Sealants

  37. Glass Ionomer Sealant Technique Steps • Examination and Diagnosis • Explanation • Preparation • Isolation • Conditioner • Placement • 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

  43. Step 6: Placement

  44. Step 6: Placement

  45. Glass-Ionomer Sealants

  46. Factors for Success

  47. Patient Management Tips

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

  49. 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

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