Abstract
Managing a carious lesion without removing any carious tissue is a radical conceptual shift in the treatment of dental caries. Strategies to manage carious lesions without removing carious tissue have the advantage of reducing and often eliminating discomfort, pain, and dental anxiety that are an inadvertent part of the more invasive operative procedures. This approach is especially invaluable in treating children whose ability is compromised by age, behavior, or disabilities. The rationale behind managing carious lesions without removing carious tissue is based on current understanding that the pathogenicity of the carious lesion is dependent on how we manage the overlying plaque biofilm. Treatment modalities that disturb the biofilm or deprive the cariogenic bacteria in the biofilm of micronutrients slow down and arrest the carious lesion. These include sealing in the carious lesion with “fissure sealing” and the “Hall technique,” arresting early proximal lesions with “resin infiltration,” and “non-restorative cavity control” with a “fluoride varnish” or the use of “silver diamine fluoride.” This chapter comprises an exhaustive discussion of each of these five procedures described step-by-step with the aid of high-quality clinical photographs, long-term follow-ups, and clinical tips.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Schwendicke F. Contemporary concepts in carious tissue removal: a review. J Esthet Restor Dent. 2017;29(6):403–8. https://doi.org/10.1111/jerd.12338.
Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona AF, Innes NP. Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res. 2016;28(2):58–67. https://doi.org/10.1177/0022034516639271.
Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth. Cochrane Database Syst Rev. 2015;(11):CD010431. https://doi.org/10.1002/14651858.CD010431.
Christiansen J. Non-operative caries treatment. In: Splieth CH, editor. Revolutions in pediatric dentistry. Berlin: Quintessence; 2011. p. 21–35.
Hansen NV, Nyvad B. Non-operative control of cavitated approximal caries lesions in primary molars: a prospective evaluation of cases. J Oral Rehabil. 2017;44(7):537–44. https://doi.org/10.1111/joor.12508.
European Academy of Paediatric Dentistry. Guidelines on the use of fluoride in children: an EAPD policy document. Eur Arch Paediatr Dent. 2009;10(3):129–35.
Toumba J. Current guidelines for the use of fluorides for caries prevention. In: Splieth CH, editor. Revolutions in pediatric dentistry. Berlin: Quintessence; 2011. p. 37–48.
dos Santos AP, Nadanovsky P, de Oliveira BH. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dentalcaries in the primary dentition of preschool children. Community Dent Oral Epidemiol. 2013;41(1):1–12. https://doi.org/10.1111/j.1600-0528.2012.00708.x.
Duangthip D, Wong MCM, Chu CH, Lo ECM. Caries arrest by topical fluorides in preschool children: 30-month results. J Dent. 2018;70:74–9.
Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Tampi MP, Pilcher L, Banfield L, Carrasco-Labra A. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc. 2018;149(10):837–849.e19. https://doi.org/10.1016/j.adaj.2018.07.002.
Bruun C, Givskov H. Formation of CaF2 on sound enamel and in caries-like enamel lesions after different forms of fluoride applications in vitro. Caries Res. 1991;25(2):96–100.
Chu CH, Lo EC. Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent. 2008;6(4):315–21.
Crystal YO, Niederman R. Silver diamine fluoride treatment considerations in children’s caries management. Pediatr Dent. 2016;38(7):466–71.
Knight GM, McIntyre JM, Craig GG, Mulyani, Zilm PS, Gully NJ. Inability to form a biofilm of Streptococcus mutans on silver fluoride- and potassium iodide-treated demineralized dentin. Quintessence Int. 2009;40(2):155–61.
Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. J Dent Res. 2009;88(2):116–25. https://doi.org/10.1177/0022034508329406.
Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent. 2017;39(6):146–55.
Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. J Calif Dent Assoc. 2016;44(1):16–28.
Chairside guide: silver diamine fluoride in the management of dental caries lesions. Pediatr Dent. 2017;39(6):478–9.
Bendit J, Young D. Silver diamine fluoride: the newest tool in your caries management kit. In: Dental academy of continuing education. July 2017; 2017. https://www.dentalacademyofce.com/courses/3347/PDF/1707cei_Bendit_Young_web.pdf. Accessed 6 Sep 2018.
Ratledge DK, Kidd EA, Beighton D. A clinical and microbiological study of approximal carious lesions. Part 1: the relationship between cavitation, radiographic lesion depth, the site-specific gingival index and the level of infection of the dentine. Caries Res. 2001;35(1):3–7.
Anusavice KJ. Present and future approaches for the control of caries. J Dent Educ. 2005;69(5):538–54.
Paris S, Meyer-Lueckel H. Microinvasive caries treatment by resin infiltration. In: Splieth CH, editor. Revolutions in pediatric dentistry. Berlin: Quintessence; 2011. p. 103–17.
Paris S, Hopfenmuller W, Meyer-Lueckel H. Resin infiltration of caries lesions: an efficacy randomized trial. J Dent Res. 2010;89(8):823–6. https://doi.org/10.1177/0022034510369289.
Robinson C, Brookes SJ, Kirkham J, Wood SR, Shore RC. In vitro studies of the penetration of adhesive resins into artificial caries-like lesions. Caries Res. 2001;35(2):136–41.
Huysmans MC. New diagnostic approaches: promise or reality? In: Splieth CH, editor. Revolutions in pediatric dentistry. Berlin: Quintessence; 2011. p. 1–10.
Paris S, Meyer-Lueckel H, Kielbassa AM. Resin infiltration of natural caries lesions. J Dent Res. 2007;86(7):662–6.
Bagher SM, Hegazi FM, Finkelman M, Ramesh A, Gowharji N, Swee G, Felemban O, Loo CY. Radiographic effectiveness of resin infiltration in arresting incipient proximal enamel lesions in primary molars. Pediatr Dent. 2018;40(3):195–200.
Paris S, Meyer-Lueckel H, Cölfen H, Kielbassa AM. Resin infiltration of artificial enamel caries lesions with experimental light curing resins. Dent Mater J. 2007;26(4):582–8.
Hesse D, Bonifácio CC, Mendes FM, Braga MM, Imparato JC, Raggio DP. Sealing versus partial caries removal in primary molars: a randomized clinical trial. BMC Oral Health. 2014;14:58. https://doi.org/10.1186/1472-6831-14-58.
Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. Pediatr Dent. 2016;38(6):263–79.
Borges BC, de Souza Borges J, Braz R, Montes MA, de Assunção Pinheiro IV. Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial. Int Dent J. 2012;62(5):251–5. https://doi.org/10.1111/j.1875-595X.2012.00117.
Ricketts DNJ, Innes NPT. To drill or not to drill? How much caries removal do we need? In: Splieth CH, editor. Revolutions in pediatric dentistry. Berlin: Quintessence; 2011. p. 119–34.
Hewlett ER, Mount GJ. Glass ionomers in contemporary restorative dentistry--a clinical update. J Calif Dent Assoc. 2003;31(6):483–92.
Berg JH. Glass ionomer cements. Pediatr Dent. 2002;24(5):430–8. Review.
Ovrebö RC, Raadal M. Microleakage in fissures sealed with resin or glass ionomer cement. Scand J Dent Res. 1990;98(1):66–9.
Evans D, Innes N. The hall technique. A minimal intervention, child centred approach to managing the carious primary molar: a users manual. November 11, 2010. 3rd ed. Dundee: University of Dundee; 2010. https://dentistry.dundee.ac.uk/files/3M_93C%20HallTechGuide2191110.pdf. Accessed 15 Sep 2018.
Innes NPT, Evans DJP. The Hall technique as a new method for managing caries in primary molars: is it really a revolution? In: Splieth CH, editor. Revolutions in pediatric dentistry. Berlin: Quintessence; 2011. p. 151–62.
Schwendicke F, Innes N. Removal strategies for carious tissues in deep lesions. In: Schwendicke F, editor. Management of deep carious lesions. New York, NY: Springer; 2018. p. 15–35.
BaniHani A, Toumba K, Duggal M, Deery CH. Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition. Int J Paediatr Dent. 2018;28:12. https://doi.org/10.1111/ipd.12314.
BaniHani A, Deery C, Toumba K, Duggal M. Effectiveness, costs and patient acceptance of a conventional and a biological treatment approach for carious primary teeth in children. Caries Res. 2019;53:65–75. https://doi.org/10.1159/000487201.
Paddick JS, Brailsford SR, Kidd EA, Beighton D. Phenotypic and genotypic selection of microbiota surviving under dental restorations. Appl Environ Microbiol. 2005;71(5):2467–72.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kher, M.S., Rao, A. (2019). Lesion Management: No Removal of Carious Tissue. In: Contemporary Treatment Techniques in Pediatric Dentistry . Springer, Cham. https://doi.org/10.1007/978-3-030-11860-0_1
Download citation
DOI: https://doi.org/10.1007/978-3-030-11860-0_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-11859-4
Online ISBN: 978-3-030-11860-0
eBook Packages: MedicineMedicine (R0)