New Advances in Caries Management: Risk Assessment, Silver Diamine Fluoride, and Glass Ionomer Cement


Topic synopsis

  1. Caries Management By Risk Assessment (CAMBRA):

    Caries is a multifactorial disease that is best managed with individualized assessment of risk factors that are causing the problem.  Once the risk factors are identified they can be treated with biofilm modification and remineralization therapies.  Do you really know how to do this?

     

  2. ADA Caries Classification System (ADA CCS):

    There must be specific terminology that describes all stages of caries lesion by site, extent, and activity if target therapies are to be given.  When do you decide to drill a tooth?  This system outlines when to treat chemically and when to treat surgically.

     

  3. Silver diamine fluoride (SDF):

    SDF is very helpful in arresting the caries process when no other means are practical.  The fluoride promotes remineralization, and silver acts as an antimicrobial agent killing bacteria. Do you know when and how to use SDF?

     

  4. Partial Caries Removal:

    When do you stop drilling? There are high levels of evidence that total caries removal is not required on vital asymptomatic teeth with decay approaching the pulp.  Surgical cleaning of the perimeter of the lesion and leaving deeper decay approaching the pulp will seal off any remaining bacteria from its nutrient source and halt demineralization.

     

  5. Glass Ionomer Cement (GIC) as a chemical treatment for caries:

GIC has unique properties that form an ionic exchange chemical bond to tooth structure resulting with a permanent remineralized layer at the tooth-restorative interface which is acid resistant.  GIC can be placed synergistically with SDF.  Proper placement and finishing technique is key to successful long term results. Why use composite? Does it have any chemical properties that help treat caries disease? 

 

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