Caries Stabilization John Zimmer DDS R Patrick Sewell

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

ECC Initiative

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

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.

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

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

Interim Therapeutic Restorations: Anterior Teeth

Interim Therapeutic Restorations: Posterior Teeth

Positive Experience

Caries Stabilization

ITR Technique Steps

Step 1: Examination and Diagnosis Children 6 -24 months

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

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 §

Step 4: Excavation

Incomplete caries removal: 40 month follow-up study Initial placement 6 months 18 months 38 months Maltz et al. Caries Research 41: 493 -6 2007

Step 5: Isolate

Step 6: Conditioner

Step 7: Placement

Step 8: Fluoride Varnish

Step 9: Provide Parent Education

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

Interim Therapeutic Restorations Before After

Glass Ionomer Sealants

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

Step 1: Examination and Diagnosis

Step 2: Explanation

Step 3: Preparation

Steps 4 and 5: Isolate and Condition

Step 6: Placement

Glass-Ionomer Sealants

Factors for Success

Patient Management Tips

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

Coding § § § Current 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.

We hope YOU incorporate Caries Stabilization into your dental program!

References § § § § American Academy of Pediatric Dentistry, Policy on Interim Therapeutic Restorations, Reference Manual V 31/No 6 09/10. Chadwick BL, Treasure ET, Playle RA, Caries Res. 2005 Jan-Feb; 39(1): 34 -40. A randomised controlled trial to determine the effectiveness of glass ionomer sealants in pre-school children. Community Dentistry and Oral Epidemiology Supplement 1 1998, 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. 1990 Aug; 98(4): 345 -50. 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 003808. Vij, Coll, Shelton, Farooq; Caries control and other variables associated with success of primary molar vital pulp therapy. Ped Dent 2004, 26: 214 -20