Caries StabilizationCaries Stabilization

John Zimmer, DDS

R. Patrick Sewell, DMD

Caries StabilizationCaries Stabilization Interim therapeutic restorations (ITRs)Interim therapeutic restorations (ITRs) Resin and glass ionomer sealantsResin and glass ionomer sealants Regular recharging of ITRs and sealants Regular recharging of ITRs and sealants

with fluoridewith fluoride Fluoride varnish applicationsFluoride varnish applications Twice daily brushing with fluoride toothpasteTwice daily brushing with fluoride toothpaste

ECC InitiativeECC Initiative

Why Caries Stabilization?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.

Indications for interim therapeutic restorations Indications for interim therapeutic restorations (ITRs), and glass ionomer sealants(ITRs), and glass ionomer sealants

Appropriate technique for placing ITRs and GI Appropriate technique for placing ITRs and GI sealantssealants

Variables that influence the success of ITRs and GI Variables that influence the success of ITRs and GI sealantssealants

Behavioral management when working with young Behavioral management when working with young childrenchildren

Oral health messages for parents and caregivers of Oral health messages for parents and caregivers of young childrenyoung children

Strategies for follow-up and codingStrategies for follow-up and coding

ObjectivesObjectives

Policy StatementPolicy Statement The AAPD recognizes ITR as The AAPD recognizes ITR as

a beneficial provisional a beneficial provisional technique in contemporary technique in contemporary pediatric restorative dentistry. pediatric restorative dentistry.

ITR may be used to restore ITR may be used to restore and prevent caries in and prevent caries in youngyoung patients, patients, uncooperativuncooperativee patients, patients with patients, patients with special special needsneeds and situations in which and situations in which traditional cavity preparation traditional cavity preparation and restorations are not and restorations are not feasiblefeasible..

Download AAPD policy on ITRs.

Indications for ITRsIndications for ITRs

No pulpal involvementNo pulpal involvement 1 or 2 surface lesions1 or 2 surface lesions Reduce fear Reduce fear Defer treatmentDefer treatment Provide care at schoolsProvide care at schools

Contraindications for ITRsContraindications for ITRs

Necrotic pulpNecrotic pulp Irreversible pulpitisIrreversible pulpitis 3 or more surfaces3 or more surfaces affected by decayaffected by decay

GLASS Ionomer (GI) MaterialsGLASS Ionomer (GI) Materials Bonds with toothBonds with tooth RemineralizationRemineralization

Bacterial reduction Bacterial reduction Within dentinWithin dentin Oral environmentOral environment

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Anterior TeethAnterior Teeth

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Anterior TeethAnterior Teeth

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Anterior TeethAnterior Teeth

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Anterior TeethAnterior Teeth

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Posterior TeethPosterior Teeth

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Posterior TeethPosterior Teeth

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Posterior TeethPosterior Teeth

Interim Therapeutic Restorations: Interim Therapeutic Restorations: Posterior TeethPosterior Teeth

Positive ExperiencePositive Experience

Caries StabilizationCaries Stabilization

ITR Technique StepsITR Technique Steps

Step 1: Examination and Step 1: Examination and DiagnosisDiagnosis

Children 6-24 monthsChildren 6-24 months

Step 1: Examination and DiagnosisStep 1: Examination and DiagnosisChildren 2 years and olderChildren 2 years and older

Need photo

Step 1: Examination and Step 1: Examination and DiagnosisDiagnosis

No pulpal involvementNo pulpal involvement One or two surface lesionsOne or two surface lesions

Step 2: ExplanationStep 2: Explanation

LimitationsLimitations BenefitsBenefits

Step 3: Tray Set-UpStep 3: Tray Set-Up

InstrumentsInstruments MaterialsMaterials SuppliesSupplies

Step 4: ExcavationStep 4: Excavation

Incomplete caries removal:Incomplete caries removal:40 month follow-up study40 month follow-up study

Maltz et al. Caries Research 41: 493-6 2007Maltz et al. Caries Research 41: 493-6 2007

Initial placement 6 monthsInitial placement 6 months 18 months 38 months 18 months 38 months

Step 5: IsolateStep 5: Isolate

Step 6: ConditionerStep 6: Conditioner

Step 7: PlacementStep 7: Placement

Step 7: PlacementStep 7: Placement

Step 8: Fluoride VarnishStep 8: Fluoride Varnish

Step 9: Provide Parent EducationStep 9: Provide Parent Education

Factors for SuccessFactors for Success

1. Proper diagnosis2. Adequate restoration3. Appropriate excavation4. Margin quality

Interim Therapeutic RestorationsInterim Therapeutic Restorations

Before After

Glass Ionomer SealantsGlass Ionomer Sealants

Glass Ionomer SealantGlass Ionomer Sealant Technique Steps Technique Steps

1.1. Examination and Examination and DiagnosisDiagnosis

2.2. ExplanationExplanation3.3. PreparationPreparation4.4. IsolationIsolation5.5. ConditionerConditioner6.6. PlacementPlacement7.7. Fluoride varnishFluoride varnish

Step 1: Examination and Step 1: Examination and DiagnosisDiagnosis

Step 2: ExplanationStep 2: Explanation

Step 3: PreparationStep 3: Preparation

Steps 4 and 5: Steps 4 and 5: Isolate and ConditionIsolate and Condition

Step 6: PlacementStep 6: Placement

Step 6: PlacementStep 6: Placement

Step 6: PlacementStep 6: Placement

Glass-Ionomer SealantsGlass-Ionomer Sealants

Factors for SuccessFactors for Success

Patient Management TipsPatient Management Tips

Oral Health MessagesOral Health Messages

Recharging ITR Twice daily brushing

with fluoride toothpaste

Fluoride varnish every three months

Goal setting to improve oral health

CodingCodingCurrent Dental Terminology 2009-10, Page 147, #12Current 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 Goals: Improve access for young children and increase options for treating ECC.and increase options for treating ECC.

We hope YOU incorporate Caries

Stabilization into your dental program!

ReferencesReferences American Academy of Pediatric Dentistry, Policy on Interim Therapeutic American Academy of Pediatric Dentistry, Policy on Interim Therapeutic

Restorations, Reference Manual V 31/No6 09/10. Restorations, Reference Manual V 31/No6 09/10. Chadwick BL, Treasure ET, Playle RA, Caries Res. 2005 Jan-Feb;39(1):34-40. 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 A randomised controlled trial to determine the effectiveness of glass ionomer sealants in pre-school children.sealants in pre-school children.

Community Dentistry and Oral Epidemiology  Supplement 1 1998, Proceedings: Community Dentistry and Oral Epidemiology  Supplement 1 1998, Proceedings: Conference on Early Childhood Caries, Ed: B. BurtConference on Early Childhood Caries, Ed: B. Burt

Lindemeyer, R. JCDA. March 2007, Vol. 73, No. 2. The Use of Glass Ionomer Lindemeyer, R. JCDA. March 2007, Vol. 73, No. 2. The Use of Glass Ionomer Sealants on Newly Erupting Permanent Molars. Sealants on Newly Erupting Permanent Molars.

Maltz M, Oliveira EF, Fontanella V, Carminatti G. Deep caries lesions after Maltz M, Oliveira EF, Fontanella V, Carminatti G. Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study. incomplete dentine caries removal: 40-month follow-up study. Caries Res. Caries Res. 2007;41(6):493–496. 2007;41(6):493–496.

Mejare I, Mior, IA. Scand J Dent Res. Mejare I, Mior, IA. Scand J Dent Res. 1990 Aug;98(4):345-50. Glass ionomer 1990 Aug;98(4):345-50. Glass ionomer and resin-based fissure sealants: a clinical study.and resin-based fissure sealants: a clinical study.

Ricketts DN, Kidd EA, Innes N, Clarkson J. Complete or ultraconservative Ricketts DN, Kidd EA, Innes N, Clarkson J. Complete or ultraconservative removal of decayed tissue in unfilled teeth. removal of decayed tissue in unfilled teeth. Cochrane Database Syst Rev. Cochrane Database Syst Rev. 2006;3:CD003808. 2006;3:CD003808.

Vij, Coll, Shelton, Farooq; Caries control and other variables associated with Vij, Coll, Shelton, Farooq; Caries control and other variables associated with success of primary molar vital pulp therapy. Ped Dent 2004, 26: 214-20success of primary molar vital pulp therapy. Ped Dent 2004, 26: 214-20