Deep Caries Clinical Trial
Official title:
Post-operative Pain After Silver Diamine Fluoride Application in Primary Molars With Deep Caries Versus Interim Restorative Therapy
Untreated dental caries is a worldwide pandemic (Edelstein, 2006). Due to limited financial
resources, poor access to basic oral care, and the high cost of restorative treatment,
children of low-income nations have their general health, social well-being, and education
opportunities affected by untreated dental caries (Baelum et al., 2007).
Traditional treatment of cavitated dentin lesions advocates complete removal of the decayed
structure, i.e. the infected and affected dentin layers. During this procedure, however, a
significant quantity of the dental structure is removed, and the pulp tissue may be exposed.
In light of this, the complete removal of all decayed structures from a tooth with cavitated
lesions is no longer seen as mandatory, as this increases the chance of pulp exposure,
post-operative pain and weakens the tooth structure, and there is growing evidence to support
incomplete removal of decayed tissue prior to the restoration of the cavity. It is argued,
however, that carious lesions remaining in the cavity must be completely sealed in order to
prevent their progression (Yee et al., 2009).
Arresting Caries Treatment (ACT) has been proposed to oversee untreated dental caries in
children of disadvantaged communities. Treatment of carious lesions based on minimally
invasive technique methods aim to prevent their progression and preserve pulp vitality by
means of standards of anticipation, remineralization and minimal intervention in the dental
tissue (Bedi and Sardo-Infirri, 1999).
A treatment option has been proposed in the last decade, based on the change in understanding
of carious biofilm development and caries progression. Sealing carious dentine beneath a
restoration deprives the caries biofilm of nutrients and alters the environment sufficiently
to slow or arrest lesion progression. This has the added benefit of avoiding pulp exposure
and subsequent treatment (Santamaria, Innes, Machiulskiene, Evans, & Splieth, 2014).
There is no clear evidence that leaving soft infected dentine, before sealing the cavity, is
deleterious. Instead, this may prevent pulp exposure, preserve the pulp vitality, reduce the
permeability of the remaining dentine by stimulating tertiary dentine formation, and so
change the environment for the remaining microorganisms and thus arresting caries process.
Silver diamine fluoride (SDF), Ag(NH3)2F, has been used to arrest caries since 1969.Silver
Diamine Fluoride is a topical drug that is applied clinically to control active dental caries
and prevent further progression of disease. Although, the ideal way to treat teeth with decay
is removal of the decay and placing a restoration, this alternative treatment allows us to
stop decay with non-invasive methods, especially with young children that have primary teeth.
Treatment with Silver Diamine Fluoride does not eliminate the need for restorative dentistry
to repair function or aesthetics, but has been effective at prevention of further decay.
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