RAMPANT CARIES AND CHEMO -MACHANICAL REMOVAL OF CARIES

UNDERTHE GUIDANCE OF-DR.ASHISH KATIYAR

PRESENTED BY-SRISHTI SRIVASTAVA (IVth yr)02/05/2023 1

CONTENTS-

RAMPANT CARIES

•INTRODUCTION•ETIOLOGY•TREATMENT

CHEMO-MECHANICAL

CARIES REMOVAL

•CARIDEX•CARISOLV•PAPAIN GEL

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INTRODUCTION

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WHAT IS DENTAL CARIES-

“Dental caries is defined as a progressive irreversible microbial disease affecting the tooth , resulting from demineralization of the inorganic constituents and dissolution of the organic constituent, thereby leading to a cavity formation.”

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DEFINITIONS OF RAMPANT CARIES-“RAMPANT CARIES defined as suddenly appearing widespread , burrowing type of caries ,resulting in early involvement of pulp and affecting those teeth , which are usually regarded as immune to decay” - MASSLER (1945)

“RAMPANT CARIES defined as caries of acute onset involving many or all the teeth in areas that are usually not susceptible . They further defined the condition to be associated with rapid destruction of crowns and frequent involvement of pulp.” - WINTER (1966)

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CLINICAL APPEARANCE

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The initial lesion usually appears on the labial surface of maxillary incisors , close to the gingival margins as a whitish area of decalcification which soon become pigmented to light yellow and extended laterally to proximal surface and downward to incisal edge and finally leading to fracture of crown.

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ETIOLOGY

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TWO MAJOR PREDISPOSING FACTORS IN RAMPANT CARIES ARE-

1- MICROORGANISM-

Streptococcus mutans is an important pathogen in development of

dental caries and along with that lactobacillus and veillonella are also responsible for development of rampant caries.

- cariogenicity of s.mutans is based upon it’s ability for– a- colonization of teeth. b- production of large amount of acid c- breakdown of salivary glycoprotein, which might be of

great importance for the initial development of carious lesions. d- production of large amounts of extracellular

polysaccharide that enable voluminous plaque formation.02/05/2023 11

2- DIET-:

The carbohydrate component of diet is associated with formation of dental caries.

- The cariogenic potential is related to texture of the carbohydrate and the frequency of consumption of sticky sugars ,rather than to the amount of sugar eaten.

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• the main CAUSE of rampant caries is found in an infant who falls asleep with milk or sugar containing substances or children who use pacifiers are commonly seen with rampant caries.

• Decrease in salivary flow rate during sleep, as well as pooling of sweet fluids around the teeth results in highly cariogenic environment.

• Rampant caries may also occur in permanent dentition of teenagers because of their frequent intake of cariogenic snacks b/w meal .

Breast milk is considered to be more cariogenic than bovine milk because it is high in lactose content where as bovine milk contains more of Ca and P.

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TREATMENT

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EARLY CARIES WITH MINIMAL LOSS OF ENAMEL-Weekly professionally applied fluoride therapy.

EXTENSIVE CAVITATION WITH NO PULPAL INVOLVEMENT - glass ionomer restorations, composite restoration, pedo-strip crowns

WITH PULPAL INVOLVEMENT- Pulpotomy or pulpectomy, followed by restoration. extraction followed by space maintainer or partial or complete denture.

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CHEMO-MECHANICAL CARIES REMOVAL• Chemo mechanical caries removal

(CMCR) is a non-invasive technique eliminating infected dentine via a chemical agent.

• This is a method of caries removal based on dissolution. Instead of drilling, this method uses a chemical agent assisted by an atraumatic mechanical force to remove soft carious structure.

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• It was introduced to dentistry as an alternative method of caries removal and is mainly indicated to overcome the inconvenience of using burs and local anaesthesia , causing less discomfort to patients and preserving healthy dental structure, there by applying the concept of the minimal invasive dentistry .

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HISTORY-:• IN 1975, HABIB introduced a method using 5%

SODIUM HYPOCLORITE to remove carious tissues and since then, many studies have attempted to improve this early technique.

• The sole use of 5% sodium hypochlorite was known to be toxic and aggressive to adjacent healthy tissues. Therefore , a new solution was developed adding sodium hydroxide, sodium chloride and glycine to the 5% sodium hypochlorite.

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• This modified formula was known as GK-101 and it was comprised of N-monochloroglycine. It was more effective than the hypochlorite alone but was very slow in carious tissue removal. Caridex was later developed by CM HABIB from a formula made of N-monochloroglycine and amino butyric acid and it was called as GK101E. Krogman,Goldman published first report on this material in 1975 and it gained FDA approval in 1984.

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VARIOUS AGENT WHICH ARE USED IN CHEMO-MECHANICAL CARIES REMOVAL -:

1-CARIDEX 2-CARISOLV 3-PAPAIN GEL

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1- CARIDEX-

it was initially introduced in US market in 1985,the system involved the intermittent application of preheated N-monochloro –DL-2-aminobutyric acid (GK-101E) in carious lesion . The solution was claimed to cause disruption of collagen in the carious dentine ,thus facilitating its removal.

• Caridex was not widely adopted due to expense ,additional clinical time and the bulky caridex delivery system which consist of reservoir , a heater , a pump and a handpiece.

• It also transpired that conventional tooth preparation was faster in removing caries than caridex.

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DISADVANTAGES OF CARIDEX-: 1. Expensive2. Large quantity required3. Short shelf life 4. Hand instruments were not optimum 5. Solution had to be heated.

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CARISOLV-: In January 1998 Chriser Hedwards with

Lars Strid of mediteam collaborated with Dan Ericson and Rolf Bronstein in SWEDEN lead to development of new system for chemo-mechanical caries removal called CARISOLV.

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CONSTITUENTS OF CARISOLV- THE formulation of carisolv is isotonic in nature and consist of –

• Syringe one: sodium hypochlorite (0.5%)• Syringe two: three amino acids (glutamic acid ,leucine,

lycine) • Gel substance : carboxymethylcellulose • Sodium chloride/sodium hydroxide• Saline solution coloring indicator (red).

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• Available as SINGLE or MULTIPLE mix syringes

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INDICATIONS FOR USE-• Atraumatic restorative technique.• Where the preservation of tooth structure is

important .• Removal of root/cervical caries.• The removal of caries at the margins of crown and

bridge abutment.• Management of primary carious lesion in deciduous

teeth. • Caries management in patient with special needs.

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INSTRUMENTS-

• To ensure the most effective removal of the softened carious dentine,

specially-designed instruments have been developed. Most of them are atraumatic, while others are designed to remove harder carious lesions. The instruments help to preserve tissue and speed up the treatment.

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PowerDrive-;The PowerDrive is an electronic torque-controlled instrumentdeveloped to simplify and speed up the Carisolv treatment.

Studies have shown that the PowerDrive makes it easier for dentists to perform the treatment with Carisolv as the instrument is operated in a similar way as the drill but with a much higher degree of tissue control and at a very low sound level.

• In addition to the Carisolv programme, the Power-drive offers a complete programme for power operated root canal cleaning (endo).

• It has a microprocessor that controls the torque with high precision.

Special emphasis has been placed on making the PowerDrive user friendly.

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MODE OF ACTION

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CLINICAL PROCEDURE-:

1-Drilling can be used whenever the cavity needs to be opened up, to adjust the periphery of the cavity or whenever there are large

amount of caries and when the risk of affecting healthy tissue or the pulp is minimal. Carisolv makes it possible to avoid drilling deep into the cavity.2- Cover the cavity with gel and wait for 30 seconds until the carious dentine has been softened.3- Softened caries can then be scraped away using the PowerDrive and/or the Carisolv hand instruments.4- Repeat steps three and four without waiting 30 seconds, until the cavity is free from caries.5- Inspect and fill as usual.

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PAPACARIE-: In 2003 , a research project in brazil led to the

development of new formula to universalize the use of chemo-mechanical method for the caries removal and promote its use in public health. Known as PAPACARIE.

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• It is basically comprised of papain , chloramines , toluidine blue , salts ,which together are responsible for papacarie`s bactericide , bacteriostatic and anti-inflammatory characteristics.

• Papin comes from the latex of the leaves and fruits of green adult papaya.

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Dental drill

Invasive

Non-selective

Low precision

Often painful 02/05/2023 42

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drill cmcr

Thank you

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