Selective caries removal to protect pulp vitality
Featured Products Promotional FeaturesPosted by: Dental Design 4th March 2023
Globally, there is a high prevalence of oral disease, with caries being the most common, affecting around 2.5 billion people worldwide.[i] When treating patients with caries, it is important to consider the best approach to prolong the life of a tooth, removing the infection and preventing the development of disease. Across many aspects of dentistry, there is a growing trend which favours the use of minimally invasive techniques. This includes in the treatment of caries, with clinical studies suggesting that selective caries removal is a reliable, minimally invasive option that is capable of producing excellent results while preserving the health of the dental pulp.[ii]
The downfalls of traditional methods
Traditionally, deep caries management has required the complete removal of all carious tissue. Often this has led to pulp exposure, and subsequent root canal treatment. If a traditional procedure is carried out, as opposed to vital pulp treatment, all pulp will be removed. This can significantly reduce the life of the tooth, as root canal treatment weakens the tooths structure, making the need for further restorative procedures in the future more likely. The removal of all tissue affected by caries can increase the rate of the restorative cycle, rather than prolonging the life of a natural tooth.[iii]
However, if no action is taken, and caries is allowed to develop, it may cause pulpitis which can then develop into pulp infection and necrosis.[iv] Because of this, clinicians should consider their options when planning treatment, discussing the options with patients too. Together, and with your professional advice, your patient should decide between doing nothing, carrying out complete, non-selective caries removal, or opting for a minimally invasive approach to preserve as much tissue as possible.
Safe and accurate treatment
Selective caries removal requires the clinician to remove the outer, infectious layer of carious tissue, while preserving the inner layer to allow for remineralisation.[v] This means that the minimum amount of dentine is removed, allowing the remaining tissue to recover and maximise the life of the natural tooth. This minimally invasive approach aims to remove the infectious tissue without disrupting the vitality of the pulp.[vi]
When dealing with deep carious lesions in particular, clinicians should consider selective caries removal, rather than complete, to avoid disruption of the dental pulp. This is an excellent way of reducing bacteria in the inner layer over time, and allows for the remineralisation of the remaining affected dentine. [vii] This is key for the long-term survival of the tooth, and in avoiding the need for root canal treatment. When selective caries removal is performed with accuracy, it can be a safe and effective alternative to complete caries removal.
Certainty and accuracy when removing infected caries tissue
When treating caries, it can sometimes be difficult to accurately identify carious tissue. During complete caries removal, clinicians take away all softened dentine until hard dentine is reached. This approach is thorough, but does not take into account the potential for dentine remineralisation, or the risk to pulp vitality should the clinician remove too much dentine. Selective caries removal, however, involves taking away infected caries tissue without removing all softened dentine. The remaining dentine should still be cuttable, and should protect the pulp. After removal is complete, immediate restoration is needed to prevent reinfection.[viii]
Even though there are numerous benefits to selective caries removal, it may be difficult for clinicians to distinguish between infected caries tissue, and remineralisable dentine. In these cases, it can be reassuring to have a clinical aid available to assist in determining which tissue should be removed, and which should not. Caries Detector from Kuraray, available through J&S Davis, is the ideal clinical tool in these scenarios, providing the clinician with certainty when removing carious dentine. By staining the infectious caries, the aid creates a clear distinction between the two layers, clearly indicating the infectious tissue which needs removing, while helping to prevent the removal of healthy, remineralisable dentine. By using Caries Detector, you are able to maximise the amount of remaining healthy tissue, and protect the pulp from accidental injury.
Minimally invasive dentistry, of any kind, aims to protect the long-term health of the teeth, and reduce the number of restorative procedures required in the future. Through the use of clinical aids, minimally invasive dentistry is becoming more predictable and straightforward, with increased visibility, and the ability to diagnose with improved accuracy and certainty, for excellent outcomes. Consider using a minimally invasive approach when treating your patients with caries, to protect them from the risk of pulp infection and help to extend the life of their natural dentition.
For more information on the industry-leading products available from J&S Davis,
visit www.js-davis.co.uk, call 01438 747 344
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Steve Brown
Director of Sales and Marketing J&S Davis Ltd
[i] https://www.who.int/news/item/18-11-2022-who-highlights-oral-health-neglect-affecting-nearly-half-of-the-world-s-population
[ii] Santamaria, Ruth, and Nicola Innes. “Trial shows partial caries removal is an effective technique in primary molars.” Evidence-Based Dentistry 15.3 (2014): 81-82. https://www.researchgate.net/profile/Nicola-Innes/publication/267744516_Trial_shows_partial_caries_removal_is_an_effective_technique_in_primary_molars/links/553e64a50cf210c0bdaa80bf/Trial-shows-partial-caries-removal-is-an-effective-technique-in-primary-molars.pdf
[iii] Bjørndal, Lars, et al. “Management of deep caries and the exposed pulp.” International endodontic journal 52.7 (2019): 949-973. https://onlinelibrary.wiley.com/doi/pdf/10.1111/iej.13128
[iv] Bjørndal, Lars, et al. “Management of deep caries and the exposed pulp.” International endodontic journal 52.7 (2019): 949-973. https://onlinelibrary.wiley.com/doi/pdf/10.1111/iej.13128
[v] Melo, M. A. S., et al. “Photodynamic antimicrobial chemotherapy and ultraconservative caries removal linked for management of deep caries lesions.” Photodiagnosis and Photodynamic Therapy 12.4 (2015): 581-586. https://repositorio.ufc.br/bitstream/riufc/18022/1/2015_art_masmelo.pdf
[vi] Bjørndal, Lars, et al. “Management of deep caries and the exposed pulp.” International endodontic journal 52.7 (2019): 949-973. https://onlinelibrary.wiley.com/doi/pdf/10.1111/iej.13128
[vii] Melo, M. A. S., et al. “Photodynamic antimicrobial chemotherapy and ultraconservative caries removal linked for management of deep caries lesions.” Photodiagnosis and Photodynamic Therapy 12.4 (2015): 581-586. https://repositorio.ufc.br/bitstream/riufc/18022/1/2015_art_masmelo.pdf
[viii] https://bmjopen.bmj.com/content/12/2/e061119
