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A visit to the dentist can be difficult at any age, but for children the prospect can be traumatic before you even consider restorative treatment. However, there are methods and materials that can help make the experience easy for patient and practitioner alike.
Carious Tissue Removal:
There are two different approaches to carious tissue removal – complete (CCR) and selective carious tissue removal (SCR). The first
approach removes all demineralized dentin until the hard dentin is reached, while the second removes only the soft dentin to reduce pulp exposure.8
No Carious Tissue Removal (Hall Technique, HT):
In contrast to traditional methods of caries removal and restorative treatment, the Hall Technique (HT) follows a non-invasive approach. The principle of HT is to seal in caries using preformed metal crowns. Thus, the bacteria will be sealed away from the oral environment and consequently slow or stop the caries process.9
Alternative treatment options:
Atraumatic Restorative Treatment (ART):
Atraumatic Restorative Treatment (ART) is a treatment option based on removing carious tissue with hand instruments alone – no drilling involved – before restoration with a cement, composite, or prefabricated crown.10 While ART isn’t commonly used worldwide, it offers a variety of benefits for uneasy or difficult pediatric patients that make it a valuable tool worth exploring. Because you don’t have to drill, you can reduce patient anxiety and discomfort, as well as make treatment easier for those who may suffer from dental phobias. Plus, ART requires no electricity or anesthesia, making it a viable option when the child has other health conditions that may make anesthesia unsafe. Overall, the technique is simple, less frightening, less painful, and can be more cost effective than other approaches. And it has been shown that utilizing ART with highly viscous glass ionomers is an adequate option to treat single-surface
carious lesions in primary teeth.11
Material options: The Glass Ionomer opportunity:
After caries removal, there are several different materials you can use to restore the tooth, however, glass ionomer restorative materials (GIs) have distinct advantages for pediatric patients.
To start, GIs are biocompatible and chemically bond to natural tooth structure – no etchants, adhesives, or time-consuming extra steps necessary. This means an easier, quicker procedure for fussy patients, and an excellent bond. But more than simply restoring, GIs actually help support healthy teeth. These unique materials contain a number of ions that support natural dentition, including fluoride, calcium and phosphate. As dental professionals well know, fluoride is key to healthy teeth. It holds onto calcium and phosphate, the building blocks of teeth, and replaces enamel’s normal crystalline composition hydroxyapatite with more decay-resistant fluorapatite.
In addition to releasing a significant amount of fluoride, GIs act as reservoirs for the ion – providing a prolonged ion-release. This means that every time the patient drinks fluoride-rich water, brushes their teeth or uses a fluoride rinse, their restoration absorbs more fluoride – which it will then release when it’s most needed. This makes GIs particularly useful for young patients at a high risk for caries. Phosphate and calcium are crucial to remineralization as well, being one of the key minerals in enamel, hydroxyapatite. By releasing these ions along with fluoride, teeth get a much-needed boost. And because GIs are water-based, these ions can move in and out of the material to where they’re needed most.
In addition, GIs are incredibly versatile – they can be used as full restorative materials, but also as liners and bases for resin-based composites. They can act as sealants or bonding agents (including for orthodontic brackets) and are flowable enough to seal sensitive dentin tubules. And because of their moisture tolerance, they’re particularly excellent for sealing early erupting molars – GIs are less technique sensitive, set rapidly, and can be placed with less-than-ideal clinical tooth isolation. However, GIs cannot be recommended for stress-bearing Class II restorations or for the restorations of the incisal section of incisors due to compressive strength and fracture issues. All of this together adds up to a material that’s ideal for pediatric patients and ECC.