Mostrando entradas con la etiqueta Dental Caries. Mostrar todas las entradas
Mostrando entradas con la etiqueta Dental Caries. Mostrar todas las entradas

domingo, 29 de junio de 2025

Top Benefits of Chemical Caries Removal in Children and Patients with Dental Anxiety

Chemical Caries Removal

Modern dentistry increasingly embraces minimally invasive approaches that prioritize preserving healthy tooth structure and enhancing the patient experience.

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In this context, chemical caries removal (CCR) has emerged as a safe, effective alternative to traditional drilling—especially valuable in pediatric dentistry and for patients with dental anxiety or phobia. This technique allows clinicians to eliminate decayed dentin without rotary tools, reducing discomfort, fear, and the need for local anesthesia.

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What Is Chemical Caries Removal?
CCR is a conservative, non-invasive technique that uses enzymatic or oxidizing agents to soften infected dentin, allowing its manual removal without mechanical drilling. Common products include Carisolv®, Papacárie Duo®, Brix3000®, and Carie-Care™, which have proven effective in clinical studies.

Why Is CCR Ideal for Children and Anxious Patients?

1. Avoids the dental drill
The sound and vibration of a dental drill often trigger anxiety in children and phobic adults. CCR eliminates the need for rotary instruments.
2. Often requires no local anesthesia
Recent studies show that chemical agents can remove caries painlessly, making injections unnecessary in many cases (Elgalaid et al., 2022).
3. Increases treatment acceptance
Minimally invasive techniques result in a more relaxed experience, improving cooperation in young children and anxious patients (Ghasempour et al., 2020).
4. Preserves healthy tooth structure
Most CCR products act selectively on infected dentin, aligning with the principles of minimally invasive dentistry.
5. Creates a calm clinical environment
Less noise and vibration help maintain a soothing atmosphere, reducing stress for both patient and provider.

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Latest Scientific Evidence
Recent clinical research highlights CCR’s effectiveness and patient acceptance:

° Elgalaid et al. (2022) found that Carisolv® significantly lowered anxiety and pain perception in children compared to conventional methods.
° Ghasempour et al. (2020) reported high satisfaction rates using Brix3000® among children aged 4–7 years.
° Santos et al. (2021) confirmed the safety and effectiveness of Papacárie Duo® in patients with mild to moderate dental anxiety.

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Clinical Guidelines

° Indications: Ideal for shallow to moderate dentin caries without pulpal involvement.
° Contraindications: Avoid in deep lesions near the pulp or sclerotic dentin.
° Chair time: Slightly longer than conventional drilling, but often compensated by improved cooperation.
° Restoration options: Compatible with adhesive and bioactive restorative materials.

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💬 Discussion
Chemical caries removal represents a paradigm shift in managing caries in vulnerable populations. Its patient-friendly and drill-free nature allows for a less traumatic and more empathetic experience. The ability to reduce fear and discomfort during treatment makes CCR especially valuable in pediatric and behavioral dentistry. It also fosters better long-term dental relationships by building trust from an early age.

💡 Conclusion
Chemical caries removal is a powerful tool for modern dentistry, particularly when treating children and patients with dental phobia. Backed by recent evidence, its use promotes a more comfortable, conservative, and effective dental care experience. CCR should be considered a standard part of the clinical toolkit when aiming for anxiety-free dental visits.

📚 References

✔ Elgalaid, M. A., Alshoraim, M. A., Alhazmi, Y. F., & Alahmari, R. A. (2022). A randomized clinical trial comparing Carisolv and rotary instruments in caries removal: anxiety and pain perception in pediatric patients. BMC Oral Health, 22, 333. https://doi.org/10.1186/s12903-022-02458-4

✔ Ghasempour, M., Yeganeh, P., & Golkari, A. (2020). Comparison of the effectiveness of Brix3000 and conventional methods in caries removal in children. Journal of Dentistry for Children, 87(3), 151–156.

✔ Santos, A. P., Freire, M. C. M., Oliveira, B. H., & Paiva, S. M. (2021). Effectiveness of Papacárie Duo in minimally invasive treatment of dental caries in anxious children: a randomized clinical trial. Pediatric Dentistry, 43(4), 259–265.

✔ Lussi, A., & Schaffner, M. (2019). Advances in minimally invasive caries removal: Chemo-mechanical agents. In Mount, G. J. & Hume, W. R. (Eds.), Preservation and Restoration of Tooth Structure (3rd ed., pp. 97–104). Wiley-Blackwell.

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miércoles, 18 de junio de 2025

Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application

Chemical Caries Removal

Chemical caries removal is a minimally invasive technique that allows for the selective elimination of decayed dentin without the use of a dental drill.

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The procedure involves softening infected dentin using a chemical agent, which is then gently removed with manual instruments. This approach reduces pain, anxiety, and the need for local anesthesia, making it ideal for pediatric, geriatric, and anxious patients.

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How Does This Technique Work?
The chemical agents dissolve denatured collagen fibers found in infected dentin, leaving healthy dentin intact. The gel is applied directly to the carious lesion, allowed to act for a few minutes, and then the softened tissue is scraped away with hand excavators.

Leading Commercial Products
Here are the most widely used products for chemical caries removal:

1. Carisolv®
➤ Composition: Amino acids (lysine, leucine, glutamate), sodium hypochlorite (0.5%), and a gel carrier.
➤ Mechanism of Action: Sodium hypochlorite breaks down denatured collagen, while amino acids buffer the solution for selective tissue removal.
➤ Advantages: Tissue-selective action, reduced need for anesthesia, well-tolerated by patients.
➤ Disadvantages: Unpleasant odor, longer procedure time compared to traditional methods.

2. Papacárie Duo®
➤ Composition: Papain, chloramine, toluidine blue, and thickening agents.
➤ Mechanism of Action: Papain, an enzyme from papaya, breaks down the protein matrix in decayed dentin. Chloramine enhances the antimicrobial effect.
➤ Advantages: Biocompatible, anti-inflammatory, gentle enzymatic action.
➤ Disadvantages: Less effective in dry or deep lesions, moderately priced.

3. Brix3000®
➤ Composition: Highly purified papain (3,000 U/mg) with EBE (Encapsulated Buffered Emulsion) technology.
➤ Mechanism of Action: Targets and hydrolyzes denatured collagen with high specificity and enhanced stability.
➤ Advantages: Fast-acting, high enzymatic activity, easy-to-use syringe.
➤ Disadvantages: Higher cost, supervision recommended in extensive lesions.

4. Carie-Care™
➤ Composition: Papain, chloramine, clove oil (eugenol), and natural extracts.
➤ Mechanism of Action: Similar to Papacárie, with an added calming effect from clove oil.
➤ Advantages: Affordable, mild analgesic and antiseptic properties.
➤ Disadvantages: Variable effectiveness depending on lesion texture.

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Clinical Guidelines for Use

° Ensure relative isolation to prevent contamination.
° Apply only to infected dentin.
° Use hand excavators to remove softened tissue.
° Visually and tactilely assess the remaining dentin to avoid overexcavation.
° Rinse with saline after the procedure.

Clinical Advantages

° Minimally invasive and conservative.
° Reduces or eliminates the need for dental drills and anesthesia.
° Excellent for children, elderly, and anxious patients.
° Preserves healthy tooth structure.
° Compatible with bioactive restorative approaches.

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Potential Disadvantages

° Longer chair time compared to rotary methods.
° Higher cost for certain products.
° May be less effective on hard or sclerotic lesions.
° Requires careful visual and tactile evaluation.

💬 Discussion

Multiple studies support chemical caries removal as a conservative alternative in restorative dentistry. Enzymatic agents such as papain and oxidizers like sodium hypochlorite have demonstrated effectiveness in dissolving infected dentin without compromising healthy tissue. Despite limitations such as longer procedure times and availability, this technique aligns with modern principles of minimally invasive dentistry and is gaining wider acceptance.

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💡 Conclusion

Chemical caries removal is a significant advancement in conservative dentistry, offering a drill-free, painless option for removing decayed tissue. While it does not fully replace mechanical methods, its integration into clinical practice provides a more comfortable and tissue-preserving approach for managing dental caries.

📚 References

✔ Abdelaziz, K. M., & Hassan, M. I. (2018). Efficacy of papain gel (Papacárie®) and Carisolv® in caries removal in primary teeth: A randomized clinical trial. Journal of Clinical Pediatric Dentistry, 42(5), 353–359. https://doi.org/10.17796/1053-4625-42.5.10

✔ Bussadori, S. K., Castro, L. C., & Galvão, A. C. (2005). Papain gel: A new chemo-mechanical caries removal agent. Journal of Clinical Pediatric Dentistry, 30(2), 115–119. https://doi.org/10.17796/jcpd.30.2.u025q822j424u5g6

✔ Koch, G., Poulsen, S., Espelid, I., & Haubek, D. (2017). Pediatric dentistry: A clinical approach (3rd ed.). Wiley Blackwell.

✔ Maragakis, G. M., Hahn, P., & Hellwig, E. (2001). Clinical evaluation of Carisolv® for removing carious dentin and effect on restorative materials and bonding. American Journal of Dentistry, 14(1), 58–60.

✔ Lussi, A., & Hellwig, E. (2019). Alternatives to drilling: Chemomechanical caries removal. In Mount, G. J., & Hume, W. R. (Eds.). Preservation and Restoration of Tooth Structure (3rd ed., pp. 95–104). Wiley-Blackwell.

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Medications for Pulp Capping in Primary Teeth: Indications, Composition, and Clinical Management

martes, 10 de junio de 2025

Medications for Pulp Capping in Primary Teeth: Indications, Composition, and Clinical Management

Pulp Capping

Pulp capping in primary teeth is a conservative procedure aimed at preserving pulp vitality following an accidental or intentional pulp exposure during caries removal.

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Its success largely depends on the material or medication used, which must be biocompatible, promote tissue repair, and provide an adequate marginal seal. With advances in biomaterials, the range of available products has expanded, making it essential to understand their properties, advantages, and limitations for proper clinical application.

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Main Medications Used

1. Calcium Hydroxide (Ca(OH)₂)

➤ Composition: Pure calcium hydroxide or formulated with hardening agents (e.g., Dycal®).
➤ Indications: Small pulp exposures without prolonged bleeding, in vital primary teeth.
➤ Advantages:
° Stimulates reparative dentin formation.
° Antibacterial properties.
° Easy to handle.
➤ Disadvantages:
° Soluble in oral fluids.
° Poor sealing ability.
° Fragile under mechanical stress.
➤ Handling: Apply a thin layer over the exposure, followed by a protective material such as resin-modified glass ionomer (RMGI).

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2. Mineral Trioxide Aggregate (MTA)

➤ Composition: Calcium, silicate, and aluminum oxides. Commercial examples: ProRoot® MTA, MTA Angelus®.
➤ Indications: Direct pulp capping in vital pulps, small pulp perforations.
➤ Advantages:
° High biocompatibility.
° Excellent sealing ability.
° Stimulates dentin bridge formation.
➤ Disadvantages:
° High cost.
° Long setting time (~2–4 hours).
° Difficult to manipulate.
➤ Handling: Mix with sterile distilled water and apply over the pulp; allow complete setting before final restoration.

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3. Biodentine®

➤ Composition: Calcium oxide, tricalcium silicate, zirconium oxide (radiopacifier).
➤ Indications: Modern alternative to MTA for direct pulp capping.
➤ Advantages:
° Faster setting time (~12 minutes).
° Biocompatible.
° Better mechanical properties than MTA.
➤ Disadvantages:
° High cost.
° May require training for proper handling.
➤ Handling: Applied directly to the exposure with a spatula, no intermediate layer needed.

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4. Zinc Oxide Eugenol (ZOE)

➤ Composition: Zinc oxide mixed with eugenol.
➤ Indications: Indirect pulp capping only (not for direct use) due to cytotoxicity risks.
➤ Advantages:
° Sedative effect on pulp tissue.
° Easy handling.
Disadvantages:
° Cytotoxic if in direct contact with the pulp.
° Inhibits polymerization of resin composites.
➤ Handling: Used as a base in deep cavities with no pulp exposure.

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5. Resin-Modified Glass Ionomer (RMGI)

➤ Composition: Polyalkenoic acid, fluoroaluminosilicate glass, hydrophilic resin (HEMA).
➤ Indications: Intermediate layer over medications like Ca(OH)₂ or MTA.
➤ Advantages:
° Excellent adhesion to dentin.
° Fluoride release.
° Good mechanical resistance.
➤ Disadvantages:
° Should not be used alone in direct contact with pulp.
➤ Handling: Apply with microbrush or spatula, light-cure, and proceed with final restoration.

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💡 Conclusion
Choosing the appropriate medication for pulp capping in primary teeth should consider factors such as exposure size, pulp vitality, the material's ability to stimulate dentinogenesis, handling properties, and cost. While calcium hydroxide remains widely used, materials like MTA and Biodentine offer significant advantages in sealing ability and biocompatibility. Using an additional protective layer, such as RMGI, improves treatment longevity and reduces microleakage risk. Continuous education in modern biomaterials is essential for achieving predictable and successful outcomes in pediatric dentistry.

📚 References

✔ Aguilar, P., & Linsuwanont, P. (2011). Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. Journal of Endodontics, 37(5), 581–587. https://doi.org/10.1016/j.joen.2010.12.004

✔ Fuks, A. B. (2008). Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives. Journal of Endodontics, 34(7 Suppl), S18–S24. https://doi.org/10.1016/j.joen.2008.02.028

✔ Murray, P. E., García-Godoy, F., & Hargreaves, K. M. (2007). Regenerative endodontics: A review of current status and a call for action. Journal of Endodontics, 33(4), 377–390. https://doi.org/10.1016/j.joen.2006.09.013

✔ Nowicka, A., Lipski, M., Parafiniuk, M., Sporniak-Tutak, K., Lichota, D., Kosierkiewicz, A., … & Buczkowska-Radlińska, J. (2013). Response of human dental pulp capped with biodentine and mineral trioxide aggregate. Journal of Endodontics, 39(6), 743–747. https://doi.org/10.1016/j.joen.2013.01.005

✔ Rodd, H. D., Waterhouse, P. J., Fuks, A. B., Fayle, S. A., & Moffat, M. A. (2006). Pulp therapy for primary molars. International Journal of Paediatric Dentistry, 16(s1), 15–23. https://doi.org/10.1111/j.1365-263X.2006.00774.x

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martes, 25 de febrero de 2025

Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide

Glass Ionomer Cement

Glass ionomer cement (GIC) is a widely used dental material in pediatric dentistry due to its strong adhesion, fluoride release, and biocompatibility.

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This article explores its characteristics, advantages, disadvantages, clinical applications, and a step-by-step guide for proper use.

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Characteristics of Glass Ionomer Cement
Glass ionomer cement consists of a powder and a liquid that, when mixed, form a rigid, adhesive matrix. The powder contains fluoroaluminosilicate glass, while the liquid consists of polyalkenoic acids in an aqueous solution. This composition enables chemical bonding to the tooth structure and sustained fluoride release, aiding in enamel remineralization and cavity prevention.

Benefits of Glass Ionomer Cement in Pediatric Dentistry
1. Fluoride Release: Provides long-term fluoride release, strengthening enamel and reducing the risk of cavities.
2. Chemical Adhesion: Bonds directly to enamel and dentin without the need for acid etching, simplifying clinical procedures.
3. Biocompatibility: Well-tolerated by dental and soft tissues, minimizing adverse reactions.
4. Thermal Expansion Similar to Natural Teeth: Reduces the risk of marginal leakage and ensures long-lasting adaptation.

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Disadvantages of Glass Ionomer Cement
1. Lower Mechanical Strength: Less resistant to wear and occlusal forces compared to composite resins.
2. Aesthetic Limitations: While improved, its translucency and color range may not fully match natural tooth appearance.
3. Moisture Sensitivity During Placement: Requires proper moisture control to prevent property alterations.

Uses of Glass Ionomer Cement in Pediatric Dentistry
° Restorations for Primary Teeth: Ideal for Class I, II, and V cavities in deciduous teeth due to its adhesion and fluoride release.
° Pit and Fissure Sealants: Used as a sealant in newly erupted permanent molars to prevent cavities.
° Liners and Bases: Serves as a protective base under restorations, providing thermal and chemical insulation.
° Cementation of Pediatric Crowns: Used for cementing stainless steel crowns on primary teeth.

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Step-by-Step Application of Glass Ionomer Cement
1. Cavity Preparation: Remove decayed tissue and clean the cavity without overextending margins.
2. Conditioning: Apply 10% polyacrylic acid for 10-15 seconds to enhance adhesion, then rinse and gently dry without dehydrating.
3. Mixing the Material: Follow the manufacturer’s recommended powder-to-liquid ratio, mixing until a homogeneous consistency is achieved.
4. Placement: Apply the glass ionomer cement into the prepared cavity, ensuring proper adaptation and avoiding air bubbles.
5. Initial Setting: Allow the material to set according to manufacturer instructions while protecting it from moisture and desiccation.
6. Finishing and Polishing: Once set, refine the restoration, adjust occlusion, and polish for improved aesthetics and longevity.

Conclusion
Glass ionomer cement is a valuable material in pediatric dentistry due to its adhesive properties, fluoride release, and biocompatibility. While it has some limitations in mechanical strength and aesthetics, its benefits for cavity prevention and ease of use make it a preferred choice for various pediatric dental applications.

References
1. Croll, T. P., & Nicholson, J. W. (2002). Glass ionomer cements in pediatric dentistry: Review of the literature. Pediatric Dentistry, 24(5), 423-429. Recuperado de
2. Berg, J. H. (2002). Glass ionomer cements. Pediatric Dentistry, 24(5), 430-438. Recuperado de
3. Sikka, N., & Brizuela, M. (2024). Glass Ionomer Cement. En StatPearls. StatPearls Publishing

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lunes, 3 de abril de 2023

Use of Silver Diamine Fluoride (SDF) - General Guide on its application

Silver Diamine Fluoride

Silver diamine fluoride (SDF) is a topical medicine that is used to stop the advance of caries and in cases of dentin hypersensitivity. It can be used in both primary and permanent dentition.

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It offers several advantages such as its easy application, low cost, it avoids the use of dental anesthetics, and it can be applied in places that do not have dental equipment.

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We share a complete guide on the benefits, advantages, and procedure for the application of Silver Diamino fluoride (SDF) in the treatment of cavities and dental sensitivity.

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lunes, 29 de noviembre de 2021

Atraumatic Restorative Treatment - Indications, Advantages and Disadvantages

Atraumatic Restorative Treatment

The atraumatic restorative treatment is a dental procedure that consists of removing the carious tissue but using manual instruments, and sealing the cavity with an adhesive material.

This technique is very useful when it is necessary to attend to oral health needs in hard-to-reach areas. The pediatric patient also generates less anxiety and stress.

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We share a video where he talks about the advantages, indications and contraindications of atraumatic restorative treatment. We thank the YouTube channel, Dr. Teeth.

Atraumatic Restorative Treatment


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martes, 14 de septiembre de 2021

Severe early childhood caries: an integral approach

Dental Caries

It is considered early childhood caries, when the carious process affects one or more primary teeth in children under 06 years of age. This infection is of multifactorial etiology, transmissible and of rapid development.

Treatment will depend on the extent of the injuries and requires interdisciplinary management to achieve successful rehabilitation. In these cases the cooperation of the parents is necessary.

Enlaces Patrocinados

We share a comprehensive article that covers severe early childhood caries and the comprehensive approach recommended for these cases.

dentinogenesis imperfecta


👉 Read and download the full article in PDF👈


Losso EM, Tavares MC, Silva JY, Urban Cde A. Severe early childhood caries: an integral approach. J Pediatr (Rio J). 2009;85(4):295-300:

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lunes, 28 de diciembre de 2020

How well do fluoride treatments work at preventing tooth decay?

Prevention

There is no doubt that prevention is the best way to avoid a number of diseases such as tooth decay. The recommendations for oral care are to brush your teeth daily, have a balanced diet and visit the dentist.

We invite you to our English-only dental publishing groups

🎯 WhatsApp Group All Odontology
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In the dental office, procedures are performed that prevent the presence of cavities, such as the use of fluoride.

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We share a video from the Osmosis channel that explains in detail the benefits of fluoride in preventing tooth decay.

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