CONTEMPORARY DENTAL CARIES MANAGEMENT CONCEPTS IN PAEDIATRIC DENTISTRY:
A SURVEY OF AWARENESS AND PRACTICE OF A GROUP OF GULF COOPERATION COUNCIL DENTISTS
when a primary tooth pulpotomy is conducted,
the dilemma of the choice of the appropriate
medicament arises, the best of which has yet to be
agreed upon. 5 These contemporary debates and
concepts were the drive behind conducting this
survey in the GCC region.
4.1. Discussion of managing a carious primary
molar (RCM)
When dealing with a primary tooth the conventional
surgical “fill after drill” philosophy had been
accepted as the norm for decades 12 although
this had been challenged and investigated 4 . The
surgical approach means giving local analgesia
(LA) to the child by injection to anaesthetise the
tooth, drilling the carious tissue out using a high
and slow speed drill, and restoring the primary
tooth with various restorative materials such as
amalgam, GIC, compomers, composite, SSCs, 12
and other newer materials like Zirconia crowns. 13 In
our study a majority (n=114, 76%) would follow the
classical surgical doctrine and restore with various
materials, while a minority (n=36, 24%) would
seal-in the caries. Although longevity studies have
shown that composites 14 and SSCs, 12 last longer
in posterior primary teeth 15 compared to GIC 16
no agreement between dentists exists. Our study
confirmed this disagreement over which material
was considered the most appropriate for a given
clinical situation; in this case an asymptomatic
class II “do” carious 74 with radiographic caries
away from the pulp in a cooperative 6 year old
(see x-ray inset in Figures 1, 2 and 3). It was clear
that the majority of those surveyed favoured the
conventional “drill and fill” modality compared
to the “biological modality”. The single largest
group (Fig. 2) was “remove caries and restore with
Figure 4. Overall pulpotomy medication of choice for tooth 74. FC: Formocresol; FS: Ferric Sulphate; CH: calcium
hydroxide; MTA: Mineral Trioxide Aggregate.
Figure 5. Pulpotomy medication of choice for tooth 74 and specialty (GDP or PD). * FC: Formocresol; FS: Ferric
Sulphate; CH: calcium hydroxide; MTA: Mineral Trioxide Aggregate.
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Stoma Edu J. 2017;4(1): 27-38. http://www.stomaeduj.com