Radiographic assessment categories (RL = radiolucency)

RA → initial stages

RA 1: RL outer ½ of enamel

RA 2: RL inner ½ of enamel +/- EDJ

RA 3: RL limited to outer ⅓ of dentin

RB → moderate

RB 4: RL reaching middle ⅓ of dentin

RC → extensive

RC 5: RL reaching inner ⅓ of dentin, clinically cavitated

RC 6: RL into pulp, clinically cavitated

Visual: Lesion Severity → ICDAS

** to eval a lesion, eval: periphery demin and shadowing

0 = sound surfaces

no evidence of visible caries after air drying

1-2 = initial caries

first distinct changes in enamel = white spot lesion and/or brown various discoloration

no evidence of surface breakdown/underlying shadowing in dentin

3-4 = moderate

White or brown spot lesion w/ localized enamel breakdown

without visible dentin exposure = 3

WITH underlying dentin shadow = 4

5-6 = extensive

A distinct cavity in opaque or discolored enamel without visible dentin

Guiding Principles of Carious Tissue Removal

to retain tooth and pulpal health as long as possible = AIM

Preservation of dental tissues → non demineralized and remineralizable

Avoidance of pulp exposure

Provision of sound cavity margins to achieve an adequate peripheral seal

Controlling the lesion and inactivating remaining bacteria

Reversible vs irreversible pulpitis; pulpal inflamm/pain

Reversible Pulpitis = instances where the inflammation is mild and tooth pulp reminds healthy enough to save

Normal responses to:

thermal tests

EPT

Patients may experience pain/sensitivity

Irreversible pulpitis = may experience pain without action to induce pain, sensitivity, and throbbing

Cause of pulpal inflammation

active caries = mild/severe

Cavity preps = mild/severe

dental materials = mild/transient

Pulpal pain

Intra-pulpal pressure on nerve endings secondary to an inflammation response

w/ absence of inflammation = Hydrodynamic inflammation

Pulpal protection

When does the pulp need protection?

Full crown preps

cervical dentin exposure due to erosion causing pain

Presence of mechanical pulp exposure

after selective Carie’s removal that have led to medium or deep cavity preps

Why must we protect the pulp?

Preserve pulpal vitality

avoid thermal sensitivity (pain) after restos

Avoid removal of sound structure to provide resistance to resto material (amalgam/gold)

How to protect pulp

eliminate progression of carious lesions

collect appropriate information regarding pulpal health before doing restos

Using appropriate cutting instruments, use water during prep, no water during caries removal

selecting/applying appropriate biological and mechanically resistant dental protective materials