Management of Deep Carious Lesions Through Sealing in Primary Teeth

The changes towards more conservative approaches to managing carious lesions in the permanent dentition have been mirrored for primary teeth. Prevention is key to treatment planning for the child with a carious primary dentition as the presence of the disease means that prevention has failed at some stage. Correct diagnosis of the presence/absence of carious lesions should be followed by investigation of whether each lesion is active/inactive and whether it is deep (advanced) or initial. Next a diagnosis of the status of the dental pulp must be made, to rule out irreversible pulpitis or infection of the dental pulp. The alternatives for managing carious lesions in an asymptomatic tooth (i.e., a tooth without signs or symptoms of irreversible damage to the dental pulp—pain/infection) are: Selective Removal to Soft Dentin and place a restoration; Sealing over the lesion with fissure sealant or resin infiltration; Sealing over the lesion with a crown using the Hall Technique; and No caries removal and no restoration using the Non-Restorative Cavity Control approach. These procedures are covered in detail in this chapter, their indications for different types of lesions and a flow chart to guide care planning is given.