Combination-Therapy for the Medical Management of Caries

Part 3 of Dr. John Frachella’s Medical Management of Caries lecture. Complete the quiz at the bottom of the page to earn 1.5 continuing education credits.

Join us for an overview of the most current and effective medical protocols for dental disease management. The course will help you understand bioactive methods, materials and strategies for caries arrest and prevention that are medical vs. surgical. Learn why dental antimicrobial, re-mineralizing and desensitizing medicines are not “alternative” or of a lower standard than treatments that treat symptoms of the disease. We will consider medical measures as initial treatments of choice as being in the best interest of patients in diverse socioeconomic populations. You will learn how, when and why to best employ medical measures for dental disease management before using surgery, sedation or general anesthesia.

Define the benefits of combination-therapy over single-agent therapy in managing and controlling dental disease
Define and understand how and why to use SDF combined with GIC in Silver Modified Atraumatic Restorative Treatment (SMART)
Identify how and why topical provodone iodine is an important caries-preventing medicine, when and how to use it, with what frequency and with what other medicines it can be used
Understand how and when patients should use 5000ppm toothpaste with other medicines to help control their own dental disease at home
Define ways in which our patient’s diets can be modified to encourage a better response to the medical management of their dental disease
Recognize new medical products to be used along with other combinations of medicines in the prevention and control of caries and when and
where to use these new medicines to re-mineralize de-mineralized enamel

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Combination-Therapy for the Medical Management of Caries – Dr. John Frachella at Hood River, Part 3

Complete this quiz to earn 1.5 continuing education credits.

To get your CE credits from the Academy of General Dentistry, must pass this quiz and submit your full name, state of licensure, license number, and AGD ID number. You may retake the quiz if necessary.

NameEmailState of LicensureLicense NumberAGD ID Number

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1. A 6 yo patient presents at his 6-month recall exam with a deep caries lesion in his newly erupted #14 multiple lesions just past middle third of dentin within 4mm of the pulp. He has no sensitivity to hot, cold or sweets. He’s a high caries risk patient with no other active caries lesions at this time but his caries is not in yet in control. He has bad home care and bad dietary habits, sips sugary drinks and is hooked on gummy bears. What’s the best caries-control course of action to take today?

Put off the treatment on #14 for 2 months when you have time in your appointment book because you’re running behind today and booked solid for the foreseeable future.

Book him for an appointment ASAP to give an injection of LA so you can excavate all the decay away completely , hope you don’t get a pulp exposure, add CaOH as IPT, acid etch and place a deep, one-surface composite resin restoration and hope he won’t need a RC.

Immediately and without LA, remove any non-remineralizable, soft, mushy decay in the lesion with cotton and dull instruments. Apply PAA conditioner for 10 seconds to remove the smear layer caused by the decay process. Rinse and dry the lesion thoroughly with cotton, apply SDF for at least 1 min then dab damp with cotton leaving all surfaces moist with SDF. Apply GIC slowly from the bottom of the lesion up then remove excess and let the GIC set. Apply FV over the restoration and give patient instruction to eat soft foods only for the next 24-48 hours.

Just apply a temporary filling in #14 using zinc oxide and eugenol and see him later for the surgical management of his caries.

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2. A 6 yo arrives in your office caries-free but with white demineralized areas not yet cavitated on the facial surfaces of her central and lateral incisors and canines. The parents and the patient don’t want anterior staining. Of the following, which 2 are among the best treatment options for arresting caries in these teeth and for re- calcifying them?

Drill and fill mechanical removal of the white spots and then replacement of what is removed with very white GIC or RMGI.

PI + FV 1X/wk for 1 month the 1X/month until the white lesions re-mineralize.

Curodont 1X with nutrition counseling + reinforcement in oral hygiene + Curodont re-application in 12 months if remin after 12 mos is questionable.

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3. A 16 yo female patient arrives for a recall exam where multiple approximal radiolucencies show up between posterior teeth on a diagnostic Panorex. All lesions are initial, not though the DEJ, there are no other active caries lesions, patient has no discomfort, OH is excellent, gums look healthy and there’s little or no plaque accumulation. Patient and parents are alarmed and they don’t want any staining from treatments. What’s the best course of action?

Prophy, scaling, FV application then re-schedule for more periodic FV applications.

Schedule for multiple visits to drill and fill these lesions with Class II composite resin restorations.

Apply SDF aproximally by teasing it between affected teeth with floss or by letting it reach interproximal surfaces via capillary action and apply FV immediately; then prescribe 1000ppm toothpaste to be used nightly instead of regular toothpaste, to be flossed approximally, and spit out, then straight to bed, no eating or rinsing. Evaluate the lesions with periodic X rays at recall visits and if the radiolucencies haven’t grow in 2 years, do nothing more.

Just apply SDF once and dismiss patient with no further appointments

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4. A 3 yo with behavioral issues in the dental chair arrives with decalcified but not cavitated anterior primary teeth in the smile line. The family is on Medicaid, wants A-traumatic treatment, and does not want staining in the smile line. Patient has no history of known diseases but is allergic to shellfish. Which is the best caries control treatment?

Just repeatedly add FV at many appointments.

If Medicaid will pay refer to a PD S for DGA hospital dentistry despite parents wish for a-traumatic care insisting that doctor knows best.

Use a papoose in-office board to drill into the decalcified teeth and then place composite resin.

In office apply PI + FV, suggest dietary changes and better home care, then give parents instructions to apply PI at home 1X/week for a month with 8 drops of PI in a shot glass, saturate one end of a cotton swab, swab across all teeth, keep mouth open for 10 sec, done. Then apply PI+FV 1X/mo in-office until lesions are arrested.

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5. SMART (SDF+GIC/RMGI) for deep caries lesions in primary and permanent teeth should be coded and charged by dentists as:

ITR

Sedative filling

Temporary Filling

Composite Filling per surface

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6. When applying GIC/RMGI over partially excavated, then SDF-saturated caries lesions which 2 of the following happen:

Everything becomes mushy

The underlying SDF hardens the lesions so that the overlying GIC/RMGI stays put

The underlying SDF makes the overlying GIC/RMGI brittle

The GIC/RMGI chemically seals out oxygen, nutrients and bacteria

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7. When combining SDF with GIC or RMGI (Resin Modified Glass ionomer):

The bond strength of GIC/RMGI is weakened

The bond strength of GIC/RMGI is unaffected

The bond strength of GIC/RMGI is strengthened

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8. Partial caries removal+SDF+GIC/RMGI do which 2 of the following?

Induce pulpal necrosis

Induce tertiary dentin formation

Serve as IPT medicines for deep caries lesions

Cause pain and inflammation if deep caries close to the pulp

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9. Taking cost, time and efficacy into account, which is the most efficacious?

SDF alone

SDF + GIC/RMGI combined ( SMART)

GIC/RMGI alone

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10. Which 2 of the following are advantages of applying FV immediately after applying SDF to a caries lesion?

FV adds a bit more F ions to the already high concentration of F ions in SDF

FV masks the metallic taste of SDF

We can charge more for FV+ SDF than for SDF alone

FV protects the super-high concentrations of medicinal F ions in SDF from immediate salivary dilution.

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This activity has been planned and implemented in accordance with the standards of the Academy of General Dentistry Program Approval for Continuing Education (PACE) through the joint program provider approval of One Community Health: Hood River and Dental Care For All International. One Community Health: Hood River is approved for awarding FAGD/MAGD credit.

The lectures for this course were filmed on May 1st, 2023, and were reviewed and re-released on this website in June, 2024. This content will expire on June 1st, 2027.

One Community Health | Hood River
Nationally/ Approved PACE Program Provider for FAGD/MAGD credit.
Approval does not imply acceptance by any regulatory authority, or AGD endorsement.
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