Partial Caries Removal in Primary Teeth: Association of Clinical Parameters with Microbiological Status

Abstract

The relationship between clinical characteristics of carious dentin and bacterial colonization after partial caries removal is not completely understood. The aim of this study was to compare microbial counts between categories of carious dentin color, consistency and humidity, and to evaluate the correlation between these characteristics and the presence of cariogenic microorganisms in deep cavities (2/3 or more of the dentin thickness) submitted to partial caries removal. Sixteen primary teeth were submitted to the removal of all carious tissue from the lateral walls of the cavity, whereas carious tissue of the pulp wall was removed superficially. Dentin in the pulp wall was classified according to color, consistency and humidity immediately after cavity preparation and 3–6 months after cavity sealing and a tissue sample was collected on the same occasion for microbiological evaluation. Before sealing, Streptococcus mutans (p = 0.033) and Lactobacillus spp. (p = 0.048) counts were higher in cavities with humid dentin compared to cavities with dry dentin. A negative correlation was observed between carious dentin consistency and S. mutans count during this phase (r_s = –0.571; p = 0.020). Arrest of dentinal caries lesions was observed after sealing, which was characterized by a reduction of bacterial counts and changes in dentin color, consistency and humidity, irrespectively of baseline dentin characteristics. The clinical characteristics of carious dentin change after the period of cavity sealing and cannot be applied as absolute indicators to limit the excavation of carious dentin when minimally invasive techniques are used.

Clinical and Ultrastructural Effects of Different Liners/Restorative Materials on Deep Carious Dentin: A Randomized Clinical Trial

“…These results are in accordance with those of Kidd et al [1993] and Lynch and Beighton [1994], who suggested that colour is not a useful criterion for the diagnosis of dentin caries because colour is not related to dentin infection level and pigmented lesions show variable degrees of contamination. Furthermore, in a recent paper, Lula et al [2011] found no correlation between dentin colour and colonization of Streptococcus mutans and Lactobacillus spp. Indeed, an observation of soft but dark carious tissue is common in clinical studies [Bjørndal et al, 1997;Maltz et al, 2002].…”

“…With regard to the colour, lining with CHC and wax, an inert material, resulted in dentin darkening, while lining/ restoration with GIC did not. Microbiologic studies by Orhan et al [2008] and Lula et al [2011] demonstrated that dentin colour is not correlated to the degree of infection before and after dentin sealing. Dentin colour appears not to be an adequate criterion for defining lesion activity while dentin consistency appears to be a more reliable parameter [Kidd et al, 1993;Lynch and Beighton, 1994;Orhan et al, 2008].…”

The effect of polymer burs on microbiological reduction of carious dentin in deciduous teeth: a systematic review

“…Although in all techniques evaluated in the included papers, there was reminiscent number of viable microorganisms in the deeper layers of dentin, we can assume that the subsequent seal--ing performed by the restoration could solve this issue, as previous--ly demonstrated [23]. Therefore, the maintenance of the cavity sealing through a dentinoenamel junction free from caries and ad--hesive restorations would inter--rupt the communication of bacte--ria present in dentin with the sur--face biofilm, with a consequent reduction in nutrients and bacteri--al viability [24].…”

Selective Excavation: A Paradigm Shift in Carious Lesion Management.

“…Partial caries excavation in this study involved complete removal of necrotic dentin from the periphery of the cavity while the soft dentin in centre of lesion was only removed superficially. This is similar to the excavation protocol followed by Lula et al(2011) where in partial caries removal was such that all carious tissue was removed from the lateral walls of the cavity, whereas carious dentin on pulpal wall was removed superficially. Phonghanyudh et al (2012) performed selective excavation in primary molars, with complete removal of soft caries up to the dentino-enamel junction.…”