[...]... tissues (operative dentistry) and prevent recurrence by preventive, nonoperative treatment • extract the tooth Preventive, non -operative treatment The management of active caries always requires preventive treatment and in cases where cavities preclude plaque control, MOD8E_01(1-32) 11/11/03 11:49 AM Page 19 Preventive, non -operative treatment operative treatment is also needed Notice the use of the... disorganized or even non-existent Regular removal of the biofilm from the surface of any lesion encourages lesion arrest and these defense reactions then predominate This retreat of the pulp from injury has important implications in the operative management of caries (see p 64) Inflammation is the fundamental response of all vascular connective tissues to injury Inflammation of the pulp (pulpitis) may, as in any... to the offending tooth, and the patient may only be able to indicate which quadrant, or even which side, of the mouth is involved (See Chapter 2 for further details on the diagnosis and management of toothache.) The relevance of the diagnostic information to the management of caries There are three approaches to the management of active caries: • attempt to arrest the disease by preventive, nonoperative... susceptible sites • Severity or rapidity of attack • The carious process in enamel • The carious process in dentine • Root caries • Secondary or recurrent caries • Residual caries Diagnosis of dental caries • The diagnostic procedure • Assessment of caries risk • Symptoms of caries • The relevance of the diagnostic information to the management of caries Preventive, non -operative treatment • Patient involvement... the better as this product may suppress counts of some acidogenic micro-organisms Sometimes patients with a dry mouth suck sweets or sip sweet drinks to alleviate the problem This is obviously very unwise in patients who are already at high risk to caries because they are short of saliva Operative treatment The role of operative dentistry in the management of dental caries is to facilitate plaque control... Fig 1.16 (a) A molar tooth with a white spot lesion formed in an area of plaque stagnation at the fissure entrance (b) A hemisection of this tooth showing a larger lesion than would be expected from examination of the outer enamel surface This is purely a function of the direction of the enamel prisms in this region (By courtesy of Dental Update.) Histologically, the carious process may be in dentine... caries 156 Removal of caries 157 Choice of restorative material 157 Lining 158 Applying the matrix and placing the restoration 158 Finishing 159 Erosion–abrasion lesions 159 Choice of restorative material for erosion–abrasion lesions 161 Cavity preparation, lining, and filling 161 Enamel hypoplasia 161 Summary of the choice of restorative materials for smooth surface lesions 161 10 Treatment of approximal... confined to the tooth surface With cavitation of enamel, bacteria have direct access to dentine and the tissue becomes infected Demineralization of dentine precedes bacterial penetration, and this is of importance in operative dentistry since an objective is to remove the infected and necrotic dentine, although uninfected but demineralized dentine may be left Of course, this is easier said than done because... there are often areas of tubular sclerosis and reactionary dentine Bacteria seem to penetrate the tissues at an earlier stage in root caries than in coronal caries, although lesions are often rather superficial Despite the presence of these bacteria, active, soft root carious lesions can be converted into arrested lesions by regular tooth brushing with a fluoride-containing dentifrice The soft surface... tive dentistry must be seen as making good a failure to prevent disease from progressing in the first place Operative dentistry also enables the patient to resume effective plaque control by filling the hole where plaque may stagnate Residual caries When preparing a carious tooth to receive a restoration the dentist removes soft, infected dentine This is part of the carious lesion, but not all of it . five editions of A manual of operative dentistry H. M. Pickard Emeritus Professor in Conservative Dentistry University of London Formerly of the Royal Dental. London Formerly of the Royal Dental Hospital of London School of Dental Surgery Pickard’s Manual of Operative Dentistry Eighth edition 1 MOD8E-PRE(i-xiv)