The treatment of the deep carious lesion which has not yet involved the pulp has for some time been the subject of intense debate. Some researchers recommend the use of a calcium hydroxide lining to stimulate odontoblasts and increase dentine formation.4,5
Other workers have claimed that this does not occur.
Some workers still recommend that infected carious dentine is removed but a layer of softened sterile dentine may be left over the intact vital pulp.
Most endodontic texts, (for example, see References 9 and 10) recommend that all softened dentine should be removed and the pulp dealt with accordingly.
There is still controversy, however, over the correct treatment of a deep, caries free, cavity, lying close to the pulp. As alluded to in Part 1, the essential treatment is to ensure that there can be no bacterial contamination of the pulp via the exposed dentine tubules.
Other workers have claimed that this does not occur.
Some workers still recommend that infected carious dentine is removed but a layer of softened sterile dentine may be left over the intact vital pulp.
Most endodontic texts, (for example, see References 9 and 10) recommend that all softened dentine should be removed and the pulp dealt with accordingly.
There is still controversy, however, over the correct treatment of a deep, caries free, cavity, lying close to the pulp. As alluded to in Part 1, the essential treatment is to ensure that there can be no bacterial contamination of the pulp via the exposed dentine tubules.
This may be achieved by either a lining of glass-ionomer cement, or the use of an acid-etched dentine bonding system. Some workers have recommended washing the cavity with sodium hypochlorite to further disinfect the dentine surface, and this seems an eminently sensible suggestion. Until further research provides conclusive evidence for or against, however, the use of an indirect pulp cap of calcium hydroxide is recommended in these situations. The calcium hydroxide cement provides a bactericidal effect on any remaining bacteria and may encourage the formation of secondary dentine and of a dentine bridge. It is certainly no longer considered necessary to reopen the cavity at a later date to confirm healing.