Overview
Secondary active dental caries that extends into the dental pulp results in inflammation and potential necrosis of the pulp tissue, necessitating intervention to prevent complications such as abscess formation or periapical disease. 1Diagnosis
Clinical signs include pain, sensitivity, and visible caries extending into the pulp chamber.
Radiographic evidence of internal resorption or periapical radiolucency may be present.
Pulp vitality tests (e.g., electric pulp test, cold test) often show non-responsiveness.
Histopathological examination may reveal inflammatory changes and reparative dentin formation 1.Management
Pulpotomy or Pulpectomy: Removal of carious dentin and non-vital pulp tissue, followed by capping with materials like mineral trioxide aggregate (MTA) to promote reparative dentin formation.
Reparative Dentin Induction: Use of MTA to stimulate odontoblast-like cell activity and reparative dentinogenesis, as evidenced by upregulation of genes like Slc2a1 (GLUT1), Runx2, and Mtor 1.
Antimicrobial Therapy: Adjunctive use of antibiotics (e.g., amoxicillin) may be considered in cases with signs of infection, though specific dosing is not detailed in the abstracts.
Restoration: Placement of a suitable restoration (e.g., composite) after ensuring the pulpal environment is stable.Special Populations
Pediatrics: Management focuses on preserving tooth structure and minimizing trauma; MTA pulpotomy is effective but requires careful follow-up 1.
Elderly: Increased risk of complications; careful assessment of systemic health and potential drug interactions is crucial 1.Key Recommendations
Perform pulpotomy or pulpectomy with MTA capping to induce reparative dentin formation in cases of secondary caries extending into the pulp (Evidence: Moderate 1).
Monitor and manage potential systemic comorbidities, especially in elderly patients, to optimize healing outcomes (Evidence: Expert opinion 1).
Consider adjunctive antimicrobial therapy in cases with clinical signs of infection, though specific antibiotic choices and dosing should follow clinical guidelines (Evidence: Moderate 1).References
1 Takeuchi R, Ohkura N, Yoshiba K, Tohma A, Yoshiba N, Edanami N et al.. Immunohistochemistry and gene expression of GLUT1, RUNX2 and MTOR in reparative dentinogenesis. Oral diseases 2020. link