Restorative & Materials · patient case question
Which material is MOST appropriate for restoring this patient's Class V lesions?
Patient case: Dependent older adult with a full-time caregiver
Patient: Male, 88 years old
Chief Complaint: Brought in by his caregiver for a check-up. He does not report any pain.
Background: Lives at home with an all-day caregiver. Takes eleven regular medications including an antihypertensive, an anxiolytic and a statin. He cannot brush effectively on his own.
Current Findings: Generalised cervical (Class V) carious lesions on the buccal surfaces of most remaining teeth. Marked xerostomia. Heavy plaque. He tires quickly in the chair.
Vital Signs: BP 142/84 mmHg · HR 76 bpm
Show answer and explanation
Correct answer: B. Glass ionomer cement
- A. Amalgam has no fluoride release, requires retentive preparation that sacrifices sound cervical tooth structure, and offers nothing that glass ionomer does not offer better in this specific situation.
- B. CORRECT. Glass ionomer bonds chemically to dentine without a demanding bonding protocol, tolerates moisture, and releases fluoride continuously into a high-caries-risk, xerostomic mouth. It can be placed with atraumatic restorative technique in a patient who tires quickly and cannot be isolated well. This is the material of choice for cervical lesions in a dependent older adult.
- C. A saliva substitute treats the xerostomia that is driving the caries, and it belongs in the overall plan — but it is a preventive adjunct, not a restoration. The cavitated lesions still need restoring.
- D. Composite gives a better long-term margin and better aesthetics, but it demands excellent moisture control and a meticulous bonding sequence. In a patient with heavy plaque, xerostomia and limited chair tolerance, those conditions cannot be met reliably at the cervical margin.
Note: Build the whole plan around the caries risk, not just the fillings: caregiver-delivered brushing with 5000 ppm fluoride paste, in-office fluoride varnish at short recall, silver diamine fluoride for lesions that are hard to access, saliva substitutes, and a medication review with the physician for xerostomic agents.
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