Deep carious lesions can often be managed with minimum-intervention approaches, even when they are associated with pain. This depends on the correct diagnosis (reversible pulpitis, irreversible pulpitis, pulp necrosis with or without periradicular periodontitis) being established, allowing choice of the correct treatment.

When the pulp is reversibly inflamed (reversible pulpitis), it is possible to resolve pain by simply managing the carious lesion. By removing the carious lesion, inactivating it or slowing its progress, the reactionary dentin being laid down by the dental pulp can provide enough of a barrier for the pulp to stop the stimulus that is causing it to be inflamed. However, removing the lesion completely can compromise the dental pulp (through irritation or exposure). This means that for deep carious lesions which are pain-free or where there is reversible pulpitis, optimal management for the dental pulp (to maintain its health) is through inactivation or selective removal (reducing its potency). This maintains as much of the tooth's integrity as possible. However, if the pulp has reached a stage where it is irreversibly inflamed, the only possibilities are to remove it and carry out a root canal treatment or to extract the tooth.

The options for managing the deep carious lesion are: nonselective removal; stepwise removal; selective removal; no removal and sealing; and no removal and a nonrestorative cavity-control approach (only appropriate for a deciduous tooth). A short summary of these methods is given in this chapter, together with indications for choosing the correct treatment options.