 How do you manage a small carousal lesion in a permanent first molar in an anxious or uncooperative child without sedation? You do it by working smarter. Hi, I'm Dr. Jared Johnson. Today's tip is to use the SMART technique to manage these small carousal lesions in permanent first molars in uncooperative kids. It's pretty simple. Using silver diamine fluoride is a great way to slow down decay progression and by placing a SMART restoration over it, you'll limit the amount of food infection and stabilize the lesion until the child is cooperative. My technique, I'll use silver diamine fluoride, a first application at their first visit, waiting two weeks and applying a second application and immediately after the second application I will go ahead and place a high viscosity glass anodomer like Riva self cure HV. This will then stabilize the lesion and I'll place the child on a three month recall to reevaluate them and work on their behavior. Eventually we'll get to a point where we can restore the tooth in a conventional manner with a very comfortable and happy child.