Selective Caries Removal (SCR) is a paradigm shift from traditional views on the treatment of caries (i.e. all caries needs to be removed). In most situations I subscribe to the traditional view but there are situations where removing all the caries will necessitate complete RCT which may not be feasible (e.g. the very young and very old). Even in typical situations, anyone who has used caries detection dye has probably struggled with “how stained is stained?” I’ve encountered numerous situations where the dentin feels hard yet the dentin “lights up” with the dye. Many clinicians will err on the side of caution and remove all dentin that becomes stained by the dye; consequently they will generally treat “all” the caries but at the expense of (possibly) sound tooth structure. On the other hand, when we are trying to avoid a direct pulp exposure by leaving carious dentin close to the pulp, we have to resist our natural instinct to remove all soft dentin. I’ve been using silver diamine fluoride for two years and there’s an “art” to it (i.e. understanding when indicated/contraindicated, how much carious dentin is ok to leave,…). For me, the key determinant of SCR as a treatment modality is the severity of the patient’s symptoms. If there are any indications of IP, then I will typically perform MTA pulpotomies or full RCT. Also, as it stains carious dentin dark brown, its usefulness in esthetic areas is limited unless you can effectively block the dark stain.The case: 24 yomThe patient reports only mild symptoms which he describes as “sensitivity” not necessarily pain. He is aware of the risks to SCR and is committed to close follow-ups in the coming weeks/months. He is scheduled for re-evaluation in 6 weeks.