10. Clinical Consent and ART Flashcards
Rampant caries often begin in elderly when
- once meds begin
- When they become
- Frail
- Dependent
- Cognitively impaired
T/F Rampant caries happens to most elderly even when they have been caries free for most of adulthood
t
T/F Most rampant caries occur after the individual has been placed in long term care facilities
F- often happens before then
Material choice for a restoration should be made when
- Caries have been removed
- Field of isolation is evaluated
T/F Survival rate of composite is better than amalgam
f
What are the advantages of Fuji IX
- Packable- dough like consistency that is easy to handle
- Non-sticky
- High compressive and flextural strength
- Excellent wear (better than conventional GI not as good as resin)
- Simple and easy technique
How long is the working time for Fuji IX
2 minutes
What material can be used when field of isolation is less than optimal
Amalgam (or GI)
Traditional stepwise is a technique that can be used when the pulp is (vital/non-vital)
vital (remove decay and leave deepest decay, temp filling then re-visit)
Define ART
Dental caries treatment involving removal of soft, demineralized tooth tissue with hand instruments alone followed by restoration with an adhesive restorative material (typically GI)
Advantages of ART
- Use of available and inexpensive hand instruments
- Biologically “tooth friendly”
- Limitation of pain, vibration and sound of drill**
- Simple infection control
- Chemical adhesion of GI
- Combination with prevention (ART sealants)
- Ease of repair
- Low cost
Disadvantages of ART
- Not well documented long term survival rates
- Not always accepted by oral health professionals
- Limited to small and medium cavities
- Hand fatigue
- Misconceptions by the public and profession
Longevity of amalgam restorations is roughly - yrs
6-10 yr (insurance number- really longer than this)
T/F No longer believe that caries must always be completely removed when lesion is deep
t- but it needs to be completely sealed and in order for it to be completely sealed you must make sure the enamel and DEJ and caries free
T/F there is no significant difference in the survival of amalgam compared to ART restorations
t (in primary teeth in permanent teeth ART was better than amalgam but only for class I fillings not class II)
T?F The survival rates of single surface ART restorations are not acceptable to meet the ADA specifications for quality restorations
f
For the studies that were done on the survival rates of ART restorations what were the caveats of these studies
- Conducted in low caries rate populations
- Nursing home and elderly persons may not qualify
The AAPD recognizes ART as an acceptable treatment for caries when….
traditional dental restorations aren’t possible
Limitations to restorative tx in NH
0Cooperation
- Isolation
- Hyper-reaction to discomfort
- Reduced toleration to fixed position
- Narrow window of motivation
- Multiple meds/safety with LA
Why can’t you use amalgam with ARt
hand instruments will not give proper bulky and retention
Silver Diamine fluoride is used to
arrest caries (off label use) and dentin hypersensitivity (FDA approved)
Downside of SDF
stains lesions black
Usefulness of SDF
- Care resistant geriatric population
- Inaccessible lesions (interproximal root caries)
T/F Application of SDF 2x/year is more effective at arresting caries than once per year
t
Clinical signs that SDF was successful at arresting the caries
darkening of the lesion
T/F SDF applied to a lesions will only prevent caries at the adjacent surfaces
F- other tooth surfaces as well (this statement however is true for GIC)
Does SDF reduce the bond strength of GI
no
SDF will lower the bond strnegths for
Panavia fluorocement and Super-bond C&B
Mechanism of caries arrest for SDF
- Increased mineral density and hardness
- Inhibition of proteins that break down exposed dentin organic matrix (MMP, cathespins, bacterial collagenases)
- Inhibition of biofilm layer
- Silver ions directly act against bacteria
How does Silver inhibit bacterial growth
- Break membranes
- Denature proteins
- Inhibit DNA replication
- Kills cariogenic bacteria in dentinal tubules
Indications for SDF
- Extreme caries risk
- Behavioral challenges or medical complexities
- Patients whose care will likely take too many visits
- Patients without access to dental care
- Prevention of secondary caries in high risk pateints
Who grants consent for a minor
legal guardian (unless emergency)
What is needed for informed consent
dentist must disclose all relevant information to enable the patient to make an informed decision regarding proposed treatment
Disclousure should include
- Dx
- Nature of proposed tx
- Anticipated outcome/ benefits
- Material risks with treatment
- Alternative treatment or procedure including no treatment
- Risks of no treatment
- No guarantee
- Opportunity for patient to ask questions
T/F Practitioner has the primary responsibility and can’t delegate
t (meaning the practitioner is responsible for informing the patient so they can give informed consent- can’t delegate that job to others in the office)
T/F a patient signature on a consent form constitutes informed consent
f