2 deciduous caries pattern and diagnosis Flashcards
why can caries be arrested in early stages?
it is possible for remineralisation to happen
what is caries?
disease of mineralised tissues (enamel, dentine, cementum) caused by action of micro-organisms on fermentable carbohydrates
what does decalcification look like?
white/brown spot lesions
white- chalky
describe active caries?
light brown soft mushy probe will sink
what else will be affected in interproximal caries?
adjacent tooth
what teeth are affected by nursing bottle (early childhood) caries?
upper incisors, 1st molars, lower canines
what causes nursing bottle caries?
bed with bottle not water
milk only safe during the day
may sleep without swallowing
less saliva
appearance of secondary caries
ditched margins, cracked
describe arrested caries
hard shiny glassy tough
what are rampant caries?
10 or more new lesions in a year
commonly lower anteriors
describe primary dentition caries pattern
molars, upper anteriors
rare in lower anteriors, buccal and lingual surfaces
no interproximal caries as no contacts occlusal caries in 1st primary molars
describe mixed dentition caries pattern?
lower 6s > upper 6s
cingulum pits of lateral incisors
incisors uncrontrolled caries
pits/grooves in palatal upper 6s and laterals, buccal lower 6s
describe caries pattern in early permanent dentition
second molars erupting
host factors
-reduced salivary rate
-high mutans count
what makes caries management difficult in children?
parental involvement
patient development
dealing with two dentitions
caries risk assessment
parent/patient management symptoms HOPC PDH -tx experience -oral hygiene habits, family history, dietary habits medical history social history
describe a caries exam
extra oral
intra-oral
-soft tissues
-oral hygiene, swellings, sinuses, ulceration, gingival health
-hard tissues
-teeth present, dental age, occlusion, loose, missing or extra teeth, trauma, dental abnormalities, caries activity
how is caries detected?
visual exam
radiographs
sensibility testing - nerve
vitality testing - blood supply
how to do a caries clinical exam?
visual
- dry teeth, good light, sharp eyes
- ortho separators
- caries detector dyes
- lasers
how does FOTI work?
light doesnt travel through caries only healthy tooth
what are orthodontic separators used for?
to see interproximally
what should you consider when evaluating the dentition?
tooth restorable parent/px compliance stage dental development space management anticipated difficulties overal prognosis
why is stabilisation used?
prevent pain preventive therapy arrest restorable lesions acclimatisation decrease bacterial load in mouth improve OH by making areas easier to clean
what co-operation issues can children have?
emotional maturity, fears, previous bad experience, behavioural problems, ability
why should you consider stage of development when treating?
primary teeth may be close to exfoliation
extractions could be part of ortho plan
space maintenance
why is caries pattern important?
indicated level of caries activity
what is caries prognosis dependant on?
preventive issues and motivation
why consider space maintanence?
effect of premature loss of primary teeth depends on -tooth size/jaw relation -muscle behaviour -age at loss -tooth loss of 1st perm molars crowding
give examples of space maintainers
band and loop
distal shoe
what are the results of early primary extractions?
crowding, tendency for space loss
greater space loss earlier removed
how to balance/compensate extractions in primary teeth
balance primary canines to prevent centre line shift
balance of 1st molars if arch crowded
what are the consequences of loosing upper FPM’s?
loss before complete eruption of 7 = rotation
& mesial movement 7 and distal drift of 5
what are the consequences of loosing lower FPM’s?
loss after optimum age = tilting 7’s
loss before optimum age = 5 drifts distally and rotates
what does relief of symptoms depend on?
nature of the pain
status of pulp
stage of dental development
level of px compliance
pain history questions for a child
where is the pain what does the tooth feel like how long has the tooth been painful does anything make the pain better or worse keet px awake? spontaneous or precipitated eg eating relieved with analgesics/antibiotics
when should you prescribe antibiotics?
systemic illness
pyrexia
facial swelling
what are the emergency tx options?
caries excavation and sedative dressing pulp therapy drainage of pus extraction -LA +/- IHS -GA
what age is IV sedation considered for?
12 and over
how can you ensure pain free LA?
topical
warm LA cartridge
lower 6s (>6yrs) use IDB
intra-papillary infiltration avoids palatal injection
how does a rubber dam increase safety?
prevents:
damage to soft tissues
risk of inhalation
cross-infection
how does a dam benefit operator and px
isolation and moisture control retraction of gingivae and cheeks effective inhalation sedation px confidence operator confidence
sequence of restoration
fissure sealants preventive restorations simple fillings eg. shallow cervical cavities fillings requiring LA but not into pulp -upper arch first pulpotomies/pulpectomies extractions
what are the methods of caries removal?
hand excavation rotary instruments chemo-mechanical removal air abrasion lasers
what are the anatomical features of primary crowns?
shorter narrower occlusal tables thin enamel and dentine broad contact areas enamel rods in gingival 1/3 extended occlusally marked cervical constrictions whiter
where is the clinical significance of primary crown anatomical features
limited room for cavity prep
clinical caries only detected if large- bitewings needed
enamel at floor of box not undermined
retention of ss crown
what are the anatomical features of primary pulp and why is it significant?
large- limited room for caivty prep
pulp horns close to surface - pulp exposure easy
what are the anatomical features of primary roots and why are they significant?
narrow mesio-distally, long, slender, flared
pulpectomy more difficult
