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KCS: Theme 6 > 27. Non-Invasive Paeds Caries Management > Flashcards

27. Non-Invasive Paeds Caries Management Flashcards

1
Q

Caries levels in children have … from … to …
Why?

A
  • dropped
  • 65% to 13% in 8 year olds
  • better prevention - fissure sealant, fluoride toothpaste etc
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2
Q

What kind of caries has risen in children?

A
  • % of caries in occlusal pits and fissures
  • 83% of cases here in 5-7 yr olds
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3
Q

5 pillars of prevention

A
  • fluoride
  • dietary advice
  • oral hygeine instruction
  • regular recall
  • fissure sealant
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4
Q

Define ‘fissure sealant’

A
  • materials that are applied to obliterate fissures
  • remove sheltered environment in which caries may thrive
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5
Q

Fissure sealant removes …

A

the anatomical plaque retentive areas

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6
Q

Explain Cochrane review of 2017

A
  • 38 studies using 7924 young people (5-16 yrs old)
  • caries reduce by 11 to 51% with sealants compared to none in 48 months
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7
Q

Has thinking changed regarding fissure sealant?

A
  • Chestnutt shows little difference in caries development when using preventative measures of either
  • fissure sealant or regular 3 monthly fluoride varnish
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8
Q

Reccomendations for use of fissure sealant in clinic

A
  • used as a preventative strategy - not isolated
  • use clinical exam and radiograph to see if the tooth is caries free
  • assess the caries risk - patient cooperation, medical history, past caries, family environment
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9
Q

How to select patients for fissure sealant?

A
  • caries active period between 5-15
  • general health (those jeopardised by dental disease or treatment, physical/emotional impairment)
  • previous caries experience/high caries risk
  • low F area, medication, social
  • anatomical factors/deep pits and fissures
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10
Q

Indications for sealants

A
  • recently erupted teeth
  • tooth can be isolated
  • non/minimal staining of pits and fissures
  • staining/non-cavitated pits and fissures (less than 1/3 into dentine)
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11
Q

Which teeth should be sealed?

A
  • if caries is found in ANY teeth, seal all sound first perm molars
  • seal second perm molars as soon as erupt
  • consider sealing premolars
  • hypomineralised/hypoplastic teeth
  • primary teeth
  • incisors/palatal pits
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12
Q

Which surfaces of teeth should be sealed?

A
  • all grooves, fissures and pits
  • occlusal fissures, buccal pits and fissures, palatal pits and fissures, cingulum pits
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13
Q

When to seal the teeth after eruption?

A
  • as soon as possible after eruption of crowns
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14
Q

Why are molars the most essential to seal?

A
  • plaque accumulation and caries susceptibility is greatest here
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15
Q

Different materials can be used for fissure sealant - how to decide?

A

based on moisture control

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16
Q

Different fissure sealant materials

A
  • Bis-GMA unfilled resin (first choice/gold standard)
  • glass ionomer cements (compliance issue/partially erupted teeth)
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17
Q

Types of Bis-GMA resin

A
  • opaque or clear
  • autopolymerizing or photo-initiated (light cured)
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18
Q

Types of glass ionomer cements

A
  • self cure
  • resin modified light cured
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19
Q

Pro and con of opaque resin

A
  • aids evaluation of sealant
  • unable to see changes underneath it
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20
Q

Pro and con of clear resin

A
  • able to see enamel and restorations beneath
  • difficult to see during placement - harder to monitor
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21
Q

Explain placement of fissure sealant

A
  • simple and quick
  • salivary contamination affects bond strength and retention of sealant
  • isolation and moisture control paramount
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22
Q

What is the primary cause of fissure sealant failure?

A

moisture contamination

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23
Q

Technique for resin -light cured fissure sealant

A
  • clean tooth
  • isolation/moisture control
  • etch 15 seconds
  • wash 15 seconds
  • check isolation and moisture control
  • dry
  • apply resin
  • cure 20 secs
  • check for adequacy
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24
Q

How to clean the tooth?

A
  • use a clean dry brush with no toothpaste
  • or use oil free prophy paste
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25
Q

Why do we clean the tooth?

A
  • won’t enhance retention on visibly clean tooth
  • used if significant plaque deposits or food debris is visible
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26
Q

Why do we isolate the tooth?

A
  • protect patient from contact with acid etch
  • can cause burns to soft tissu
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27
Q

Why do we use moisture control?

A
  • prevents saliva from re-mineralising the etched tooth
  • and washing off sealant
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28
Q

Equipment for isolation and moisture control

A
  • cotton wool rolls
  • saliva ejector
  • high volume aspiration
  • dry tips
  • rubber dam
  • metal flanged saliva ejectors
29
Q

When do you replace cotton wool rolls?

A

when they are saturated

30
Q

What are dry tips?

A
  • small or large pieces with a smooth shiny side and rough absorbant side
  • placed over parotid duct opening against cheek for the duration of the procedure
  • absorbs up to 30x its weight not releasing any mositure
  • also called sticker, sponge
31
Q

How to release a dry tip?

A
  • needs wetting to release it for removal
32
Q

What is a saliva ejector?

A
  • placed lingually between teeth and tongue
  • sucks saliva pooling in floor of mouth
  • can be bent to fit mouth
  • patient holds in place so they can focus and be involved
  • also called curly wurly, straw
33
Q

The high volume aspirator in fissure sealant is used when?

A
  • when washing off the etch
34
Q

What acid is in the acid etch? What percentage?

A

37.5% phosphoric acid

35
Q

Pros of gel acid etch

A
  • coloured, easy to see, viscous, stayed where placed
36
Q

Cons of liquid acid etch

A
  • clear
  • hard to see
  • runny
37
Q

What is used to apply fissure sealant?

A

pear shaped burnisher

38
Q

Completed fissure sealant fills what 2 criteria?

A
  • extends into buccal fissures
  • 1/3 up cusp height
39
Q

How to check adequacy?

A
  • has it set?
  • is it adhered to the tooth?
  • is it in all pits and fissures?
  • is there the right amount of material?
  • any blows or bubbles?
40
Q

If fissure sealant is completely debonded, what happened?

A
  • poor moisture control
  • start again
41
Q

If fissure sealant is not fully extended what happened?

A
  • poor moisture control
  • remove fragments and re-start
42
Q

If fissure sealant is not set, what happened?

A
  • position of the curing light was wrong
  • wipe off and restart
43
Q

If fissure sealant has air bubbles at the surface , what happened?

A
  • too much mixing of it or brush used wrong
  • polish area of air bubble with white polishing stone
44
Q

If fissure sealant has air bubbles through to enamel, what happened?

A
  • too much mixing
  • use of brush when applying
  • reseal area of bubble, if moisture lost re-etch
45
Q

If fissure sealant has used too little material, what happened?

A
  • wrong instrument used to apply
  • start again or simply add more
46
Q

Advice to parent/patient after sealant

A
  • fully set
  • can eat straightaway
  • may taste bitter
  • won’t last forever so regular monitoring
  • may need replacing or topping up
47
Q

How to monitor sealant?

A
  • at recall intervals
  • radiographs
  • repair/replenish
48
Q

What happens as sealant wears?

A
  • teeth loose 5-10% of it per year
  • partial loss allows ingress of bacteria to fissure system
  • surface risk caries if not sealed
  • need marginal integrity
49
Q

How do bonding agents help?

A
  • significanly increase retention at 12 motnhs in palatal and buccal fissures particularly
  • time taken = coop of child
  • reccomended with hypomineralised/hypoplastic enamel
50
Q

Where would bond fit in the technique?

A
  • etch
  • wash
  • dry
  • apply bond - scrub for 20 secs and air dry for 5 secs
  • apply sealant
  • cure together
51
Q

When to use glass ionomer fissure sealant?

A
  • partially erupted teeth, no moisture control
  • patients with limited cooperation (hypomineralised enamel or patient factor)
  • non AGP procedure
52
Q

What did Alirazaei find about resin and GIC?

A
  • resin sealant retained better
  • no difference in caries preventative effect
53
Q

Compare resin and glass ionomer sealant

A
  • resin has better retention
  • GIV application is less technique-sensitive
  • resin takes longer to apply
  • resin acts as a barrier only, no residual effect if lost. GIC releases fluoride so some effect when lost
54
Q

Explain the standard GIC material

A
  • pink in colour
  • full triage may be slightly superior to other GICs for fluoride release
  • light cure to set so doesn’t need petroleum jelly protection or GIC varnish
55
Q

How to spot carious fissures

A
  • stained/sticky
  • investigate safely - don’t use sharp probe to cavitate
  • radiographs essential
  • dont watch - intervene
  • if in doubt, seal
56
Q

How does acid etch work?

A
  • prisms/rod structures in enamel are too smooth for an adequate bond
  • surface area increases with the etch to allow microscopic adhesion
57
Q

When to use unfilled resin fissure?

A
  • recently erupted teeth
  • tooth can be isolated/compliant
  • no/minimal staining of pits and fissures (preventative)
  • staining/non-cavitated pits and fissures that extend less than a third of way into dentine on a radiograph
58
Q

Technique for fissure sealant application

A
  • clean tooth
  • isolation/moisture control
  • etch 15 secs
  • wash 15 secs
  • check isolation and moisture again
  • apply bond (air dry and then cure for 20 secs)
  • apply resin
  • cure 20 secs
  • check for adequacy
59
Q

What is used to apply fissure sealant?

A

pear shaped burnisher

60
Q

When to use Fuji Triage Glass Ionomer?

A
  • partially erupted/no moisture control
  • patients with limited cooperation (patient factor or dental factor like hypomineralised patient)
  • non AGP procedure
61
Q

Steps of Fuji Triage Glass Ionomer

A
  • clean tooth
  • isolation/moisture control
  • dry tooth (3 in 1/CW roll)
  • apply Fuji Triage GIC with pear shaped burnisher
  • cure 20-40 secs
  • check for adequacy
62
Q

How to prepare the Fuji Triage Ionomer?

A
  • open package
  • push plunger in using finger/bench
  • mix in amalgamator for 10 secs
  • place capsule in GIC gun
  • extrude into dappens dish
  • apply with pear shaped burnisher
63
Q

What is silver diamine fluoride?

A
  • colourless odourless liquid
  • contains silver and fluoride (44800 ppm) stabilised in ammonia
64
Q

When to use silver diamine fluoride?

A
  • caries arrest for young and precooperative/uncooperative kids
  • acclimatisation
  • stabilise dentition
  • extensive tooth tissue loss making restoration challenging
  • manage sensitivity and prevent breakdown in MIH molars
65
Q

How to apply SDF?

A
  • apply vaseline to the lips, buccal mucosa, gingiva adjacent to where you’re placing the SDF
  • remove food debris or soft caries with cw roll and excavator
  • dry the teeth with cotton woll roll/3 in 1
  • place a cotton wool at gingival margin bucally for isolation and catch SDF running off teeth
  • pierce top of capsule with micro-brush or SDF in dappens dish
  • carefully paint on labial aspects of teeth for up to 3 mins but at least a min
  • blot teeth try with cotton wool
66
Q

ART technique started when? Developed by a … community

A
  • 1970s
  • Austtalian
67
Q

ART is currently used for what patients?

A
  • anxious and uncooperative kids
68
Q

What is the Inger’s technique within ART/atraumatic restorative technique?

A
  • used for disto-occlusal cavities in first primary molars
  • used when no gap between first and second primary molars
  • creates a cleansable cavity where SDF can be placed to arrest cavity
  • follows similar principle of non-carious cavity control from SDCEP

KCS: Theme 6 (4 decks)

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