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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
Why do we clean the tooth?
- won't enhance retention on visibly clean tooth - used if significant plaque deposits or food debris is visible
26
Why do we isolate the tooth?
- protect patient from contact with acid etch - can cause burns to soft tissu
27
Why do we use moisture control?
- prevents saliva from re-mineralising the etched tooth - and washing off sealant
28
Equipment for isolation and moisture control
- cotton wool rolls - saliva ejector - high volume aspiration - dry tips - rubber dam - metal flanged saliva ejectors
29
When do you replace cotton wool rolls?
when they are saturated
30
What are dry tips?
- 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
How to release a dry tip?
- needs wetting to release it for removal
32
What is a saliva ejector?
- 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
The high volume aspirator in fissure sealant is used when?
- when washing off the etch
34
What acid is in the acid etch? What percentage?
37.5% phosphoric acid
35
Pros of gel acid etch
- coloured, easy to see, viscous, stayed where placed
36
Cons of liquid acid etch
- clear - hard to see - runny
37
What is used to apply fissure sealant?
pear shaped burnisher
38
Completed fissure sealant fills what 2 criteria?
- extends into buccal fissures - 1/3 up cusp height
39
How to check adequacy?
- 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
If fissure sealant is completely debonded, what happened?
- poor moisture control - start again
41
If fissure sealant is not fully extended what happened?
- poor moisture control - remove fragments and re-start
42
If fissure sealant is not set, what happened?
- position of the curing light was wrong - wipe off and restart
43
If fissure sealant has air bubbles at the surface , what happened?
- too much mixing of it or brush used wrong - polish area of air bubble with white polishing stone
44
If fissure sealant has air bubbles through to enamel, what happened?
- too much mixing - use of brush when applying - reseal area of bubble, if moisture lost re-etch
45
If fissure sealant has used too little material, what happened?
- wrong instrument used to apply - start again or simply add more
46
Advice to parent/patient after sealant
- fully set - can eat straightaway - may taste bitter - won't last forever so regular monitoring - may need replacing or topping up
47
How to monitor sealant?
- at recall intervals - radiographs - repair/replenish
48
What happens as sealant wears?
- 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
How do bonding agents help?
- significanly increase retention at 12 motnhs in palatal and buccal fissures particularly - time taken = coop of child - reccomended with hypomineralised/hypoplastic enamel
50
Where would bond fit in the technique?
- etch - wash - dry - apply bond - scrub for 20 secs and air dry for 5 secs - apply sealant - cure together
51
When to use glass ionomer fissure sealant?
- partially erupted teeth, no moisture control - patients with limited cooperation (hypomineralised enamel or patient factor) - non AGP procedure
52
What did Alirazaei find about resin and GIC?
- resin sealant retained better - no difference in caries preventative effect
53
Compare resin and glass ionomer sealant
- 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
Explain the standard GIC material
- 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
How to spot carious fissures
- stained/sticky - investigate safely - don't use sharp probe to cavitate - radiographs essential - dont watch - intervene - if in doubt, seal
56
How does acid etch work?
- prisms/rod structures in enamel are too smooth for an adequate bond - surface area increases with the etch to allow microscopic adhesion
57
When to use unfilled resin fissure?
- 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
Technique for fissure sealant application
- 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
What is used to apply fissure sealant?
pear shaped burnisher
60
When to use Fuji Triage Glass Ionomer?
- partially erupted/no moisture control - patients with limited cooperation (patient factor or dental factor like hypomineralised patient) - non AGP procedure
61
Steps of Fuji Triage Glass Ionomer
- 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
How to prepare the Fuji Triage Ionomer?
- 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
What is silver diamine fluoride?
- colourless odourless liquid - contains silver and fluoride (44800 ppm) stabilised in ammonia
64
When to use silver diamine fluoride?
- 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
How to apply SDF?
- 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
ART technique started when? Developed by a ... community
- 1970s - Austtalian
67
ART is currently used for what patients?
- anxious and uncooperative kids
68
What is the Inger's technique within ART/atraumatic restorative technique?
- 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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