5. Managing caries in paediatric patient Flashcards
Why should we restore primary teeth?
- prevent pain and infection
- maintain space
- prevent extractions and anxiety
- contra-indicating medical history, eg. if pt has bleeding disorder
How does caries affect a child’s life?
- reduced intake of food and drink
- disturbed sleep
- increased absence from school
- decreased growth
- a 3 year old with nursing caries were on average 1kg lighter than those without caries
When should you not restore a tooth?
- if it is asymptomatic
- if there is infection
- if it is close to exfoliation
- if there is remineralisation potential with fluoride eg
- if there is difficulty in diagnosis
- if cooperation/access/moisture control is poor
- parents wishes
Why can you not just monitor interproximal lesions?
- because of the broad, flat contacts of primary teeth, if the lesions is interproximal then you can also get decay on adjacent tooth
What depends on whether you should remove or restore the tooth?
- child factors- cooperation
- tooth factors- diagnosis, restorability
- stage and extent of disease- holistic management
What can you use to diagnose caries in primary teeth?
- fibre-optic transillumination
- electrical caries meter
- laser fluorescence device
What is ICDAS 0?
- sound tooth surface
What is ICDAS 1?
first visual change in enamel, can only see with drying etc
What is ICDAS 2?
distinct visual change in enamel
What is ICDAS 3?
Enamel breakdown with no dentine visible
What is ICDAS 4?
Underlying dentinal shadow, not cavitated into dentine
What is ICDAS 5?
Distinct cavity with visible dentine
What is ICDAS 6?
extensive distinct cavity with visible dentine
What can you do to a tooth if you are unsure if there is interproximal caries?
- place a separator
- remove it after 5 days allowing visualisation
When should you take radiographs for high caries risk?
every 6 months
When should you take radiographs for low caries risk in primary teeth?
- every 12/18 months
When should you take radiographs for low caries risk in secondary teeth?
- every 24 months
What size films do you use in horizontal bitewings?
- size 0 primary dentition
- size 1 if they have 6’s
- size 2 if older
What do vertical bitewings show?
- peri-radicular area, furcation and permanent successors
When are lateral obliques used?
- used for child who cannot manage intraorals or cannot stand still for an OPG
When do you use USO? What size films do you use?
- useful for trauma cases or to identify if permanent successors are there
- for a small child use size 2 film
- for larger use size 4
What are the radiographic codes when describing caries, eg. E1?
- E1- outer half of enamel
- E2- inner half of enamel
- D1- less than 1/3rd through dentine
- D2- more than 1/3rd, less than 2/3rd through dentine
- D3- more than 2/3rd through dentine
- P- more than 2/3rd through dentine, touching pulp
- +- peri-radicular pathology
What guidelines do you use for dental caries in children?
SDCEP
What guidelines do you use for MID or pulp treatment?
BSPD
What guidelines do you use for prevention toolkit?
DBOH
What guidelines do you use for recall periods?
NICE guidelines
What guidelines do you use for radiographic selection criteria?
RCS or FGDP
What treatment do you do for a symptomatic tooth with clinical or radiographic signs of inflammation or infection, if the pt is cooperative and the tooth is restorable?
- pulp therapy
- PMC
What treatment do you do for a symptomatic tooth with clinical or radiographic signs of inflammation or infection, if the pt is cooperative and the tooth is unrestorable?
- extract
- dress
- pulpectomy
What conventional treatment can you use for an asymptomatic tooth with no clinical or radiographic signs of inflammation or infection?
- caries removal
- place PMC, RMGIC or composite
What biological treatments can you use for an asymptomatic tooth with no clinical or radiographic signs of inflammation or infection?
- avoid LA- partial or no caries removal- enhanced prevention, hall crown, ART, SDF
- seal the tooth
What is ART?
- atraumatic restoration technique
- only use hand instruments and no electrical equipment
When can you seal a tooth instead of restoring?
- if it is occlusal
- if there is dentine involvement you cannot seal, you have to restore
- only can seal for ICDAS 0-3
What is the problem with class 2 restorations?
- in primary teeth, class 2 restorations have poor survival rates
- instead use enhanced prevention like 3 month recalls, fluoride varnish, mouthwash
What is the percentage and concentration of SDF?
- 38%
- 448000 ppm fluoride
What are the capsules in SDF?
- green capsule is potassium iodide
- do not use- it is meant to reduce the staining of SDF but its effect on caries is not proven
What do the silver and fluoride do in SDF?
- silver is bactericidal
- fluoride promotes remineralisation
- SDF also inhibits collagen degradation
What are the indications for using SDF?
- poor cooperation
- cleansable cavitated carious lesions
- no pulp involvement
- asymptomatic
- for stabilisation
- acclimatisation
- SMART
What is the contraindications for using SDF?
- symptomatic
- pulpitis/sinus/swelling
- pulpal involvement seen radiographically
- active ulceration
- allergy
- pregnancy/breastfeeding
What is the simple atraumatic restoration technique?
- avoid LA
- hand excavation of soft dentine
- seal in caries with RMGIC
What is the silver modified atraumatic restoration technique?
- avoid LA
- hand excavation of soft dentine
- place SDF after
- tooth restored with RMGIC
What techniques can you use to place hall crowns?
- conventional
- hall
What materials can you use for restorations in primary teeth?
- composite
- RMGIC
- compomer
- PMC
What is the rules for using amalgam in primary teeth?
- shall not be used in treatment of deciduous teeth, children younger than 15, pregnant or breast feeding women
- except when strictly deemed necessary by the practitioner on the grounds of specific medical needs of the patient
-The use of amalgam in restoring primary teeth is contra-indicated due to the superiority of preformed metal crowns in class II lesions and comparable success rates of composite in occlusal restorations
When should you use amalgam in permanent teeth?
High caries risk patient with multiple carious lesions
Class II restorations that extend beyond the proximal
line angles of permanent molar
Allergy to Bisphenol A and phthalates
Compromised co-operation and limited attention span
Poor moisture control
