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Paediatrics > 5. Managing caries in paediatric patient > Flashcards

5. Managing caries in paediatric patient Flashcards

1
Q

Why should we restore primary teeth?

A
  • prevent pain and infection
  • maintain space
  • prevent extractions and anxiety
  • contra-indicating medical history, eg. if pt has bleeding disorder
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2
Q

How does caries affect a child’s life?

A
  • 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
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3
Q

When should you not restore a tooth?

A
  • 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
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4
Q

Why can you not just monitor interproximal lesions?

A
  • because of the broad, flat contacts of primary teeth, if the lesions is interproximal then you can also get decay on adjacent tooth
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5
Q

What depends on whether you should remove or restore the tooth?

A
  • child factors- cooperation
  • tooth factors- diagnosis, restorability
  • stage and extent of disease- holistic management
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6
Q

What can you use to diagnose caries in primary teeth?

A
  • fibre-optic transillumination
  • electrical caries meter
  • laser fluorescence device
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7
Q

What is ICDAS 0?

A
  • sound tooth surface
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8
Q

What is ICDAS 1?

A

first visual change in enamel, can only see with drying etc

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9
Q

What is ICDAS 2?

A

distinct visual change in enamel

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10
Q

What is ICDAS 3?

A

Enamel breakdown with no dentine visible

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11
Q

What is ICDAS 4?

A

Underlying dentinal shadow, not cavitated into dentine

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12
Q

What is ICDAS 5?

A

Distinct cavity with visible dentine

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13
Q

What is ICDAS 6?

A

extensive distinct cavity with visible dentine

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14
Q

What can you do to a tooth if you are unsure if there is interproximal caries?

A
  • place a separator
  • remove it after 5 days allowing visualisation
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15
Q

When should you take radiographs for high caries risk?

A

every 6 months

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16
Q

When should you take radiographs for low caries risk in primary teeth?

A
  • every 12/18 months
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17
Q

When should you take radiographs for low caries risk in secondary teeth?

A
  • every 24 months
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18
Q

What size films do you use in horizontal bitewings?

A
  • size 0 primary dentition
  • size 1 if they have 6’s
  • size 2 if older
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19
Q

What do vertical bitewings show?

A
  • peri-radicular area, furcation and permanent successors
20
Q

When are lateral obliques used?

A
  • used for child who cannot manage intraorals or cannot stand still for an OPG
21
Q

When do you use USO? What size films do you use?

A
  • 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
22
Q

What are the radiographic codes when describing caries, eg. E1?

A
  • 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
23
Q

What guidelines do you use for dental caries in children?

A

SDCEP

24
Q

What guidelines do you use for MID or pulp treatment?

A

BSPD

25
Q

What guidelines do you use for prevention toolkit?

A

DBOH

26
Q

What guidelines do you use for recall periods?

A

NICE guidelines

27
Q

What guidelines do you use for radiographic selection criteria?

A

RCS or FGDP

28
Q

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?

A
  • pulp therapy
  • PMC
29
Q

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?

A
  • extract
  • dress
  • pulpectomy
30
Q

What conventional treatment can you use for an asymptomatic tooth with no clinical or radiographic signs of inflammation or infection?

A
  • caries removal
  • place PMC, RMGIC or composite
31
Q

What biological treatments can you use for an asymptomatic tooth with no clinical or radiographic signs of inflammation or infection?

A
  • avoid LA- partial or no caries removal- enhanced prevention, hall crown, ART, SDF
  • seal the tooth
32
Q

What is ART?

A
  • atraumatic restoration technique
  • only use hand instruments and no electrical equipment
33
Q

When can you seal a tooth instead of restoring?

A
  • if it is occlusal
  • if there is dentine involvement you cannot seal, you have to restore
  • only can seal for ICDAS 0-3
34
Q

What is the problem with class 2 restorations?

A
  • in primary teeth, class 2 restorations have poor survival rates
  • instead use enhanced prevention like 3 month recalls, fluoride varnish, mouthwash
35
Q

What is the percentage and concentration of SDF?

A
  • 38%
  • 448000 ppm fluoride
36
Q

What are the capsules in SDF?

A
  • 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
37
Q

What do the silver and fluoride do in SDF?

A
  • silver is bactericidal
  • fluoride promotes remineralisation
  • SDF also inhibits collagen degradation
38
Q

What are the indications for using SDF?

A
  • poor cooperation
  • cleansable cavitated carious lesions
  • no pulp involvement
  • asymptomatic
  • for stabilisation
  • acclimatisation
  • SMART
39
Q

What is the contraindications for using SDF?

A
  • symptomatic
  • pulpitis/sinus/swelling
  • pulpal involvement seen radiographically
  • active ulceration
  • allergy
  • pregnancy/breastfeeding
40
Q

What is the simple atraumatic restoration technique?

A
  • avoid LA
  • hand excavation of soft dentine
  • seal in caries with RMGIC
41
Q

What is the silver modified atraumatic restoration technique?

A
  • avoid LA
  • hand excavation of soft dentine
  • place SDF after
  • tooth restored with RMGIC
42
Q

What techniques can you use to place hall crowns?

A
  • conventional
  • hall
43
Q

What materials can you use for restorations in primary teeth?

A
  • composite
  • RMGIC
  • compomer
  • PMC
44
Q

What is the rules for using amalgam in primary teeth?

A
  • 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

45
Q

When should you use amalgam in permanent teeth?

A

􏰁 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

46
Q
A

Paediatrics (8 decks)

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