5. Managing caries in paediatric patient

Question 1

Why should we restore primary teeth?

Answer 1

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

Question 2

How does caries affect a child’s life?

Answer 2

• 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

Question 3

When should you not restore a tooth?

Answer 3

• 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

Question 4

Why can you not just monitor interproximal lesions?

Answer 4

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

Question 5

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

Answer 5

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

Question 6

What can you use to diagnose caries in primary teeth?

Answer 6

• fibre-optic transillumination
• electrical caries meter
• laser fluorescence device

Question 7

What is ICDAS 0?

Answer 7

• sound tooth surface

Question 8

What is ICDAS 1?

Answer 8

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

Question 9

What is ICDAS 2?

Answer 9

distinct visual change in enamel

Question 10

What is ICDAS 3?

Answer 10

Enamel breakdown with no dentine visible

Question 11

What is ICDAS 4?

Answer 11

Underlying dentinal shadow, not cavitated into dentine

Question 12

What is ICDAS 5?

Answer 12

Distinct cavity with visible dentine

Question 13

What is ICDAS 6?

Answer 13

extensive distinct cavity with visible dentine

Question 14

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

Answer 14

• place a separator
• remove it after 5 days allowing visualisation

Question 15

When should you take radiographs for high caries risk?

Answer 15

every 6 months

Question 16

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

Answer 16

• every 12/18 months

Question 17

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

Answer 17

• every 24 months

Question 18

What size films do you use in horizontal bitewings?

Answer 18

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

Question 19

What do vertical bitewings show?

Answer 19

• peri-radicular area, furcation and permanent successors

Question 20

When are lateral obliques used?

Answer 20

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

Question 21

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

Answer 21

• 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

Question 22

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

Answer 22

• 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

Question 23

What guidelines do you use for dental caries in children?

Answer 23

SDCEP

Question 24

What guidelines do you use for MID or pulp treatment?

Answer 24

BSPD

Question 25

What guidelines do you use for prevention toolkit?

Answer 25

DBOH

Question 26

What guidelines do you use for recall periods?

Answer 26

NICE guidelines

Question 27

What guidelines do you use for radiographic selection criteria?

Answer 27

RCS or FGDP

Question 28

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?

Answer 28

- pulp therapy - PMC

Question 29

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?

Answer 29

- extract - dress - pulpectomy

Question 30

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

Answer 30

- caries removal - place PMC, RMGIC or composite

Question 31

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

Answer 31

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

Question 32

What is ART?

Answer 32

- atraumatic restoration technique - only use hand instruments and no electrical equipment

Question 33

When can you seal a tooth instead of restoring?

Answer 33

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

Question 34

What is the problem with class 2 restorations?

Answer 34

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

Question 35

What is the percentage and concentration of SDF?

Answer 35

- 38% - 448000 ppm fluoride

Question 36

What are the capsules in SDF?

Answer 36

- 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

Question 37

What do the silver and fluoride do in SDF?

Answer 37

- silver is bactericidal - fluoride promotes remineralisation - SDF also inhibits collagen degradation

Question 38

What are the indications for using SDF?

Answer 38

- poor cooperation - cleansable cavitated carious lesions - no pulp involvement - asymptomatic - for stabilisation - acclimatisation - SMART

Question 39

What is the contraindications for using SDF?

Answer 39

- symptomatic - pulpitis/sinus/swelling - pulpal involvement seen radiographically - active ulceration - allergy - pregnancy/breastfeeding

Question 40

What is the simple atraumatic restoration technique?

Answer 40

- avoid LA - hand excavation of soft dentine - seal in caries with RMGIC

Question 41

What is the silver modified atraumatic restoration technique?

Answer 41

- avoid LA - hand excavation of soft dentine - place SDF after - tooth restored with RMGIC

Question 42

What techniques can you use to place hall crowns?

Answer 42

- conventional - hall

Question 43

What materials can you use for restorations in primary teeth?

Answer 43

- composite - RMGIC - compomer - PMC

Question 44

What is the rules for using amalgam in primary teeth?

Answer 44

- 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

Question 45

When should you use amalgam in permanent teeth?

Answer 45

􏰁 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