Caries Flashcards
Define caries
- Reversible in it’s earliest stages
- Disease of the dental hard tissues caused by the action of micro-organisms on fermentable carbohydrates
Most common hospital admission reason in children between 5-9
Caries
How many caries present
- Decalcification (WSL or BSL)
- Pit and fissure caries
- Smooth surface caries (buccal/lingual cervical areas)
- Occult (hidden so only on rx)
- Recurrent/Secondary
- Arrested
Define SECC
- Any sign of smooth surface caries in children below 3
- If between 3-5, 1 or more smooth surface lesions (either cavitated, missing or filled)
- Dmfs is greater than or equal to age plus 1
Most likely teeth to get caries
- Mandibular molars
- Maxillary molars
- Maxillary anteriors
Where is caries rare and why
Mandibular anteriors
- Buccal and lingual surfaces
- Protective action of saliva buffer and tongue
In which primary teeth are you more likely to get occlusal caries
-E’s>D’s
When would you get inter proximal caries
-Not until contacts develop
In which primary teeth are you most likely to get caries (in order of likelihood)
-36/46 > 16/26
Which pits and grooves are you most likely to get caries in mixed dentition
- Palatal of Upper 6s
- Palatal of Upper laterals
- Buccal of Lower 6s
What factors specific to children are involved in caries management
- Parental involvement
- Patient development
- Dealing with 2 dentitions
3 main indicators of a child being at increased risk of developing caries within the next X years
- 3 years
- Previous carious experience (any dmfs)
- Healthcare workers opinion
- Resident in area of deprivation (postcode)
Who can give a healthcare worker opinion
- Health visitor, public health nurse or dental health support worker
- Identified the need for additional preventative care
Other factors that may influence patient risk assessment
- Sibling history with caries
- Oral hygiene
- Diet
- Access to fluoride
- Medical history
- Clinical findings
- Habits
- Social History
- Saliva
- Level of mutans
Name things that would indicate a high risk individual
-Look at slides
Name things that would indicate a low risk individual
-Look at slides
What would caries risk assessment inform
- Treatment plan (provision of preventative techniques)
- Frequency of rx
- Frequency of recall
name ways in which you can detect caries
Clinical Examination
- clean dry tooth
- mag
- light
- ortho separators
- sharp eyes
- FOTI (fibre optic transillumination)
Rx
Sensibility testing
Vitality testing
Laser/electric caries detectors
How do you determine vitality of primary molars
- Using history, clinical assessment and vertical bitewings
- vitality unreliable
should you do a rx on initial examination of a child and what rx
how often if so
- bitewings should be taken at initial examination for all high risk children
- 6 monthly rx should be taken until no new or active lesions are apparent and the individual has entered another risk category
when should you note record and review a lesion on rx
- if small lesion is less than half way through proximal enamel is detected
- preventitve tx should be instigated
what features on rx examination indicate cavitation
- if lesion extending into dentine
- may require intervention
if a low risk child, when should you bitewing
- Child with no or little caries activity does not require bitewings at every recall
- If low caries risk then rx at 12-18 months in primary dentition and 2 years In permanent dentition
When should you investigate unerpted teeth
- If failure of eruption beyond the normal age
- then rx
At what age should you palpate canines
- In late mixed dentition
- If pt is 11+ and canines cannot be palpated then rx is required
Name some alternatives to taking rx when detecting caries
- Orthodontic separators
- Elective tooth separation
- Direct assessment of approximate surfaces
- Silicone impression material can be used to confirm cavitation
- Transullimination
- Electrical caries monitor
How can electric be used to detect caries
- Electrical caries monitor measures bulk resistance
- Loss of mineral leads to increased porosity of tooth structure
- Porosities filled with fluids
- Decreased electrical resistance
What is diagnodent
- Laser fluorescence
- Wavelength of 655nm
- Clean healthy tooth structure exhibits no or little fluorescence
- Altered tooth substances and bacteria fluoresce when exposed to a certain wavelength of light
- Carious tooth structure will exhibit fluorescence proportionate to the degree of caries, resulting in elevated scale readings
What must you consider when thinking about xla or restoration
- Natural tooth structure remaining (restorability of tooth)
- Signs symptoms
- Caries risk
- Med history
- Pt and parent compliance
- Stage of dental development
- Space management
List ICDQS codes and criteria
0- sound tooth structure. no evidence of caries after prolonged drying
1- white opacity not visible until prolonged drying
2- white opacity visible when wet
3- localised enamel breakdown
4- underlying dark shadow from dentine
5- distinct cavity with visible dentine
6- extensive (more than half the surface) with visible dentine
Benefits of restorative therapy
- Stopping progression of caries
- Restoring integrity of tooth structure
- Prevent spread of infection
- Prevent shifting of teeth
Risk of restorative therapy
- Lessens the longevity of teeth by making them more susceptible to fracture
- Recurrent lesions
- Restoration failure
- Pulpal exposure iatrogeni
- iatrogenic damage to adjacent teeth
RMGIC or GIC
- RMGIC more successful than GIC
- Small to moderate sized class II
- RMGIC can be considered for Class I and II restoration of primary molars in a high risk population because of fluoride release
- Conditioning the dentine also improves success rate
- Cavosurface bevelling leads to high marginal failure in RMGIC and is therefore not recommended
Advantages of RMGIC
- Biocompatible
- Adhesive (chemical bonding)
- Coefficient of thermal expansion similar to tooth strcture
- Reasonable wear resistance
- Release of fluoride
- Sets by command light cure
- LEss sensitive to moisture than resin
- Tooth coloured
- Better aesthetics than GIC
Disadvantages of RMGIC
Care needs to be taken to mix material to correct consistency
Components have sensitising potential- avoid contact of skin and mucosa with uncured material
Inferior cohesive strength, wear resistance and aesthetics compared to composite resin
Most common reason for restoration failure esp composites
-Recurrent caries
Stabilisation of paeds patient
- Preventitive therapy
- Prevent pain and further infection
- Arrest/stabilise restorable lesions
- Acclimatization
- Remove unrestorable teeth
How may stage of dental development affect tx
- PRimary teeth
- Assess time for exfoliation
- Space maintenance
Ortho implications when restoring teeth
- Increasing crowding increases tendency for space loss
- Earlier the tooth is xla the greater the amount of space loss
- If centre line shift, balance the cs
4 options in management of caries of anterior primary teeth
1) Prevention
2) Interproximal disking
3) Strip crowns
4) XLA
Aim and indications for topical fluoride
-To prevent new, arrest active and reverse earlier
- Early cervical decalcification, pre-cooperative child
- Evidence of changed eating/bottle habits
What is a toxic dose of fluoride
5mg/kg
Indications for interproximal stripping (disking)
- Exfoliation time close
- Precooperative
- Extensive superficial/minimal inter proximal
+ and - of inter proximal stripping
+
-Simple, quick, open contacts, renders self cleansing
-
- PULP
- food impaction
- space loss
- poor aesthetics
How do you inter proximally disc
- Soft flex paper discs
- Tapered stone or diamonds in slow speed
- Tapered crown- narrow incisally
- Round off proximal surfaces
- Polish and fluoride varnish
Technique for strip crown
- LA and rubber dam
- Tapered prep
- Labial groove
- 2mm incisor reduction
- Cellulose acetate crown form and composite
When else can strip crowns be used
- Enamel hypoplasia
- Dental anomalies (AI/DI)
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