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Paediatrics > Caries > Flashcards

Caries Flashcards

1
Q

Define caries

A
  • Reversible in it’s earliest stages

- Disease of the dental hard tissues caused by the action of micro-organisms on fermentable carbohydrates

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2
Q

Most common hospital admission reason in children between 5-9

A

Caries

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3
Q

How many caries present

A
  • Decalcification (WSL or BSL)
  • Pit and fissure caries
  • Smooth surface caries (buccal/lingual cervical areas)
  • Occult (hidden so only on rx)
  • Recurrent/Secondary
  • Arrested
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4
Q

Define SECC

A
  • 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
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5
Q

Most likely teeth to get caries

A
  • Mandibular molars
  • Maxillary molars
  • Maxillary anteriors
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6
Q

Where is caries rare and why

A

Mandibular anteriors

  • Buccal and lingual surfaces
  • Protective action of saliva buffer and tongue
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7
Q

In which primary teeth are you more likely to get occlusal caries

A

-E’s>D’s

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8
Q

When would you get inter proximal caries

A

-Not until contacts develop

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9
Q

In which primary teeth are you most likely to get caries (in order of likelihood)

A

-36/46 > 16/26

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10
Q

Which pits and grooves are you most likely to get caries in mixed dentition

A
  • Palatal of Upper 6s
  • Palatal of Upper laterals
  • Buccal of Lower 6s
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11
Q

What factors specific to children are involved in caries management

A
  • Parental involvement
  • Patient development
  • Dealing with 2 dentitions
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12
Q

3 main indicators of a child being at increased risk of developing caries within the next X years

A
  • 3 years
  • Previous carious experience (any dmfs)
  • Healthcare workers opinion
  • Resident in area of deprivation (postcode)
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13
Q

Who can give a healthcare worker opinion

A
  • Health visitor, public health nurse or dental health support worker
  • Identified the need for additional preventative care
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14
Q

Other factors that may influence patient risk assessment

A
  • Sibling history with caries
  • Oral hygiene
  • Diet
  • Access to fluoride
  • Medical history
  • Clinical findings
  • Habits
  • Social History
  • Saliva
  • Level of mutans
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15
Q

Name things that would indicate a high risk individual

A

-Look at slides

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16
Q

Name things that would indicate a low risk individual

A

-Look at slides

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17
Q

What would caries risk assessment inform

A
  • Treatment plan (provision of preventative techniques)
  • Frequency of rx
  • Frequency of recall
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18
Q

name ways in which you can detect caries

A

Clinical Examination

  • clean dry tooth
  • mag
  • light
  • ortho separators
  • sharp eyes
  • FOTI (fibre optic transillumination)

Rx

Sensibility testing

Vitality testing

Laser/electric caries detectors

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19
Q

How do you determine vitality of primary molars

A
  • Using history, clinical assessment and vertical bitewings

- vitality unreliable

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20
Q

should you do a rx on initial examination of a child and what rx
how often if so

A
  • 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
21
Q

when should you note record and review a lesion on rx

A
  • if small lesion is less than half way through proximal enamel is detected
  • preventitve tx should be instigated
22
Q

what features on rx examination indicate cavitation

A
  • if lesion extending into dentine

- may require intervention

23
Q

if a low risk child, when should you bitewing

A
  • 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
24
Q

When should you investigate unerpted teeth

A
  • If failure of eruption beyond the normal age

- then rx

25
Q

At what age should you palpate canines

A
  • In late mixed dentition

- If pt is 11+ and canines cannot be palpated then rx is required

26
Q

Name some alternatives to taking rx when detecting caries

A
  • Orthodontic separators
  • Elective tooth separation
  • Direct assessment of approximate surfaces
  • Silicone impression material can be used to confirm cavitation
  • Transullimination
  • Electrical caries monitor
27
Q

How can electric be used to detect caries

A
  • Electrical caries monitor measures bulk resistance
  • Loss of mineral leads to increased porosity of tooth structure
  • Porosities filled with fluids
  • Decreased electrical resistance
28
Q

What is diagnodent

A
  • 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
29
Q

What must you consider when thinking about xla or restoration

A
  • Natural tooth structure remaining (restorability of tooth)
  • Signs symptoms
  • Caries risk
  • Med history
  • Pt and parent compliance
  • Stage of dental development
  • Space management
30
Q

List ICDQS codes and criteria

A

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

31
Q

Benefits of restorative therapy

A
  • Stopping progression of caries
  • Restoring integrity of tooth structure
  • Prevent spread of infection
  • Prevent shifting of teeth
32
Q

Risk of restorative therapy

A
  • Lessens the longevity of teeth by making them more susceptible to fracture
  • Recurrent lesions
  • Restoration failure
  • Pulpal exposure iatrogeni
  • iatrogenic damage to adjacent teeth
33
Q

RMGIC or GIC

A
  • 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
34
Q

Advantages of RMGIC

A
  • 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
35
Q

Disadvantages of RMGIC

A

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

36
Q

Most common reason for restoration failure esp composites

A

-Recurrent caries

37
Q

Stabilisation of paeds patient

A
  • Preventitive therapy
  • Prevent pain and further infection
  • Arrest/stabilise restorable lesions
  • Acclimatization
  • Remove unrestorable teeth
38
Q

How may stage of dental development affect tx

A
  • PRimary teeth
  • Assess time for exfoliation
  • Space maintenance
39
Q

Ortho implications when restoring teeth

A
  • 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
40
Q

4 options in management of caries of anterior primary teeth

A

1) Prevention
2) Interproximal disking
3) Strip crowns
4) XLA

41
Q

Aim and indications for topical fluoride

A

-To prevent new, arrest active and reverse earlier

  • Early cervical decalcification, pre-cooperative child
  • Evidence of changed eating/bottle habits
42
Q

What is a toxic dose of fluoride

A

5mg/kg

43
Q

Indications for interproximal stripping (disking)

A
  • Exfoliation time close
  • Precooperative
  • Extensive superficial/minimal inter proximal
44
Q

+ and - of inter proximal stripping

A

+
-Simple, quick, open contacts, renders self cleansing

-

  • PULP
  • food impaction
  • space loss
  • poor aesthetics
45
Q

How do you inter proximally disc

A
  • Soft flex paper discs
  • Tapered stone or diamonds in slow speed
  • Tapered crown- narrow incisally
  • Round off proximal surfaces
  • Polish and fluoride varnish
46
Q

Technique for strip crown

A
  • LA and rubber dam
  • Tapered prep
  • Labial groove
  • 2mm incisor reduction
  • Cellulose acetate crown form and composite
47
Q

When else can strip crowns be used

A
  • Enamel hypoplasia

- Dental anomalies (AI/DI)

48
Q

read last few slides

A

last few slides

Paediatrics (16 decks)

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