CARIES Flashcards
What are 5 characteristics of primary teeth to consider when treatment planning?
- progresses rapidly
- the teeth are smaller with larger pulp chambers
- the contact areas are broad
- irreversible pathological changes can occur prior to pulpal exposure
- the involvement of radicular pulp is earlier than in permanent dentition
What are 6 signs and symptoms associated with pulpal inflammation in primary teeth?
- any history of spontaneous pain, especially at night
- reported pain on biting
- the necessity for analgesics
- the clinical extent of caries, notably the presence of marginal ridge breakdown
- the presence of any intra-oral swelling or sinus
- a history of intra-oral or facial swelling
What 2 special investigations can be done on a paeds patient?
- gentle finger pressure to determine if mobile/tender
- radiographs: provide info on extent of caries, check for permanent successor, proximity of pulp horn
- no pulp testing as not appropriate
What are 3 indications for tooth retention?
- medical factors: patients at risk if a GA is required
- dental factors: minimal number of extensively carious primary molars likely to require pulp therapy, hypodontia, prevention of mesial migration, crowding
- social factors: regular attender with good compliance
What are 3 indications for tooth removal?
- medical factors: patient at risk from residual infection
- dental factors: tooth unrestorable after pulp therapy, extensive internal root resorption, extensive pathology or acute facial swelling
- social factors: irregular attender with poor compliance and unfavourable parental attitudes
What are 4 treatment options for caries in primary teeth?
- hall crowns cemented with GI provide an effective seal and a fluoride reservoir
- site specific prevention
- none restorable cavity control
- caries removal and restoration
What are 3 treatment options for caries in primary teeth with pulpal involvement?
- indirect pulp capping: arrest the carious process and arrest decay, stimulate remineralisation of remaining carious dentine to promote pulpal healing
- direct pulp capping: to encourage the formation of a dentine bridge at the point of pulpal exposure with preservation of pulpal health
- pulpotomy: a pulpotomy entails the removal of the coronal pulp and maintenance of the radicular pulp
What are the symptoms of reversible pulpitis?
- pain to cold/sweet
- tooth not ttp
- resolves on removal of stimulus
- tooth difficult to localise
- eases with pain relief
What are the symptoms of irreversible pulpitis?
- spontaneous pain wakens child at night
- does not resolve on removal of stimulus
- pain to hot/cold
- does not resolve with placement of a temp dressing
What are the symptoms of a dental abscess/periradicular periodontitis?
- spontaneous pain wakens child at night
- tooth mobile and ttp
- swelling
- malaise
What is the treatment option for a child with reversible pulpitis symptoms?
restore or place a dressing and restore later
What is the treatment for an uncooperative child patient with irreversible pulpitis?
- try to dress with sub lining of corticosteroid abx paste
- refer for treatment/XLA with sedation or GA
What is the treatment for a cooperative child with irreversible pulpitis symptoms?
- XLA or appropriate pulp therapy
What is the treatment for a child with multiple abscessed teeth?
refer for XLA with sedation or GA
What is the management for a child with symptoms of abscess or infection?
- XLA or pulpectomy
