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Paediatric Dentistry > Caries > Flashcards

Caries Flashcards

1
Q

Define: Caries

A

Disease of mineralised tissues due to the action of microorganisms on fermentable carbohydrates

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2
Q

Define: Early Childhood Caries

What is the DMFS?

A

Presence of one or more cavitated or non-cavitated carious lesions before the age of 6

  • DMFS >1 before age 6
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3
Q

Define: Severe Early Childhood Caries

What is the DMFS?

A

Presence of smooth surface caries in children less than three

  • DMFS (age+1)
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4
Q

What does DMFS stand for?

A

Decayed, missing, filled surfaces

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5
Q

Methods of caries detection in children

A
  • Clinical examination
  • Radiographs
  • Ortho separators
  • Laser fluoresence
  • Electric caries detector
  • Transillumination
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6
Q

Checklist before taking radiographs in children?

A
  • Check previous radiographs first
  • Clinically justify exposure
  • Determine most appropriate radiograph for diagnosis
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7
Q

Radiograph recall in paediatrics?

  • Initial appt
  • High risk
  • Low risk (primary and permanent dentition)
A
  • BW at initial appt
  • 6 months for high risk (until risk status changes)
  • 12-18 months for low risk in primary dentition
  • 2 years for permanent dentition
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8
Q

Indications for radiographs in children?

A
  • Caries
  • Ix for unerupted teeth
  • Retained primary tooth
  • Poor prognosis 6s as part of ortho assessment
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9
Q

Rationale of electrical caries detector

A

Loss of mineral = increased porosity of tooth structure

Increased porosity = decreased electrical resistance

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10
Q

Rationale of laser fluorescence for caries detection

A

Caries exhibits fluorescence proportional to the degree of caries

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11
Q

Relationship between ICDAS and caries management in high risk

A

HIGH RISK - ICDAS 0-4 = seal, ICDAS 5,6 = RESTORE

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12
Q

Consequences of ECC (9)

A
  • Pain/discomfort
  • Sepsis (Ludwig’s angina)
  • Space loss
  • Reduced QOL
  • Disruption to growth and development
  • Disruption to intellectual development
  • Higher incidence of hospitalisation
  • Increased risk of caries in permanent dentition
  • Risk of dental anxiety
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13
Q

Benefits of restoring primary teeth

A
  • Stop progression of caries and spread of infection to pulp
  • Restore function and integrity of teeth
  • Reduced risk of consequences (pain, sepsis, space loss)
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14
Q

Risks associated with restorative treatment

A
  • Weakened tooth structure = more susceptible to fracture
  • Recurrent lesions
  • Restorative failure
  • Iatrogenic pulp exposure
  • Damage to adjacent teeth
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15
Q

What is Ludwig’s Angina?

A

Rapidly progressive cellulitis of FOM which has a high mortality rate (8-10%)

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16
Q

Evidence for risk of sepsis from caries

A
  • Pine et al found 5% of children attending hospital for sepsis had dental sepsis, with highest predictor being caries
  • Unkel found 47% of facial cellulitis were odontogenic in origin
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17
Q

Consequences of premature tooth loss

A 
Deviation of midline 
Canines moving distally 
Molars moving mesially 
Crowding 
Impaction 
Ectopic eruption 
Crossbite formation
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18
Q

What is a space maintainer

A

Removable or fixed appliance intended to keep the space open for the permanent tooth to erupt into place

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19
Q

UK clinical guidelines for paediatric dentistry - When to use space maintainers -

A
  • Loss of Es in all arches (Except spaced arches)

- Following loss of D or E where crowding is >3.5mm per quadrant

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20
Q

Disadvantages of space maintainers

A
  • Plaque retention
  • Can dislodge
  • May impinge on soft tissue
  • Issue with compliance if removable
  • May affect eruption of adjacent tooth
  • Regular checks by dentist required
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21
Q

How can reduced dental QOL be observed in children?

A

Verbal complaints of pain

Pain manifesting in eating, sleeping and behavioural problems

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22
Q

3 features indicating failure to thrive

A
  • Weight of height below 3rd percentile for age
  • Failure to maintain previously established growth pattern
  • Growth failure of unknown origin
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23
Q

Link between caries and failure to thrive

A
  • Children with ECC weighed approx 1kg less than controls and <80% their ideal weight for age
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24
Q

Evidence that caries tx improves growth in children

A

Post tx, children with ECC had a significant increase in growth velocity until they caught up with controls (catch up growth)

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25
Q

Define: catch up growth

A

Phenomenon seen in children after a period of growth retardation after the growth deficit is removed

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26
Q

Link between nutrition and ECC

A

ECC was a risk marker for under nutrition and iron deficiency

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27
Q

What is the importance of chronic iron deficiency in children?

A

Associated with impaired brain development and function

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28
Q

Evidence for increased risk of caries and ECC

A
  • Skeie et al - clinical predictor at 5yo for being high risk at 10 was presence of primary Es with >2 carious surfaces
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29
Q

How does caries in the E influence caires in the 6 ?

A
  • Mejare et al - if distal caries present in the E, the 6 is 15x more likely to be carious
30
Q

How can direct conditioning cause dental anxiety?

A

Association between pain/stress with the dental setting

31
Q

How can latent inhibition prevent dental anxiety?

A

Positive or neutral visits to the dentist serve as a defence against the development of dental phobias in children

32
Q

Management strategies of caries in the primary dentition (5)

A

Complete caries removal and restore

  • Partial caries removal and restore
  • No removal, seal
  • No removal, prevention only
  • Extract
33
Q

How can carious primary teeth be sealed? (2)

A
  • Fissure sealant

- Hall crown

34
Q

Benefits of retaining caries

A

Avoids need for LA and preparation

No risk of iatrogenic pulp exposure or damage to adjacent teeth

35
Q

Indications for extraction of primary molar

A

Unrestorable tooth
Signs of sepsis
Pulp therapy unsuccessful

36
Q

What is a self-cleansing preparation

A

Modification of a lesion resulting in a cavity form allowing easy cleaning

37
Q

Materials used in primary teeth

A

RMGIC
Composite
Preformed metal crowns

38
Q

Use of amalgam in children

A

Minimata treaty - amalgam no longer used in the treatment of deciduous teeth or children under 15 unless deemed necessary

39
Q

Indications for RMGIC as a restorative material

A

Class I or II cavities in high risk children

Temporary sealant

40
Q

Adv of RMGIC

A 
Biocompatible 
F release 
Reasonable wear resistance 
Increased working time and rapid set 
Less sensitive than composite 
Better aesthetics than GIC
41
Q

Disadvantages of RMGIC

A

Sensitising potential due to resin
Inferior mechanical properties than composite
Inferior aesthetics compared to composite

42
Q

Indications for composite in primary teeth

A

Occlusal and proximal lesions where moisture control can be achieved
Fissure sealants
PRR

43
Q

Advantages of composite

A

Superior mechanical properties
Excellent longevity and aesthetics
Adhesive (MI)

44
Q

Disadvantages of composite

A

Demanding for pt and dentist (moisture control)
Time consuming
Technique sensitive

45
Q

Indications for PMC

A

Primary teeth with extensive caries, decalcification or developmental defects
After pulp therapy
Intermediate restoration of fractured tooth
High caries risk

46
Q

Advantages of PMC

A

Durable- Low failure rate
Cheap
Low susceptibility to secondary caries
Simple to fit

47
Q

Disadvantages of PMC

A

Poor aesthetics

Contraindicated for nickel allergy

48
Q

Methods for isolation in paeds

A

Cotton wool
Rubber dam
Dry tips
Dry dam

49
Q

Methods to manage caries in primary anterior teeth

A
  • Prevention
  • Inter-proximal disking
  • Strip crowns
  • Extraction
50
Q

What is interproximal stripping / disking

A

Removal of superficial caries proximally, resulting in a crown with parallel mesial and distal surfaces that taper towards the incisal edges

51
Q

How much caries is removed in disking?

A

Superficial caries only

Any deeper caries can be left as the prep is self-cleansing

52
Q

Indications for inter-proximal disking

A

Superficial caries proximally
Tooth fully erupted and exfoliation close
Good pt cooperation

53
Q

Advantages of inter-proximal disking

A

Simple
Quick
Renders tooth self-cleansing due to open contacts
No effect on space loss

54
Q

Disadvantages of inter-proximal disking

A
  • Poor aesthetics
  • Risk of iatrogenic pulp exposure
  • Food impaction
  • Sensitivity - fluoride varnish required
55
Q

Indications for strip crowns

A

Caries affecting primary anterior teeth >1 surrface
Enamel hypoplasia
Fractured primary incisors
Discoloured incisors following trauma

56
Q

What is a strip crown?

A

Acetate crown form is adjusted to fit the tooth and then filled with composite. The crown form is then removed from the final restoration

57
Q

Advantages of strip crowns

A

Aesthetic

58
Q

Disadvantages of strip crowns

A

Technique sensitive due to composite
Moisture control required
Reduction required - risk of pulp exposure, damage to adjacent teeth, weakened tooth structure

59
Q

What is the Hall Technique?

A

Evidence-based restorative technique involving PMC placement on a primary molar tooth without the need for LA, caries removal or tooth preparation.

60
Q

Rationale behind hall technique

A

Manipulates the plaque environment by denying the plaque biofilm bacteria from the source of nutrition, thus slowing down or arresting caries progression

61
Q

List the clinical indications for hall crown technique

A 
Class I and II lesions 
Restorable tooth 
Good patient cooperation 
No pulpal involvement (clinically or radiographically)
Developmental defects 
Fractured molar tooth
62
Q

Why does the patient have to be cooperative?

A

Can be dangerous working with a small crown - risk of compromising airway

63
Q

Contraindications for Hall technique

A 
Irreversible pulpitis 
Unrestorable tooth 
Uncooperative
Unhappy with aesthetics 
Risk of endocarditis
Nickel allergy
Root resorption >50%
64
Q

Advantages of hall crown

A

Excellent success in primary teeth
Cheap and quick to place - cost-effective
Non-invasive - No LA or prep
Can acclimatise patient before need for invasive techniques

65
Q

Disadvantages of hall crowns

A

Poor aesthetics

Risk of compromising airway

66
Q

Compare hall crowns vs conventional restorations

A
  • Studies show less pain, secondary caries, pulpal symptoms, filling loss with hall crowns v conventional restorations in the long-term (Innes)
67
Q

How should the hall crown fit the tooth?

A
  • Smallest possible size that can fit should be used
  • Must cover all cusps and approach contact points
  • Should demonstrate slight spring back (but not over contact points)
68
Q

Cement used with hall crowns

A

GIC

69
Q

Ways to protect the child’s airway when placing PMC?

A
  • Sit child upright
  • Cooperative child
  • Use of gauze or tape
70
Q

When should ortho separators be placed prior to PMC placement

A
  • Tight contact points

- Loss of mesio-distal width of a tooth due to tooth fracture

71
Q

How long is ortho separator be placed for?

A

3-5 days before next appt

72
Q

How should the ortho separator look in correct position

A

Half of the band is visible above the marginal ridge

Paediatric Dentistry (11 decks)

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