Caries Flashcards
Define: Caries
Disease of mineralised tissues due to the action of microorganisms on fermentable carbohydrates
Define: Early Childhood Caries
What is the DMFS?
Presence of one or more cavitated or non-cavitated carious lesions before the age of 6
- DMFS >1 before age 6
Define: Severe Early Childhood Caries
What is the DMFS?
Presence of smooth surface caries in children less than three
- DMFS (age+1)
What does DMFS stand for?
Decayed, missing, filled surfaces
Methods of caries detection in children
- Clinical examination
- Radiographs
- Ortho separators
- Laser fluoresence
- Electric caries detector
- Transillumination
Checklist before taking radiographs in children?
- Check previous radiographs first
- Clinically justify exposure
- Determine most appropriate radiograph for diagnosis
Radiograph recall in paediatrics?
- Initial appt
- High risk
- Low risk (primary and permanent dentition)
- 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
Indications for radiographs in children?
- Caries
- Ix for unerupted teeth
- Retained primary tooth
- Poor prognosis 6s as part of ortho assessment
Rationale of electrical caries detector
Loss of mineral = increased porosity of tooth structure
Increased porosity = decreased electrical resistance
Rationale of laser fluorescence for caries detection
Caries exhibits fluorescence proportional to the degree of caries
Relationship between ICDAS and caries management in high risk
HIGH RISK - ICDAS 0-4 = seal, ICDAS 5,6 = RESTORE
Consequences of ECC (9)
- 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
Benefits of restoring primary teeth
- Stop progression of caries and spread of infection to pulp
- Restore function and integrity of teeth
- Reduced risk of consequences (pain, sepsis, space loss)
Risks associated with restorative treatment
- Weakened tooth structure = more susceptible to fracture
- Recurrent lesions
- Restorative failure
- Iatrogenic pulp exposure
- Damage to adjacent teeth
What is Ludwig’s Angina?
Rapidly progressive cellulitis of FOM which has a high mortality rate (8-10%)
Evidence for risk of sepsis from caries
- 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
Consequences of premature tooth loss
Deviation of midline Canines moving distally Molars moving mesially Crowding Impaction Ectopic eruption Crossbite formation
What is a space maintainer
Removable or fixed appliance intended to keep the space open for the permanent tooth to erupt into place
UK clinical guidelines for paediatric dentistry - When to use space maintainers -
- Loss of Es in all arches (Except spaced arches)
- Following loss of D or E where crowding is >3.5mm per quadrant
Disadvantages of space maintainers
- 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
How can reduced dental QOL be observed in children?
Verbal complaints of pain
Pain manifesting in eating, sleeping and behavioural problems
3 features indicating failure to thrive
- Weight of height below 3rd percentile for age
- Failure to maintain previously established growth pattern
- Growth failure of unknown origin
Link between caries and failure to thrive
- Children with ECC weighed approx 1kg less than controls and <80% their ideal weight for age
Evidence that caries tx improves growth in children
Post tx, children with ECC had a significant increase in growth velocity until they caught up with controls (catch up growth)
Define: catch up growth
Phenomenon seen in children after a period of growth retardation after the growth deficit is removed
Link between nutrition and ECC
ECC was a risk marker for under nutrition and iron deficiency
What is the importance of chronic iron deficiency in children?
Associated with impaired brain development and function
Evidence for increased risk of caries and ECC
- Skeie et al - clinical predictor at 5yo for being high risk at 10 was presence of primary Es with >2 carious surfaces
How does caries in the E influence caires in the 6 ?
- Mejare et al - if distal caries present in the E, the 6 is 15x more likely to be carious
How can direct conditioning cause dental anxiety?
Association between pain/stress with the dental setting
How can latent inhibition prevent dental anxiety?
Positive or neutral visits to the dentist serve as a defence against the development of dental phobias in children
Management strategies of caries in the primary dentition (5)
Complete caries removal and restore
- Partial caries removal and restore
- No removal, seal
- No removal, prevention only
- Extract
How can carious primary teeth be sealed? (2)
- Fissure sealant
- Hall crown
Benefits of retaining caries
Avoids need for LA and preparation
No risk of iatrogenic pulp exposure or damage to adjacent teeth
Indications for extraction of primary molar
Unrestorable tooth
Signs of sepsis
Pulp therapy unsuccessful
What is a self-cleansing preparation
Modification of a lesion resulting in a cavity form allowing easy cleaning
Materials used in primary teeth
RMGIC
Composite
Preformed metal crowns
Use of amalgam in children
Minimata treaty - amalgam no longer used in the treatment of deciduous teeth or children under 15 unless deemed necessary
Indications for RMGIC as a restorative material
Class I or II cavities in high risk children
Temporary sealant
Adv of RMGIC
Biocompatible F release Reasonable wear resistance Increased working time and rapid set Less sensitive than composite Better aesthetics than GIC
Disadvantages of RMGIC
Sensitising potential due to resin
Inferior mechanical properties than composite
Inferior aesthetics compared to composite
Indications for composite in primary teeth
Occlusal and proximal lesions where moisture control can be achieved
Fissure sealants
PRR
Advantages of composite
Superior mechanical properties
Excellent longevity and aesthetics
Adhesive (MI)
Disadvantages of composite
Demanding for pt and dentist (moisture control)
Time consuming
Technique sensitive
Indications for PMC
Primary teeth with extensive caries, decalcification or developmental defects
After pulp therapy
Intermediate restoration of fractured tooth
High caries risk
Advantages of PMC
Durable- Low failure rate
Cheap
Low susceptibility to secondary caries
Simple to fit
Disadvantages of PMC
Poor aesthetics
Contraindicated for nickel allergy
Methods for isolation in paeds
Cotton wool
Rubber dam
Dry tips
Dry dam
Methods to manage caries in primary anterior teeth
- Prevention
- Inter-proximal disking
- Strip crowns
- Extraction
What is interproximal stripping / disking
Removal of superficial caries proximally, resulting in a crown with parallel mesial and distal surfaces that taper towards the incisal edges
How much caries is removed in disking?
Superficial caries only
Any deeper caries can be left as the prep is self-cleansing
Indications for inter-proximal disking
Superficial caries proximally
Tooth fully erupted and exfoliation close
Good pt cooperation
Advantages of inter-proximal disking
Simple
Quick
Renders tooth self-cleansing due to open contacts
No effect on space loss
Disadvantages of inter-proximal disking
- Poor aesthetics
- Risk of iatrogenic pulp exposure
- Food impaction
- Sensitivity - fluoride varnish required
Indications for strip crowns
Caries affecting primary anterior teeth >1 surrface
Enamel hypoplasia
Fractured primary incisors
Discoloured incisors following trauma
What is a strip crown?
Acetate crown form is adjusted to fit the tooth and then filled with composite. The crown form is then removed from the final restoration
Advantages of strip crowns
Aesthetic
Disadvantages of strip crowns
Technique sensitive due to composite
Moisture control required
Reduction required - risk of pulp exposure, damage to adjacent teeth, weakened tooth structure
What is the Hall Technique?
Evidence-based restorative technique involving PMC placement on a primary molar tooth without the need for LA, caries removal or tooth preparation.
Rationale behind hall technique
Manipulates the plaque environment by denying the plaque biofilm bacteria from the source of nutrition, thus slowing down or arresting caries progression
List the clinical indications for hall crown technique
Class I and II lesions Restorable tooth Good patient cooperation No pulpal involvement (clinically or radiographically) Developmental defects Fractured molar tooth
Why does the patient have to be cooperative?
Can be dangerous working with a small crown - risk of compromising airway
Contraindications for Hall technique
Irreversible pulpitis Unrestorable tooth Uncooperative Unhappy with aesthetics Risk of endocarditis Nickel allergy Root resorption >50%
Advantages of hall crown
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
Disadvantages of hall crowns
Poor aesthetics
Risk of compromising airway
Compare hall crowns vs conventional restorations
- Studies show less pain, secondary caries, pulpal symptoms, filling loss with hall crowns v conventional restorations in the long-term (Innes)
How should the hall crown fit the tooth?
- 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)
Cement used with hall crowns
GIC
Ways to protect the child’s airway when placing PMC?
- Sit child upright
- Cooperative child
- Use of gauze or tape
When should ortho separators be placed prior to PMC placement
- Tight contact points
- Loss of mesio-distal width of a tooth due to tooth fracture
How long is ortho separator be placed for?
3-5 days before next appt
How should the ortho separator look in correct position
Half of the band is visible above the marginal ridge
