Caries Curriculum Flashcards
What are the four D’s to follow when planning a caries treatment plan?
Determine, Detect, Decide, Do
What should you do during the ‘Determine’ stage of CariesCare 4D?
determine the patients caries risk via medical, dental and social history
What should you do during the ‘Detect’ stage of CariesCare 4D?
detect caries by clinical examination using good lighting and clean, dry teeth. Stage the lesion severity using ICDAS and assess the lesion activity
What should you do during the ‘Decide’ stage of CariesCare 4D?
decide on a personalised treatment plan based on information from determine and detect
What should you do during the ‘Do’ stage of CariesCare 4D?
Do the treatment plan you decided upon whether that is prevention (NOC) or intervention (TPOC)
Why is vital pulp preservation important?
the preservation of pulp vitality underpins the successful practice of endodontics
What are the two routes of pulp treatment modalities?
vital pulp therapy and nonvital pulp therapy
What are the requirements of an ideal pulp capping agent?
maintain pulp vitality, stimulate reparative dentine, be bacteriocidal or bacteriostatic, provide a bacterial seal, adhere well to dentine and restorative materials, resist forces under the restoration, be sterile, radio-opaque
Which three materials are currently recommended as pulp capping agents?
Calcium Hydroxide, Mineral Trioxide Aggregate (MTA), Biodentine
What is vital pulp therapy?
the treatment initiated on an exposed pulp to repair and maintain the pulp vitality
Which vital pulp therapy is used in cases of deep carious lesions?
indirect pulp capping
Which vital pulp therapy is used in cases of pulp exposure?
direct pulp capping or pulpotomy
Why is calcium hydroxide used for vital pulp therapy?
it acts as a protective barrier for pulpal tissues by blocking dentinal tubules and by neutralising the attack of inorganic acids from certain cements and filling materials
What are the four zones of healing when treating with calcium hydroxide?
Zone of obliteration, zone of coagulation necrosis, zone of dentine bridge formation, line of demarcation
What occurs in the zone of obliteration?
the pulp tissue immediately in contact with the calcium hydroxide is usually completely deranged and distorted
What occurs in the zone of coagulation necrosis?
the tissue together with its plasma proteins within the zone of obliteration takes the brunt of the calcium hydroxide chemical thrust
What occurs in the zone of dentin bridge formation?
Mineralisation is initiated by calcium hydroxide and there is no distinct structural configuration
What occurs in the line of demarcation?
this develops between the deepest level and the subadjacent vital pulp tissue
What are some advantages of using MTA over Calcium Hydroxide?
it produces more dentinal bridging with superior structural integrity, less inflammation, antimicrobial properties, highly biocompatible, hydrophilic, when set it is alkaline, presence of blood has little impact on the degree of leakage
Why does MTA work so well as a pulp capping agent?
hydration is needed for it’s setting process
What is biodentine?
a calcium-silicate based material that preserves pulp vitality and promotes its healing process
What is a negative of biodentine?
it takes approx 10 mins to set and there should be no salivary contamination in that time
What are some advantages of biodentine?
does not stain tooth, excellent radiopacity, no need for surface preparation, higher compressive strength than dentine, absence of shrinkage
What is infected dentine?
soft and demineralised dentine with lots of bacteria
What are some features of infected dentine?
collagen is irreversibly damaged, cannot remineralise, soft necrotic tissue is followed by dry leathery dentine which flakes away with an intrument
What is affected dentine?
demineralised dentine not yet invaded by bacteria
What are some features of affected dentine?
collagen cross-linking remains, can act as a template for remineralisation, discoloured and softer than normal dentine but does not flake easily
What is indirect pulp capping?
a procedure in which the deepest layer of the remaining affected carious dentine is covered with a thin layer of bio-compatible material in order to prevent pulpal exposure
What is the desirable results of indirect pulp capping?
disinfection of the residual affected dentine is easier, arrests the carious process, patient comfort is immediate, rampant dental decay is stopped
What symptoms may a patient feel if they need indirect pulp capping?
tolerable, dull pain, mild discomfort when eating, no history of spontaneous excruciating pain
What may be seen in the clinical examination of a patient needed indirect pulp capping?
large carious lesion with positive response to sensitivity tests and normal response to percussion
What may be seen in the radiograph of a patient needing indirect pulp capping?
large carious lesion with possible pulp exposure, lamina dura appears normal
What procedure is used for indirect pulp capping?
stepwise caries excavation
What thickness of dentine should be left during indirect pulp capping?
0.5-2mm of dentine
When should you review the patient after vital pulp therapy?
within 6-12 months, then annually for the next three years
What are the options a clinician has if the pulp becomes exposed?
direct pulp capping, partial pulpotomy, full pulpotomy, pulpectomy
What are four variables that make the outcome of pulpal exposure favourable?
the pulpal exposure is due to trauma rather than caries, bleeding is controlled within 10 mins, exposure site is less than 1mm, treatment is done within 48 hours of exposure
What is the thickness of enamel in primary molars?
1mm
Is the enamel in primary molars uniform in thickness?
yes
Do primary molars have contact points or areas?
broad contact areas
What are some of the characteristics of the pulp of primary molars?
large pulp, large mesio-buccal pulp horn, thin pulpal floor, early radicular pulpal involvement
Is the enamel in permanent molars uniform in thickness?
no
How can the anatomy of primary molars make things difficult for restorative dentistry?
rapid caries progression, short clinical crown makes matrix bands difficult, broad contact points to restore, thin enamel, less tooth structure protecting the pulp, long flared roots
