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Paeds > Caries diagnosis and treatment planning > Flashcards

Caries diagnosis and treatment planning Flashcards

1
Q

What is dental caries

A
  • Disease of mineralized dental tissues caused by action of
    microorganisms on fermentable carbohydrates
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2
Q

In its early stages…
remineralisation is possible above a critical pH of

A

The disease can be arrested
5.5

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3
Q

Clinical caries diagnosis involves the process of what 3 things

A

1) Caries detection (non cavitation or cavitated)
2) Diagnosing if the lesion is arrested/active/ progressing rapidly
3) Recording findings

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4
Q

Early caries diagnosis allows

A

Successful caries prevention and management

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5
Q

Professor Nigel Pits created what to demonstrate caries diagnosis?

A

The iceberg of dental caries

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6
Q

The iceberg of dental caries is what

A

Demonstrative of the diagnostician thresholds used in epidemiology and practice

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7
Q

Describe the ‘Iceberg of dental caries’

A

In epidemiological surveys the iceberg floats at D3 threshold ie. cavity in dentine

Most lesions are stable by preventative care are hidden below the water

Patients who only present with D1 and D2 lesions are described as ‘caries free’ by epidemiologists.

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8
Q

No active care needed

(Under water)

A

Sub clinical initial lesions in a dynamic state of progression/regression

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9
Q

Preventative care advised

(Under water)

A

Lesions detectable only with traditional diagnostic aids

D1 Clinically detectable enamel lesions with ‘ion tact surfaces’

D2 Clinically detectable ‘cavities’ limited to enamel

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10
Q

Preventative and operative care advised

A

D3 Clinically detectable lesions in dentine

D4 Lesions into pulp

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11
Q

Caries classification
Anatomical site?
Activity?

A

Occlusal/ smooth surface (proximal/buccal)/root

Activity Active/arrested

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12
Q

Caries classification
Virginity?
Extent?

A

primary/ recurrent
incipient/occult/cavitation

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13
Q

Tissue?
No. Surfaces?

A

initial/superficial/moderate/deep/deep complicated OR
enamel/dentine/pulp

simple/compound/complex

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14
Q

Chronology?
Tooth surface affected?

A

early childhood/adolescent/adult

mesial/distal/occlusal/
buccal

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15
Q

Blacks Classification

A

class I,II,III, IV, V, VI

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16
Q

Methods of caries diagnosis in the paediatric patient-

Conventional techniques of caries diagnosis?

A

Simple visual
Tactile
Radiographs

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17
Q

Simple visual?

A

Dry the tooth
Separator

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18
Q

Tactile?

A

Probe

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19
Q

Radiographs?

A

Digital image enhancement
Digital subtraction radiography

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20
Q

Caries diagnosis-
Novel techniques?

A

Electrical current
Fluorescence
Enhanced visual techniques

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21
Q

Electrical current?

A

Electrical conduction measurement

Electrical impedance

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22
Q

Fluorescence?

A

Visual: QLF
Laser diagnodent

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23
Q

Enhanced visual techniques?

A

FOTI
DiFOTI

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24
Q

What should remain the standard practice in the clinical diagnosis of primary caries in paeds patients?

A

Visual inspection combined with bitewing radiographs for proximal surfaces

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25
Q

What is required for the visual diagnosis of caries?

A
  • Dry tooth – compressed air
  • Clean teeth – brush, prophy
  • Good light
  • Dental mirror
  • Sharp eyes
    . Blunt or ball ended probe (NOT a sharp probe)
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26
Q

What is the purpose of drying the tooth

A

To identify white spot lesion and brown spot lesion.

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27
Q

White spot lesion on a dry tooth?

A

Penetrated 1/2 way through enamel

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28
Q

White spot lesion and brown spot lesion on wet tooth?

A

Through enamel and may be into dentine

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29
Q

How to carry out temporary tooth separation and what is it for?

A
  • Elastomeric separator inserted for 30 mins-1 week
  • Direct exam or indirectly via impression
  • Diagnosis of interproximal lesions
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30
Q

What is the importance of temporary tooth separation?

A

May avoid need for radiograph/
supplement radiograph

31
Q

What must temporary tooth separation be carried out over?

A

Multiple visits

32
Q

Tactile diagnosis of caries- how do you do it and what do you use?

A
  • Visual is aided by ball ended explorer NOT sharp probe
  • Remove any remaining plaque and debris and to check for surface contour, minor cavitation or sealants.
  • Sharp probe – not increased accuracy and may damage intact enamel over a carious lesion (Lussi 93)
33
Q

How may a probe reflect morphology of fissure ?

A

Stickiness with the probe

34
Q

Tactile diagnosis of caries in extracted teeth?
Methods and percentage caries detected?

A
  • Visual inspection of cavitated occlusal lesion
    – 62% caries detection
  • Bitewings only
    – 79% caries detected
  • Visual inspection + BW’s
    – 90% caries detection
35
Q

Clinical caries diagnosis can be .. for example..

A

Difficult
With dentine caries there may be no break in the surface

36
Q

What is required because of the difficult caries diagnosis?

A

Adjunctive diagnostic aids ie radiographs are the most common used

37
Q

What radiographs could we use in caries diagnosis?

A

Bitewings
Lateral oblique jaw views
OPT

38
Q

What radiographs are the first choice for caries diagnosis in the primary and mixed dentition in kids?

A

Bitewings ie intra-oral radiography

39
Q

What ages should radiographs be used in children as an adjunct to visual diagnosis?

A

4 and above

40
Q

When should radiographs be taken

A

After clinical examination

41
Q

What could be an example of when you don’t need radiographs?

A

Well spaced dentition with open contacts

Record why you haven’t taken bitewings

42
Q

What stuff with radiographs should you record?

A

Why you haven’t taken them
If child is pre cooperative or lacking cooperative ability

43
Q

What are the advantages of BWs?

A
  • Surfaces inaccessible to clinical exam can be studied
  • Depth of lesion can be assessed
  • Non-invasive
  • Radiographs can be re-examined and comparisons can be made
    . Increased diagnostic yield when compared to clinical
    examination alone:…
44
Q

Increased diagnostic yield compared with examinations alone?… how

A

The number of approximal lesions detected increases by a factor of between 2 and 8 when bitewings taken when compared to clinical examination alone.

  • Detection of inadequate restorations (86%) which otherwise appeared clinically sound or adequate on examination alone
45
Q

Limitations of Radiographs in the diagnosis
of Caries

A
  • Age/ cooperation limitations
  • Occlusal caries may not be visible (enamel)
  • May get triangular radiolucencies on mesial surface upper E’s and
    6’s due to Cusp of Carabelli
  • Usually underestimate the extent of a lesion
  • Use of ionising radiation -DNA damage
    . May have overlapping
46
Q

Radio graphic investigations frequency-
High caries risk status?

A

6 monthly

47
Q

Moderate caries risk status?

A

12 monthly

48
Q

Low caries risk status?

A

12-18 monthly for primary and mixed dentition

2 yearly for permanent dentition

49
Q

Radiography should only be performed when

A

the patient history/ or objective findings and symptoms
lead to the conclusion that further useful information
might be obtained.

50
Q

When should a radiograph not be taken?

A

When it is not expected to change diagnosis
or treatment or add other useful information

51
Q

Radiographs are

A

Adjuncts, not replacement to a good history and clinical examination

52
Q

Ensuring successful radiography in children?

A

Use smaller film sizes (size 0)

Use smaller holders or adhesive tabs

Use child friendly terminology

Demonstrate the equipment first

Distraction techniques (counting, nose breathing)

53
Q

What is the benefit of a lateral oblique jaw view?

A

Avoids an intra oral film
Less cooperative ability required
Provides additional information on the developing dentition

54
Q

Lateral oblique jaw view and bitewings?

A

Fair to good agreement with each other

55
Q

Benefit of OPT

A

Can detect occlusal dentine lesions eg large lesions

56
Q

Disadvantages of OPTs

A

Increased radiation dose
Lower sensitivity for caries diagnosis, especially approximally

57
Q

Digital subtraction radiography- what does it do?

(DSR)

A
  • Determines qualitative changes that occur between 2 digital radiographic images taken at different time
  • Shows progression or regression
58
Q

How does digital subtraction radiography work?

A
  • Subtract pixel values for each coordinate of the 1st radiograph from equivalent coordinate in a 2nd radiograph= subtraction image
  • If 0- no change
59
Q

Methods of caries diagnosis in the paeds patient- novel techniques?

A

1) Enhanced visualisation – FOTI

2) Fluorescence - Laser Fluorescence (Diagnodent) and
QLF (Qualitative light fluorescence)

3) Electric – Electronic caries meter (Cariescan pro)

1)Chemicals- caries detector dyes

60
Q

Principles of treatment planning- each treatment plan should comprise…

A
  • Relief of pain

– Prevention

– Behaviour Management / Acclimatisation

– Operative procedures
* Logical treatment progression building on each
previous visit

  • Recall interval and radiograph frequency
61
Q

Preclinical phase?

A

Exposure

Primary prevention

Maintaining physiological equilibrium

62
Q

Clinical phase- non cavitated?

A

Early diagnosis

Primary prevention

Maintaining physiological equilibrium

OR

Secondary prevention

Non operative treatment

63
Q

Cavitated?

A

Late diagnosis

Secondary prevention

Non operative treatment

OR

Tertiary prevention

Operative treatment

64
Q

Prevention treatment plan-
Diet drinks advisce, brushing, dentist

A

Limit sugar to 4/5 times/day

Water or milk as main drinks

x2 day, appropriate F toothpaste for age and caries risk, consider F mouthwash

  • Dentist
    – Fissure sealants- resin or GIC

– Fluoride varnish

Prevention treatment plan…

65
Q

Dentist- prevention treatment plan?

A

Primary prevention if no
disease
* Secondary prevention if early disease

66
Q

Treatment plan for non cavitated lesions in primary teeth? Occlusal?

A

Complete caries removal

Incomplete caries removal

Fissure seal with resin or GIC

67
Q

Treatment plan for non cavitated lesions in primary teeth?
Proximal?

A

Complete caries removal

Incomplete caries removal

Seal with a Hall Crown

68
Q

Treatment plan for cavitated lesions in primary teeth (no pulp involvement)?
Occlusal?

A

Complete caries removal

Incomplete caries removal

Seal with a Hall Crown

69
Q

Treatment plan for cavitated lesions in primary teeth (no pulp involvement)?
Proximal?

A

Complete caries removal

Incomplete caries removal

Seal with a Hall Crown

70
Q

What are the coexisting considerations for caries removal in children?

A
  • Presence of absence of symptoms/ infection
  • Number of visits required
  • Number and extent of carious lesions, Oral Hygiene
  • Distance travelled, attendance history
  • Patient compliance
  • Parental motivation
  • Previous medical history
  • Caries rate/risk
  • Anaesthesia to be used
71
Q

Planning- using quadrant dentistry- what’s the benefits?

A

Reduces number of visits
Reduces number of episodes of LA

72
Q

Planning- using quadrant dentistry- what are the things to note?

A

Take care with LA dose

Requires good compliance often beyond younger children/ those with special needs

73
Q

What are the possible alternatives to treatment?

A
  • Preventive approach E.g.
    – To obtain stabilisation until compliance
    established
    – If carious lesions are arrested
    – If close to exfoliation and there is a permanent
    successor developing
74
Q

There are some example cases with questions at the end to look at

A

Paeds (11 decks)

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