Caries in Children Flashcards
how would you treat a child in pain due to pulpitits in a vital primary tooth with irreversible symptoms and no evidence of dental abscess?
pulpotomy
what factors should you take into account when choosing a caries management strategy in a primary tooth?
- the time to exfoliation
- the site and extent of the lesion
- the risk of pain or infection
- the absence or presence of infection
- preservation of tooth structure
- the number of teeth affected
- avoidance of treatment-induced anxiety
what factors should you take into account when choosing a caries management strategy in a **permanent **tooth?
- the site and extent of the lesion
- the risk of pain or infection
- preservation of tooth structure
- the health of the dental pulp
- avoidance of treatment-induced anxiety
- lifetime prognosis of the tooth
- orthodontic considerations
- occlusal development
state 3 priorties of the dental team
- to relieve pain or infection if present
- to invoove both the child and their parent/carer in decisions regarding the child’s oral health care
- if caries in the permanent dentition does occur, to diagnose it early and manage it appropriately
what elements should be included in a comprehensive assessment of a child if the personal care plan is to be effective in improving the child’s oral health?
- parent/carer motivation and responsibility
- patient history
- clinical examination
- caries risk assessment
why does caries affected enamel have a white appearance?
acidic solutions preferentially dissolve prism sheaths in enamel, creating pores
these pres refect light, relfecting it back instead of letting it pass through
how would you describe the caries shown?
- matt, opaque chalky white lesion
- suggests only the enamel layer is affected
how would you desribe the caries shown?
- opalescent white lesion
- suggests caries has passed enamel dentine junction and infected the dentine
how would you desribe the caries shown?
- cavitation visible as dark, carious dentine
- surrounded by an opalescent white halo (where the enamel sub-surface is partially demineralised and refelcts light back)
- white halo isis not affected and appears shiny rather than matte white
- dark halo is due to carious dentine underneath
why must teeth be clean and dry for effective caries diagnosis?
if surface enamel pores fill with saliva, they allow light to be transmitted through the enamel
how do you tell the difference between active and arrested enamel caries through its clinical characteristics?
- arrested enamel surface will feel smooth to a probe lightly drawn across it
- if the surface feels rough or the probe is felt to drag compared to adjacent sound enamel, the lesion is active
what is the difference in appearance of active and arrested dentinal caries?
active- soft lesion, matt in apearance
arrested- harder lesion, may appear shiny
colour is not a reliable indictor
give an example of when a panoramic radiograph would be clinically justified
as part of a gre-general anaesthetic assessment
what can you use to assess for cavitation if enamel-only proximal lesions are identified?
orthodontic separators
how can cusp of carabelli sometimes show on a bitewing radiograph?
a traingle shaped radiolucency seen on the mesial surface
can be mistaken for proximal caries
how is initital occlusal caries in primary teeth classifed?
noncavitated, dentine shadow or minimal enamel cavitation
radiograph- outer third dentine
how is advanced occlusal caries in primary teeth classified?
dentine shadow or cavitation with visible dentine
radiograph- middle or inner third dentine
how is initial proximal caries in primary teeth classified?
white spot lesion or shadow
radiograph- lesion confined to enamel
how is advanced proximal caries in primary teeth classified?
enamel cavitation and dentine shadow or cavity with visible dentine
radiograph- may extend into inner third dentine
how is initial anterior caries in primary teeth classified?
white spot lesions but no dentinal caries
how is advanced anterior caries classified in primary teeth?
cavitation or dentine shadow
how is caries with pulpal involvement classified in primary teeth?
any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically
how is caries in a tooth near to exfoliation classified in primary dentition?
clinically mobile
root resorption shown in radiograph
how is an unrestorable carious tooth classified in primary teeth?
crown destroyed by caries or fractured, or pulp exposed with pulp polyp
how is initial occlusal caries classified in permanent dentition?
noncavitated enamel carious lesions;
* white spot lesions
* discoloured or stained fissures
radiograph- up to the enamel-dentine junstion or not visible
how is moderate occlusal caries classified in permanent dentition?
Enamel cavitation and dentine shadow or cavity with visible dentine Radiograph: up to and including middle third dentine
how is extensive occlusal caries classified in permanent teeth?
Cavitation with visible dentine or widespread dentine shadow Radiograph: inner third dentine
how is initial proximal caries classified in permanent dentition?
White spot lesions or dentine shadow. Enamel intact Radiograph: outer third dentine
how is moderate proximal caries classified in permanent dentition?
Enamel cavitation or dentine shadow
Radiograph: outer or middle third dentine
how is extensive proximal caries classified in permanent dentition?
Cavitation with visible dentine or widespread dentine shadow Radiograph: inner third dentine
how is initial anterior caries in permanent teeth classified?
White spot lesions but no dentinal caries
how is advanced anterior caries classified in permanent dentition?
cavitation or dentine shadow
how is caries with pulpal involvement classified in permanent dentition?
Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically
when is a permanent tooth classified as unrestable?
Crown destroyed by caries or fractured, or pulp exposed with pulp polyp (pain/infection free)
what is molar incisor hypomineralisation (MIH)
hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors
what are the signs/symptoms of MIH?
- sensitive to temperature
- painful on toothbrushing
- increased caries susceptibility
- lesions can range from small white opacities with no breakdown, to large, dark yellow/brown areas that can fracture off
where are sinuses usually present?
on the non-attached mucosa adjacent to the attached mucosa
name indicators of established dental infection
- tenderness to percussion in a non-exfoliating tooth
- alveolar tenderness, sinus or swelling
- non-physiological mobility
- radiographic signs, including inter-radicular radiolucency
which factors must you take into consideration when deciding on management of a carious primary tooth?
- extent of the lesion
- site of the lesion
- activity of the lesion
- time to exfoliation
- number of other lesions present in the dentition
- the child’s medical status
- anticipated cooperation of the child
- anticipated cooperation of the parent/carer with the preventative interventions and to attend repeat management appointments
- the range of clinical procedures the clinician has the skill to provide
what does a pulp polyp in a carious primary molar suggest about the canals?
at least one of the root canals is vital and the other canals may be necrotic
what are the 4 possible scores when recording plaque levels?
which children would you class as being at increased risk of dental caries?
- SIMD score 1-3
- decayed teeth present
- missing teeth due to caries
- any filled teeth
at what age are the effects of dental anxiety most apparent?
< 4 years
how can you measure a child’s dental anxiety?
the modified child dental anxiety scale (MCDAS)
what is the aim of behaviour management?
to promote a positive attitude to dental care and facilitate ongoing prevention and care
give examples of behaviour management strategies
- communication
- enhancing control
- tell show do
- behaviour shaping and positive reinforcement
- structured time
- distraction
- relaxation
- systematic desensitisation
what advice would you give a parent with severe dental anxiety?
another adult should bring the child to appointments- reduces risk of child developing same anxiety as parent
if a cooperative child presents with irreverisble pulpitis symptoms in a primary molar, what treatmetn should you consider other than extraction?
pulpotomy
what is the treatment for symtoms of pain thought to be due to food packing/reversible pulpitis but diagnosis is uncertain?
place a temporary dressing
review 3-7 days later to check symptoms
