Caries in primary molars and radiographs in children

Question 1

describe anatomy of primary molars/ compare with permanent

a. enamel thickness
b. occlusal table
c. contact points
d. pulp size/ shape
e. pulpal floor
f. dentine layer

Answer 1

a. enamel thickness: uniform 1mm (permanent= 2-3mm)
b. occlusal table: narrow
c. contact points: broad (contact AREAS)
d. pulp size/ shape: large, follows contour of tooth. –> early pulpal involvement
e. pulpal floor: thin
f. dentine layer: thin (thicker in permanent)

Question 2

which is the largest pulp horn in primary molars –> should be avoided

Answer 2

mesio-buccal

Question 3

by how much do radiographs increase diagnostic yield in

a. children high risk
b. children mod risk
c. children low risk
d. adults

Answer 3

a. children high risk: 167%-800%
b. children mod risk: 150%-270%
c. children low risk: unclear but can be 2-3x more than COE
d. adults: x4

Question 4

by how much is radiation risk increased in children

Answer 4

x3

tissues are more radiosensitive and lifespans are longer –> more time for mutation to occur

Question 5

recommended radiograph freq for

a. children high risk
b. children mod risk
c. children low risk

Answer 5

a. children high risk: 6 months or until no new progressing lesions are evident
b. children mod risk:1 yr (post bitewings)
c. children low risk:12-18months (primary dentition), 2yrs (mixed/ permanent dentition)

Question 6

EAPD guidelines for radiograph freq for 
a. high risk children
LOW RISK @:
b. 5yo
c. 8-9yo
d. 12-16yo
e. 16yo

Answer 6

a. high risk children: 1yr
LOW RISK @:
b. 5yo: 3yr
c. 8-9yo: 3-4yr
d. 12-16yo:2 yr
e. 16yo: 3yr

Question 7

relevance of radiographs to GA and importance of this

Answer 7

GA cannot be planned without radiographs (unless caries limited to primary incisors)
tx planning should be to limit to ONE GA

Question 8

what % of chlildren have radiographs BEFORE referral
a. nationally
b. at BDH
why is this?

Answer 8

a. nationally: 12%
b. at BDH: 10%
often intra-orals not possible due to small mouths/ fidgety children and GDP practices don’t have other x ray machines

Question 9

2 consequences of small % of children who have radiographs included in referral

Answer 9

• additional exposure to radiation

- other cavities not diagnosed pre-referral –> more teeth extracted or GA delayed to facilitate restorations

Question 10

4 indications for radiographs in children

Answer 10

• detection of caries in primay/ mixed/ permanent dentition with approximal contacts
• dental trauma
• disturbances in tooth development and growth
• examination of pathoogical conditions

Question 11

types of intraoral radiographs 2

Answer 11

bitewing

periapical

Question 12

types of extraoral radiographs 3

Answer 12

• DPT (PR, OPG)
• occlusal
• oblique lateral

Question 13

4 limitations of radiographs in diagnosis of caries in children

Answer 13

• age/ co operation limited
• anatomical: narrow arch, shallow palate
• occlusal caries may not be visible
• may have overlapping

Question 14

what should teeth be before taking radiograph 2

Answer 14

clean

dry

Question 15

what film to use for children

a. aged 4-7
b. aged 7-10
c. aged 10+

Answer 15

a. aged 4-7: size 0 or phosphor plate with tab
b. aged 7-10: size 0 or phosphor plate with holder
c. aged 10+: size 2 or phosphor plate with holder

Question 16

what technique is recommended for deciduous incisors? describe

Answer 16

modified technique

film placed flat in occlusal plane and bisecting angle technique for deciduous incisors

Question 17

selection criteria for taking radiographs in kids

Answer 17

• there has been clinical examination
• there has been caries risk assessment
• there is diagnostic yield from radiographs
• obtain previous radiographs before repeating them
• forward pt radiographs when referring