Caries management Flashcards
caries managament options
- no caries removal - hall crown
- no caries removal - FS
- selective caries removal and restore
- pulpotomy
- XLA
- complete caries removal and restore
- prevention only
- non restorative cavity control and prev
how rto manage a symptomatic primary tooth with signs of infection
- intraradicular radiolucency
- non physiological mobility
- sinus
- pain kept up at night
- ttp
- lymphadenopathy and associated swelling
treat - pulpectomy / XLA
initial caries sign in a primary molar
- clinical
- Rg
- non cavitated - staining/white spot/discoloured/dentine shadowing
- caries into initial 1/3 of dentine
management of initial caries of primary molar
-fissure sealant
top up and review at every appt, check visually and with probe
-GI sealant if bis-GMA too difficult
-hall techniquead
advanced occlusal caries in primary molar
signs -clinical/Rg
-teeth with visible shadowing/cavitation
Rg - bitewing, caries extends to inner third, clear band of dentine should separate pulp and caries
advanced occlusal caries in primary molar, management ops
why not complete caries removal
- selective caries removal and restore
- hall technique (also if proximal lesion)
- if non restorative - self cleanse
- > risk of pupl exposure
signs of reversible pulpitis in a child
sensitive to cold/sweet, short lasting pain, not kept up at night or TTP
management of reversible pulpitis in a child
-place hall crown
-if occ = selective caries removal
- if food packing/unsure of diagnosis then place a temp dressing (ZOE?) and check symps 3-7 days later. If better - hall crown/restoration.
If worse XLA/PULPOTOMY
irreversible pulpitis symps in a child
sTILL VITAL BUT INFLAMED NOT TTP kept up at night tender to cold/hot/sweet pain spontaneous lasts after stimulus applied
management of irr pulpitis in a child
if anxious - remove debris and apply antibiotic corticosteroid paste under temp dressing
- if good co-op - PULPOTOMY
symps in dental abscess/Periradicular periodontitis
kept up at night spontaneous pain sensitive to hot/cold/sweet long lasting pain sinus/swelling association TTP increased mobility
-Rg - increased sign of intrarradicular pathology
management of dental abscess/periradicular periodontitis
PRIMARY
- drain inf through pulp, hand excavate
- if tender place corticosteroid paste
- even if asymp, XLA tooth
- if restorable = pulpectomy
PERMANENT
- drainage through pulp
- access pulp chamber and remove necrotic tissue
- ST drainage if swelling
indications for a primary molar pulpotomy
- irreversible pulpititis (vital pulp)
- advanced lesion with no clear dentine band (Rg)
Pulpotomy technique steps
-LA and dam
- caries removal/access
-remove pulp (round slow speed/sp exc)
-irrigate pulp with sterile water (3in1)
-identify canal orifices
Max primary molars = 2b,1p
Mand primary molars = m/d canals
-assess haemostasis - cotton pledget and ferric sulphate (30s-2min)
if no bleed/major dark bleed = pulpectomy
-remove pledget and place MTA/ZOE/ns CaOH on stumps and floor
-fill cavity with ZOE and place SSC
- annual review
when to carry out a balancing XLA
If c of poor prognosis - avoid midline shift
premature exf of c
when NOT to carry out a balanced XLA
primary incisors
primary D loss - unless c centreline shift
primary E loss
identify initial caries lesion in perm molar
visual - white spot lesion, stain in fissures
Rg - lesion up to ADJ/not visible
initial caries management in perm molars
FS
PRR
review at every appt for top up, check with probe
identify moderate carious lesion
visual - probe, dark stain, shallow cavitation
Rg - bitewing - extend to mid 1/3 dentine
management of moderate carious lesion in perm molar
selective caries removal and restore
seal other teeth
identify extensive occlusal caries
teeth with cavitation, widespread dentinal shadow
management of extensive occlusal lesion in perm tooth
stepwise caries removal, avoid pulpa exposure
1. caries removal (superficial) - enough to allow effective marginal seal
2. temp restoration - inhibit further progression and allow reactionary dentine to be laid down
3 6-12mth later re-enter cavity and restore tooth (temp will have allowed reactionary dentine to further distance from pulp.
how can proximal caries be identified and subsequently be seen more easily in children
-Initial- white spot lesion/dentine shadowing especially distal of E/mesial of 6,
Rg - outer 1/3 dentine
-moderate - enamel cavitation/dentine shadowing
Rg - extend to outer/mid 1/3 of dentine
-extensive - cavitation/visible dentine
Rg - reach inner 1/3 of dentine but not reach pulp
use of ortho separator (5 days)
management of proximal caries in perm molars
- initial - arrest enamel only lesions, site specific prevention, seal lesion
- mod - selective caries removal/complete caries removal, seal remaining fissures
- extensive - stepwise caries removal
how to manage a poor prog 1st perm molar - XLA?
younger child?
- OPT - identify if all teeth present/good condition anf position
- if poor of above = refer for specialist opinion
- if pain =LA then refer for specialist opinion#
-younger - keep free of syms until old enough for XLA, hall technique for space maintenance (take photos of inner crown condition)
Rg signs indicating good time for 6 XLA
bifurcation of 7 age 8-10 8's present class 1 inc relationship buccal segment crowding good co-op
Permanent tooth - rev pulpitis, irr pulpitis and abscess treatment
- rev pulpitis -stepwise caries removal/complete caries removal
- irr pulpitis - RCT/XLA
pulp therapy in primary molar ind
- good co-op
- avoid GA
- MH - haemophilia
- child’s age (root resoption)
- space maintenance
- hypodontia
pulp therapy in primary molars - contraind
- poor co-op
- MH - cardiac defect/immunosuppressed
- tooth unrestorable
- multiple carious teeth in mouth
- close to exfoliation
- severe pain/inf
- gross bone loss
Vital pulpotomy in primary molar
- ind
- technique
ind - carious/traumatic exposure/nosymps/no Rg sign of inf
Technique
-access and caries removal (LA/Dam), remove pulp chamber roof
-amputate coronal pulp - -slow speed/spoon excavator
-irrigate and dry chamber
-arrest haemorrhage - FERRIC SULPHATE sotton ball
-assess radicular stumps -if arrested continue, if not and hyperaemic then complete pulpectomy
-dress root stumps with ZOE/MTA/CaOH
-Restore -SSC
Non vital - pulpectomy
ind
technique
-ind - hyperaemic pulp/irreversible pulpitis/exposure of non bleeding pulp
-technique
-LA/dam
-access and caries removal - pulp chamber roof
removed
-amputate coronal pulp - -slow speed/spoon excavator
-irrigate and dry chamber
-locate root canals
-file to 2mm from apex
-irrigate canals (CHX/sodium hypochlorite)
-dry canals - paper points
-obturation - calcium hydroxide and iodoform paste (VITAPEX)
-place ZOE/CaOH/GI in coronal access cavity
-Place SSC
-review every 6mth
clinical and Rg signs of failure of SSC post pulpotomy/pulpectomy
Clinical - pain/sinus/pathological mobility
Rg - inter-radicular radiolucency(bone loss at furcation)/external or internal resorption/greater radiolucency
complications of SSC placement
Failure to exfoliate
Damage to perm successor
Early loss
ind for SSC
- badly broken down primary tooth
- following pulpectomy/pulpotomy
- severe enamel hypoplasia
- space maintenance
- # tooth
technique for SSC placement
- select crown size - measure m-d/trial and error using a sticky plaster to retain crown while trying on
- LA
- Prep
- mesial prep (marginal ridge->cervical portion), produce knofe edge finish with no ledge or shoulder
- distal portion (SAME)
- occlusal portion - reduce by uniform depth of 1mm (keep cusp form)
- peripheral reduction - reduce buccal/lingual portion of occlusal 1/3 of cusps with 45 degree chamfer - adapt crown using crimp pliers
- cement - GI
- remove and thoroughly clean crown and tooth
- isolate with cotton rolls
- place GI in crown and use digital pressure
- use cotton roll for patient to bit onto
- remove excess with microbrush/probe
issues with a SSC
- rocking, indicates?
- canting to one side
- rocking = discrepancy between crown circumference and tooth circumference
- canating to one side - uneven reduction of occlusal surfaceeg if steel crown cants lingually = buccal cusps too high
Important aspects of a child’s history
- PC/HPC
- MH: asthma/CVD/Immunocomp/cancer
- DH: reg attendance/OH/phobia?
- SH: school or nursery/best time to attend/Childsmile/diet
Important aspects of child exam
- E/O
- I/O
- teeth: eg order of exam
E/O: nides/TMJ/MoM and any signs of Non Accidental inj
-I/O: ST-Lips/BM/tongue/FoM/HP/SP
-Exam: chart / caries / to be done /plaque scores / BPE (>7yr)
Describe the plaque score system
10/10 - clean tooth
8/10 - cervical line of plaque
6/10 - cervical 1/3rd plaque
4/10 - mid 1/3rd of plaque
Describe a BPE in Paeds
- what age from and what teeth
- what scores used
- BPE from age 7
- age 7-17 = 16/11/26/36/31/46
-codes: 7-11 = codes 0/1/2
12-17 = codes 0-4
Caries Risk Assessent factors
- diet
- clinical evidence
- fluoride
- saliva quality
- MH
- SH
- plaque control
Instructions for parents regarding OH
- brush 2x daily with adult help (<7yr)
- brush last thing at night
- no bottle overnight
- only water/plain milk between meals
- spit don’t rinse
- MW only at different time to brushing
Duraphat prescription :
Child >16yrs with high caries risk
Sodium Fluoride toothpaste 1.1% (5000ppm)
- send: 51g
- label: brush teeth for 3min after meals, spit don’t rinse 3x daily
Duraphat prescription:
Child >10yrs with high caries risk
Sodium Fluoride toothpaste 0.619% (2800ppm)
- send 75ml
- label: brush teeth 2x daily for 1 min after meals, spit don’t rinse.
Additional information to inform patients of before prescribing Duraphat toothpaste (aftercare)
- spit/don’t rinse
- dont eat/drink/rinse for 30min after brushing teeth
- only for prescribed patient
- keep out of reach of small children
